WASHINGTON — Early-stage drug development worldwide has nearly doubled over the past decade and shifted from a U.S.-dominated model to a dual hub centered in the United States and China, according to new research described by Georgetown University health policy experts.
The new examination of global early-stage biopharmaceutical development programs from 2015 through 2025 found that while the United States remains the single largest originator of early-stage drug programs, China’s share has grown substantially.
In 2015, about 48% of early-stage programs originated in the U.S. and 8% in China. By 2024, the U.S. share had declined to just over 37%, while China’s share rose to just over 32%. Overall, the number of early-stage drug development programs increased from 10,417 in 2015 to 18,999 in 2024, an 82.4 percent increase.
The findings were published March 26, 2026 online in JAMA . (Research Letter: “Geographic Shifts in Early-Stage Biopharmaceutical Innovation”).
“Early-stage drug development is where the future pipeline is built,” said So-Yeon Kang, PhD, MBA, assistant professor in the Department of Health Management and Policy at the Georgetown University School of Health and member of Lombardi Comprehensive Cancer Center. “Understanding where that innovation originates is essential for countries thinking strategically about regulatory coordination, workforce development, and long-term patient access to new therapies.”
The researchers conducted analysis using the Clarivate Cortellis Drug Development Database , which tracks global pharmaceutical research and development activity across public and private entities. An early-stage drug development program was defined as development of a specific drug for a specific indication.
Programs in discovery, preclinical development, or early clinical testing between January 1, 2015, and September 30, 2025, were included. Discovery and preclinical programs were categorized together as preclinical. Programs were assigned to a country based on the global headquarters of the originator company and were not reassigned following licensing or acquisition.
The analysis examined overall program counts as well as distribution by development stage, drug modality, and therapeutic area.
Growth in early-stage development was observed across multiple countries, but expansion was most pronounced in China. The number of Chinese-origin programs increased from 829 in 2015 to 6,145 in 2024, a 641 percent increase.
“We observed shifts that reflect structural changes in how and where early scientific discovery is occurring,” said Yunan Ji, PhD, professor at Georgetown University’s McDonough School of Business and research associate at the National Bureau of Economic Research. “Where early-stage development happens shapes where capital flows, which companies attract investment, and ultimately which drugs reach patients — making these patterns critical for policymakers and investors to monitor.”
This study provides one of the first systematic global empirical assessments of how China’s rapid expansion in early-stage drug development is reshaping the geography of innovation. By analyzing origin at the program level, it offers a clearer view of where scientific discovery occurs. The strength of a country’s early-stage R&D ecosystem is critical for economic competitiveness and long-term patient health outcomes.
“Continued monitoring will be essential for policymakers seeking to design effective financial and regulatory incentives and to understand what this evolving two-hub system ultimately means for patients, scientific talent, and capital investment across the globe,” Kang added.
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This study did not receive external funding. Kang reports research funding from Arnold Ventures, the National Institute for Health Care Management Foundation, and the American Society of Clinical Oncology and fees from the Colorado Consumer Health Initiative. Ji reports research funding from the National Institute on Aging.
JAMA
Meta-analysis
Not applicable
Geographic Shifts in Early-Stage Biopharmaceutical Innovation
26-Mar-2026
This study did not receive external funding.