China Now Runs More Early-Stage Drug Trials Than the U.S. America's Distinctive Answer Isn't Scale. It's a System That Remembers Every Patient for Life.

The argument that the United States is in a biotechnology race with China has become close to conventional wisdom in Washington, and the numbers behind the anxiety are real. China now conducts more early-stage clinical trials than the United States, and in 2025 Chinese companies captured nearly half of global pharmaceutical licensing deals. A common proposal for how America responds points to an unexpected asset: the Department of Veterans Affairs, with its more than 9 million enrolled patients, as a national advantage few countries can match.

The instinct is sound, but the usual framing of why misses the point, and the miss matters. The VA's value in this competition is not that it is big. On sheer population, China has vastly more people to enroll in trials than any American institution. The VA's distinctive advantage is something scale alone cannot buy and China's numbers do not automatically confer: a single, integrated health system that follows the same patients for decades and remembers everything. In a competition where China's edge is throughput, America's most defensible countermove runs on a different axis entirely, continuity rather than volume, and understanding that changes both what the VA is good for and how much of the surrounding race rhetoric to accept.

Where the two countries actually stand

Start with an honest map, because the competition is real but lopsided in specific ways rather than uniformly. China has become a genuine competitor in operational domains: the scale of its research, the speed of its clinical-trial execution, its biomanufacturing capacity, and its regional biotech clusters. The trial-volume and licensing figures reflect that operational strength, and they are not propaganda.

The United States, meanwhile, retains enduring structural advantages that are harder to build and harder to copy: foundational science, first-in-class discovery, world-leading academic medical centers, venture-backed translational research, deep capital markets, regulatory credibility, and the ability to attract global scientific talent. The picture is not America falling behind across the board. It is China pulling ahead on operational speed and scale while the United States keeps its lead in the harder-to-replicate work of originating genuinely new science.

That asymmetry is the key to seeing where the VA fits. If China's advantage is running many trials quickly, then simply trying to run more trials faster is competing on China's strongest axis. The more strategic move is to compete where the United States has a structural edge China cannot easily match, and the VA is a specific instance of exactly that kind of edge.

The real asset is continuity, not size

Here is what makes the VA distinctive, and it is not the headcount. American healthcare is otherwise extraordinarily fragmented. A patient's records are scattered across insurers, hospital systems, and clinics that do not talk to each other, so a person's medical history is broken into pieces that are hard to assemble and easy to lose when they change jobs, insurers, or cities. That fragmentation is a genuine weakness in research, because studying long-term outcomes requires following the same people over time, and the American system loses track of people constantly.

The VA is the opposite. It is a single integrated system in which enrolled veterans often stay for life, with their care, their prescriptions, their outcomes, and increasingly their genomic data recorded in one place over decades. That produces something rare and valuable: a longitudinal record, the ability to see not just whether a drug works in a twelve-week trial but what happens to the same patients over ten or twenty years, how a therapy interacts with aging, with other conditions, with real life. The VA's Million Veteran Program, one of the largest genomic-and-health databases in the world, exists precisely because the system's continuity makes that kind of assembly possible.

This is the asset China's population scale does not automatically provide and American private healthcare cannot easily replicate. China has more people, but a research advantage comes from integrated, longitudinal, linkable data on a stable population, not from population size alone, and building that continuity is a structural and institutional achievement, not just a matter of numbers. The VA already has it. That is why it is a national asset, and it is a different and more durable kind of asset than "many patients."

Why continuity answers China's specific edge

Follow the logic one more step, because it reframes what the VA should be used for. China's operational advantage is throughput: starting and completing many trials quickly to test many candidates. That is powerful for rapidly screening whether new drugs work in the near term. It is much weaker at answering the questions that require watching the same patients for years, because those questions are slow by nature and cannot be accelerated by running more trials in parallel.

Longitudinal, real-world evidence is therefore a domain where speed of throughput does not help and continuity of data does, which makes it a domain where the VA's structural strength is most decisive. The United States competing by trying to out-throughput China plays to China's strength. The United States competing by producing the deepest, longest, most rigorous evidence about how therapies actually perform over time in real patients plays to its own, and the VA is the single best instrument the country has for that. The strategic insight is not "the VA is big, so use it for trials." It is "the VA can answer questions China's model structurally cannot, so use it for those." That is a sharper and more defensible role than treating it as simply another pool of trial subjects.

The framing deserves scrutiny too

It is worth stepping back from the race language itself, because it is not neutral and not universally accepted, and an honest treatment has to say so. A significant body of serious analysis argues that the single-linear-race framing is misleading, and that US-China biotechnology competition is better understood as asymmetric convergence than as a sprint with a finish line, with health and medicine among the few areas where narrowly bounded cooperation may still serve American interests. Reasonable, security-minded people hold both views, that the competition is genuine and urgent, and that framing all of biomedicine as a nationalist contest can distort priorities and foreclose collaboration that has historically strengthened American science. This piece takes no position on which China policy is correct; it notes that the framing is contested by credible people, which is itself a reason not to swallow it whole.

The framing also carries a specific ethical weight when the instrument is the VA, and it should be named plainly. Veterans are not a research resource to be deployed for national advantage; they are patients the system exists to care for, many of whom already gave a great deal in service. Using their integrated records and their bodies to win a geopolitical competition, however worthy the goal, raises real questions of consent, autonomy, and priority that the stirring race rhetoric tends to skip. There is a meaningful difference between conducting excellent longitudinal research that benefits veterans first and happens also to strengthen the country's scientific position, and treating veterans as an industrial-policy asset in a contest with Beijing. The first is defensible and arguably admirable. The second instrumentalizes a population that has already been asked to sacrifice, and the distinction between them lives in guardrails, genuine informed consent, veteran benefit as the primary aim, and independent oversight, that a pure competitiveness framing is prone to treat as obstacles rather than obligations.

How to read it

The measured takeaway is that the VA genuinely is a distinctive and hard-to-replicate national asset in biomedical research, but for a more precise reason than its size, and with more caveats than the race framing invites. Its edge is continuity, a single system that follows the same people for life and can therefore answer the long-horizon, real-world questions that fragmented American healthcare and even China's high-throughput trial machine struggle with. That is a real strategic strength, and using the VA to produce the world's best longitudinal evidence about how therapies perform over time would play to an American advantage that is difficult for any competitor to match.

Whether to wrap that in the language of a race with China is a separate question, and a genuinely contested one. The competition is real, the Chinese gains are real, and the impulse to marshal American advantages is understandable. But the strongest version of the argument does not actually need the nationalist frame, because the case for the VA doing deep, continuous, rigorous research is compelling on its own terms, for veterans first and for American science second. The weakest version leans on the race to justify instrumentalizing a population that deserves to be the beneficiary of the research rather than its raw material. The useful way to hold it is that America does have an asset here that China cannot easily copy, that the asset is continuity rather than scale, and that its value is greatest when it is deployed to serve the people in the system rather than to win a contest over them. Get that ordering right, and the VA strengthens both veteran care and the country's scientific position. Get it backward, and the race rhetoric ends up justifying the wrong priorities in the name of the right goal.

Primary sources

1. STAT's First Opinion essay by former VA Secretary David Shulkin for the framing of the VA as a national biotech asset, the more than 9 million VA enrollees, and the figures that China now conducts more early-stage clinical trials than the United States and that Chinese companies captured nearly half of global pharmaceutical licensing deals in 2025.
2. The Asia Society Policy Institute's "Beyond the Biotech Race" paper for the enduring US structural advantages in foundational science, first-in-class discovery, academic medical centers, capital markets, regulatory credibility, and talent, and for the argument that the competition is better understood as asymmetric convergence than a linear race.
3. The Asia Society overview of US-China life-sciences competition for China's biomanufacturing prioritization in its five-year planning, the national-security and cooperation tensions, and the areas where bounded cooperation may remain viable.
4. BioSpace for the American Biotech Innovation Alliance, the "space race" framing among industry leaders, and the observation that many headlining oncology assets were created and tested in China before reaching US patients.
5. The Washington Times and Foreign Affairs for the national-security framing of the competition and the description of China's state-directed, whole-of-nation biotech strategy.
6. Morrison Foerster for the BIOSECURE Act's designation of "biotechnology companies of concern" and the bipartisan supply-chain and data-security context.