Cross-section Pharma & APIs, Antifragile

View on the map →IF method →Read from surface (top) to matter (bottom). Hover a node to reveal what it depends on.

0Patients & health systems1

■Drug shortages, FDA / EMA / WHO

Hundreds of drugs simultaneously in shortage in the United States and the EU (post-2023 records)

Critical node· FDA (Silver Spring)

−IFormulation & sterile fill6

●Novo Nordisk, Kalundborg (Denmark)

World's largest insulin plant; ≈1.6M m², ≈4,400 employees; dominant semaglutide API site

Critical node· Novo Nordisk (Bagsværd / Kalundborg)↑ Sterile fill, Patients & shortages

●Catalent, fill-finish (Bloomington)

Acquired by Novo Holdings for $16.5bn (Dec. 2024); 3 sites resold to Novo Nordisk for $11bn

Critical node· Novo Holdings (Copenhagen)↑ Patients & shortages

■Iodinated contrast media, GE HealthCare (Shanghai)

Omnipaque + Visipaque ≈50% of the US contrast market; a single site

Critical node· GE HealthCare (Shanghai)↑ Patients & shortages

●Single-use bioreactors & bags

Cytiva, Sartorius, Thermo Fisher, Merck: global core of single-use bioreactors and bags (Sartorius/Thermo/Cytiva trio ≈45% of the market)

Critical node· Cytiva

●Needles & syringes, BD

BD (Becton Dickinson) dominates the world's needles and syringes (global leader, >70% of the syringe/needle market)

Dependency· BD (Becton Dickinson)

●Sterilizing filters, Sartorius & Pall

Sartorius, Pall (Danaher), Merck: sterilizing filter membranes for injectables (the three ≈65% of the pharma-grade market)

Dependency· Sartorius

−IIBiologics, isotopes & critical containers9

●Borosilicate glass, Schott (Mainz)

Schott >230,000 t/yr of pharma glass; Type I borosilicate tubing concentrated across ≈4 producers (exact share unverified)

Critical node· Schott (Mainz)↑ Sterile fill, Semaglutide API

●WuXi Biologics, Wuxi

≈209 new projects signed in 2025, half for US clients; backlog ≈$23.7bn

Critical node· WuXi Biologics (Wuxi)↑ Sterile fill, Patients & shortages

■Molybdenum-99, HFR Petten

HFR Petten ≈30% of global Mo-99; a handful of ageing research reactors

Critical node· NRG (Petten)↑ Patients & shortages

●Insulin (Novo, Lilly, Sanofi)

3 firms ≈96% of world volume (2024)

Critical node· Novo Nordisk

●Lipid nanoparticles (messenger RNA)

mRNA vaccines rely on lipid nanoparticles whose ionizable lipids are locked by patents (Acuitas, Genevant, Arbutus); Moderna settled the litigation in 2026 (~$950M)

Critical node· Acuitas Therapeutics

●Viral vectors (gene therapy)

Gene therapies depend on viral vectors (AAV, lentivirus) made by very few CDMOs: 5 leaders ≈ 1/3 of world capacity, ~50% in the US

Critical node· Oxford Biomedica

■Vaccine adjuvants & Chilean soapbark

Potent adjuvants (QS-21, Matrix-M) come from Chilean soapbark; Desert King is effectively the only GMP human-vaccine-grade supplier

Critical node· Desert King (Chile)

■Plasma & immunoglobulins

US ~70% of the world's collected plasma; CSL, Grifols, Takeda process most of it

Critical node· CSL Behring

●Samsung Biologics, Songdo

≈785,000 L of capacity at Songdo (plants 1-5), largest bioproduction capacity in the world

Redundancy· Samsung Biologics (Songdo)↑ Sterile fill, Patients & shortages

−IIIActive ingredients & chemical synthesis5

●Generic APIs, China & India

China + India ≈66% of generic APIs (volume); ≈22.6% of EU API imports come from China

Critical node· Zhejiang Pharmaceutical↑ Patients & shortages

■Paracetamol, China (Hebei)

0 sites in North America or the EU; ≈13 Chinese producers, last European site closed in 2008

Critical node· Hebei Jiheng Pharmaceutical (Hengshui)↑ Patients & shortages

■Heparin, porcine mucosa (China)

≈80% of global supply and 74% of US supply derived from porcine mucosa, mostly Chinese

Critical node· Crude heparin producers of Jiangsu and Shandong↑ Patients & shortages

●Chromatography resins (Protein A)

Antibody-purifying Protein A resins are held by very few suppliers (Cytiva/Danaher ~35%, Merck ~16%, Repligen ~14%)

Critical node· Cytiva

●Pharma vitamins, China (Zhejiang NHU)

China ≈73% of the world's vitamin A and >90% of vitamin C

Dependency· Zhejiang NHU (Xinchang)↑ Generic APIs, Patients & shortages

−IVFermentation, precursors & starting materials2

▲6-APA & antibiotics, ChinaDossier

≈80-90% of the world's antibiotic APIs; ≈90% of 6-APA capacity, 5 of the 7 global sites

Critical node· CSPC Pharmaceutical (Shijiazhuang)↑ India precursors, Generic APIs

▲KSM & API, India (Hyderabad)

≈70% of Indian KSM/API imported from China; near 100% for some antibiotics

Dependency· Aurobindo Pharma (Hyderabad)↑ Generic APIs