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 permits. Yet few companies, even Fortune 500 giants, have been willing to bring a formal trade complaint for fear of angering Beijing.

Just as American companies have become dependent on the Chinese market, the United States as a whole now relies on the PRC for many vital goods and services. The COVID-19 pandemic has shown a spotlight on that dependency. For example, China is the world’s largest producer of certain protective equipment, such as face masks and medical gowns. In March, as the pandemic spread around the world, the PRC hoarded the masks for itself, blocking producers—including American companies—from exporting them to other countries that needed them. It then attempted to exploit the shortage for propaganda purposes, shipping limited quantities of often defective equipment and requiring foreign leaders to publicly thank Beijing for these shipments.

China’s dominance of the world market for medical goods goes beyond masks and gowns. It has become the United States’ largest supplier of medical devices, while at the same time discriminating against American medical companies in China. China’s government has targeted foreign firms for greater regulatory scrutiny, instructed Chinese hospitals to buy products made in China, and pressured American firms to build factories in China, where their intellectual property is more vulnerable to theft. As one expert has observed, American medical device manufacturers are effectively “creating their own competitors.”

America also depends on Chinese supply, Chinese supply chains in other vital sectors, especially pharmaceuticals. America remains the global leader in drug discovery, but China is now the world’s largest producer of active pharmaceutical ingredients, known as “APIs.” As one Defense Health Agency official noted, “[s]hould China decide to limit or restrict the delivery of APIs to the [United States],” it “could result in severe shortages of pharmaceuticals for both domestic and military uses.”

To achieve dominance in pharmaceuticals, China’s rulers went to the same playbook they’ve used to gut other American industries. In 2008, the PRC designated pharmaceutical production as a “