This summer, cancer patients in India discovered that a chemotherapy shortage can begin far from a pharmaceutical factory, with a disruption in the supply of a metal.
Cisplatin and carboplatin are decades-old generic drugs that remain a backbone of chemotherapy for many cancers. Both depend on platinum. When platinum prices more than doubled, Indian manufacturers struggled to obtain raw materials and absorb the higher costs. Some reduced production, while one manufacturer temporarily stopped making both drugs. Because India regulates their prices, manufacturers could not simply pass the increase on to patients. The government ultimately raised its price ceilings by 50% to help restore supply.
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The United States should pay attention because India’s experience shows that identifying a mineral as critical does not by itself protect the medical products that depend on it. Platinum is already on the U.S. critical minerals list.
Washington is also building a new safeguard. In February, the Export-Import Bank approved a loan of up to $10 billion for Project Vault, alongside nearly $2 billion in private investment, to establish a U.S. Strategic Critical Minerals Reserve intended to protect manufacturers against supply shocks.
Experts have identified pieces of the problem. A June Council on Foreign Relations report called for a strategic reserve of critical medicines and longer-term measures to make domestic or allied production of pharmaceutical raw materials and ingredients economically viable. Columbia University researchers have separately warned that Project Vault faces unresolved questions about prioritization and participation, including whether smaller manufacturers can afford upfront fees for access.
India’s experience exposes another gap: medical necessity does not always produce a strong commercial demand signal.
Cisplatin and carboplatin show why. Their importance to cancer patients is enormous, but they are inexpensive generic medicines sold in markets where manufacturers may have little room to absorb sudden increases in raw-material costs. A company making an essential medicine may therefore have less ability to pay for years of protection against a mineral shortage than a large industrial buyer, even when losing access to that medicine would have serious consequences for patients.
Platinum also illustrates the complexity. The U.S. already stores platinum in the National Defense Stockpile. But having platinum in a government stockpile would not by itself guarantee supplies of cisplatin or carboplatin. The metal must still move through processing and pharmaceutical manufacturing before becoming a finished medicine. A mineral reserve can protect one upstream vulnerability, but it cannot substitute for resilience throughout the pharmaceutical supply chain.
For critical minerals tied to essential drugs, diagnostics, or medical devices with few substitutes, the Department of Health and Human Services should have a role in determining what medical demand must be protected within the reserve. If commercial participation is insufficient, the government should provide the missing demand signal through dedicated allocations, subsidized participation, or another mechanism that guarantees access to medically necessary quantities during a serious disruption.
The Council on Foreign Relations is right that America needs stronger protection for critical medicines. Columbia is right that Project Vault must resolve questions of prioritization and participation. India has now shown why healthcare should be one of those priorities.
OPINION: TARIFF INDIA, AND HALF OF AMERICA’S MEDICINE CABINET COULD DISAPPEAR
India learned the connection between mineral security and medical security after patients began searching for chemotherapy. America has the opportunity to learn it before patients here have to do the same.
Market demand can tell Washington what manufacturers are willing to pay to protect. It cannot always tell Washington what patients cannot afford to lose.
Professor David Adler is a senior pharmaceutical leader in oncology clinical drug development and translational medicine with more than 15 years of industry and academic leadership experience. He spent a decade in senior leadership at Bayer AG’s Global Oncology Clinical Development organization and currently serves as chief scientific & medical officer of the Pathora Institute of Pathology & Tissue Medicine. He also holds academic appointments at the Hebrew University of Jerusalem, Ben-Gurion University of the Negev, and the University of Bonn.
