The positioning of China in the global footprint of multinational pharmaceutical companies is undergoing a fundamental restructuring.

 

Earlier this month, Novo Nordisk President and CEO Lars Fruergaard Jørgensen told Xinhua News Agency that China is Novo Nordisk's second-largest market globally, and that the company is optimistic about China's innovation ecosystem and will continue to advance the deep integration of its China business with global strategy.

 

Coincidentally, earlier this year, Sanofi Greater China President Shi Wang revealed that the company had reached a consensus with headquarters: for parts of the global product pipeline that cannot fully cover China market demand, Sanofi China has the authority to independently supplement through BD and licensing-in — "no country market has ever had similar decision-making power before."

 

Even more directly persuasive is the flow of capital. In the first half of this year, a host of MNCs — including Novo Nordisk, Sanofi, Novartis, Eli Lilly, and AstraZeneca — successively unveiled major investment plans in China, spanning the entire value chain of R&D, manufacturing, and supply chain.

 

At the same time, in the first half of this year, the total value of Chinese innovative drug License-out transactions exceeded the $100 billion mark. MNCs were virtually "sweeping up" Chinese assets with heavy bets: AstraZeneca committed $18.5 billion to partner with CSPC, BMS invested $15.2 billion to collaborate with Hengrui, and Eli Lilly directly secured three of the TOP 10 deals in a single sweep. The collaboration has transcended the product level, evolving into a systematic integration of Chinese pharmaceutical companies' R&D systems.

 

Looking at the strategic layout of major multinational pharmaceutical companies in China in recent years, their development paths have formed a highly consistent pattern — shifting from the early "product import + local sales" model to a new paradigm of "deep localization + global synergy." China has transcended its position as a single market to become an indispensable strategic component of the MNC full value chain, from early-stage R&D to market supply.

 

Behind this lies the MNCs' reaffirmation of China's industrial value: the deep potential of a super-large market, a mature industrial chain, unparalleled cost advantages, and increasingly prominent local innovation capabilities — these factors combined have elevated China from a "cost and production center" to an "innovation and strategic hub" in the global pharmaceutical landscape.

 

1: Global Clinical and Regulatory Synchronization

 

The most tangible manifestation of this restructuring lies in the synchronization of global clinical research and drug approval.

 

Driven by multiple factors, "China-first launch of innovative drugs" is evolving from isolated cases into a systemic trend. Multinational pharmaceutical companies are increasingly inclined to include China in the early stages of global R&D, and even to make China the first stop for global product launches.

 

For instance, Novo Nordisk launched the "China Same Initiative" at the end of 2019 to better leverage China's local innovation capabilities and promote simultaneous clinical development, regulatory approval, and market launch of innovative drugs in China and globally.

 

The "China Same Initiative" achieved its first milestone in 2024 with Novo Nordisk's NovoSen® — achieving simultaneous clinical development and approval both domestically and globally, and securing market access and reimbursement within six months of approval in China, enabling Chinese patients to access global innovative drugs earlier.

 

This June, another major achievement of the "China Same Initiative" was reached, as Novo Nordisk's once-weekly basal insulin/GLP-1 RA therapy, NovoJie®, made its global debut in China. "This is an exciting moment. It is the first time in the company's history that we have launched a product first in China — not only ahead of Europe and the U.S., but even ahead of our home market of Denmark," said Jørgensen.

 

NovoJie® is the world's first and currently only approved once-weekly basal insulin/GLP-1 RA therapy, indicated for adult type 2 diabetes patients with inadequate glycemic control on basal insulin or GLP-1 RA therapy, to be used in combination with oral antidiabetic drugs on a background of diet and exercise.

 

Notably, the Phase III clinical study COMBINE 1 for NovoJie® was led by Professor Ji Linong from Peking University People's Hospital — marking the first time a Chinese expert has served as the global lead principal investigator for a pivotal clinical study, also a first in Novo Nordisk's history.

 

Chinese physicians' real-world exploration and application provide important references for the global promotion of this innovative therapy, further highlighting China's strategic value in the global pharmaceutical innovation landscape.

 

Novo Nordisk's practice is not an isolated case, but rather a microcosm of MNCs' reassessment of China's R&D standing.

 

Data shows that Boehringer Ingelheim China has achieved 100% inclusion of its human pharma portfolio in global pivotal clinical studies and 73% inclusion in Boehringer Ingelheim's global early clinical studies.

 

In November 2025, Sanofi's second-generation cardiac myosin inhibitor, Xingshuping (Afikaitai tablets), made its "global debut" at the 8th CIIE. In December of the same year, the drug received formal NMPA approval for market launch in China, achieving a "global first launch" ahead of the U.S., EU, and other countries and regions.

 

According to Sanofi's plan, approximately one-third of its future global new research projects will be conducted in China, with China's participation in over 90% of global synchronous development projects, driving innovation outcomes led by or deeply involving China to reach the global market first.

 

Novartis is following a similar path. Since 2022, 100% of Novartis's new drug and new indication development in China has been synchronized with global development. Starting in 2026, 100% of new drug and new indication registration applications in China will be synchronized with global development.

 

Overall, in the global innovation pipeline landscape of MNCs, "China's power" is moving to center stage. Chinese researchers are no longer mere "data contributors" to global clinical trials, and the China market is no longer the "last stop" for global innovation — "China-first launch" is redefining the rhythm and coordinates of MNCs' global market access.

 

2: Continued Investment Expansion in China

 

If "China-first launch" means MNCs placing China at the forefront of their global market access timelines, then the billion-dollar supply chain investments represent the deepest form of commitment — embedding production capacity as the most compelling testament to this strategic priority.

 

Recently, Novo Nordisk announced an additional RMB 200 million investment in its strategic production base in Tianjin to increase injection pen assembly capacity. Since entering the Chinese market, Novo Nordisk has cumulatively invested over RMB 17 billion in China.

 

Another weight-loss giant and "sweeping buyer," Eli Lilly, has also demonstrated ambitious production plans in China.

 

In 2024, Eli Lilly first invested an additional RMB 1.5 billion in its Suzhou plant, specifically to enhance local filling and packaging capabilities for blockbuster GLP-1 drugs such as Tirzepatide.

 

In 2026, Eli Lilly unveiled another major plan — investing a total of US$3 billion in China over the next decade to comprehensively expand its supply chain in China, while partnering with local CDMOs to advance commercial formulation production of its oral small-molecule GLP-1 receptor agonist Orforglipron — directly plugging into the global core oral weight-loss drug supply chain.

 

On the last day of June, the National Medical Products Administration (NMPA) officially approved the domestic production of Tirzepatide injection at Eli Lilly's Suzhou plant. Through an "imported API + local aseptic filling" model, the approval shortens cross-border logistics timelines and significantly mitigates global supply chain volatility.

 

AstraZeneca also unveiled a multi-billion-dollar investment plan early this year, announcing over RMB 100 billion (US$15 billion) in investment in China by 2030 to expand its presence in drug manufacturing and R&D.

 

In March, several investments were implemented simultaneously: a radioconjugate drug production and supply base in Guangzhou focused on actinium-225-based prostate cancer therapeutics; a cell therapy commercial manufacturing supply base in Shanghai Lingang New Area supplying CAR-T products to China and Asian markets; and a Gracell Cell Therapy Innovation Center in Zhangjiang Hi-Tech Park covering the full spectrum from early research to registration support.

 

Novartis is also steadily increasing its commitment. In March this year, Novartis announced an investment of over RMB 3.3 billion to expand its R&D, manufacturing, and operations footprint in China. Of this, approximately RMB 1.5 billion is allocated to the expansion and upgrade of its Changping plant, introducing new manufacturing technologies such as sterile preparation and liquid filling; RMB 1.8 billion is for the Phase II development of the Shanghai campus — a milestone expansion on the tenth anniversary of the operation of Novartis China headquarters.

 

Previously, Novartis had invested RMB 600 million in Haiyan, Zhejiang, to build China's first radiopharmaceutical production project — leveraging the unique industrial base of Qinshan Nuclear Power Plant to enable just-in-time precision manufacturing and distribution of radioligand therapies in the Yangtze River Delta region, with operations expected to commence by the end of 2026.

 

Sanofi is also keeping pace, making the largest single MNC investment in China to date. In October 2025, Sanofi announced an investment of approximately €1 billion to build a new, advanced insulin API production base in the Beijing Economic-Technological Development Area, with ground breaking in early 2026.

 

In May 2025, Roche invested over RMB 2 billion to launch a new biologics manufacturing base in Shanghai's Zhangjiang Hi-Tech Park, introducing internationally leading processes. The first phase is dedicated to localized production of its breakthrough retinal disease drug, Roche's Vabysmo (Faricimab).

 

Looking across this wave of investment, a clear commonality emerges: MNC capacity expansion is no longer about marginal packaging or repackaging operations, but is focusing on cutting-edge areas such as cell therapy, radiopharmaceuticals, and oral GLP-1 — deeply binding the "lifeline capacity" of core products to China.

 

As China upgrades from a "manufacturing workshop" to a core hub of the global innovative drug supply chain, MNCs are considering not only leveraging China's mature and efficient industrial environment to achieve localized production and cost reduction, but more importantly, using "China's advantages" to optimize the cost, efficiency, and flexibility of their global supply chains.

 

3: Embracing China's R&D System

 

The "China-first" approach to products represents MNCs' reordering of global markets; the multi-billion-dollar supply chain investments represent their strategic anchoring of production capacity. Beyond these two, an even more far-reaching thread is unfolding — MNCs are systematically integrating Chinese pharmaceutical companies' R&D systems into their own global innovation architecture.

 

Collaboration with local companies has long been an important part of MNCs' China strategy. While the previous sections address what MNCs are "doing in China" and "building in China," this section addresses what they are "finding in China."

 

Since 2024, MNCs' acquisition of Chinese innovative drug assets has grown explosively, with the upfront payment threshold for TOP 50 licensing deals rising above US$100 million, and total transaction values continuously breaking records. But more significant than the numbers is the fundamental evolution in MNC collaboration models — from "buying products" to "buying systems."

 

In the early stages, MNCs' asset acquisitions in China focused primarily on late-stage clinical assets, exemplified by differentiated molecules such as ADCs and bispecific antibodies (PD-1/VEGF, TCE, etc.). The logic at that time was clear: seek mature assets with validated clinical data and relatively controllable risk to rapidly fill gaps in the global pipeline.

 

As the frequency and depth of collaboration with Chinese innovative pharma companies increased, MNCs discovered that China's innovative pharma industry exhibited a "systemic advantage": differentiated molecular design capabilities, high clinical execution speed, relatively controllable R&D costs, and rapid patient enrollment and clinical POC validation enabled by a large patient population.

 

The combination of these factors gives China a rare efficiency advantage globally in new molecule discovery and early clinical development.

 

At the same time, MNCs' perception of China's innovation ecosystem continues to evolve — from initial caution regarding preclinical and early-stage data, to gradually building trust, and now to systematically incorporating Chinese pharmaceutical companies' R&D systems into their own global R&D architecture.

 

The essence of this shift is: MNCs view Chinese pharmaceutical companies' R&D capabilities as an "accessible external innovation resource pool" — no longer limited to single-project licensing, but treating Chinese partners' technology platforms, R&D systems, and early development capabilities as an extensible part of their own global R&D systems.

 

The most typical example is Eli Lilly. In 2026, leveraging the dual high performance and market capitalization achieved through its GLP-1 products, Eli Lilly has been both aggressively acquiring companies globally through small-to-mid-sized M&A and deepening its footprint in China.

 

 

In the first half of the year, Eli Lilly successively reached multi-billion-dollar BD deals with Innovent Biologics, Haisco, Abbisko, and Insilico Medicine, securing China's small-molecule innovative R&D resources. Through multi-point positioning and multiple partners, it is systematically accessing China's R&D capabilities across different stages — from AI drug discovery to early small-molecule development.

 

Similarly, AstraZeneca's deep integration with CSPC and BMS's strategic collaboration with Hengrui Medicine show the same characteristics: Chinese pharmaceutical companies are becoming systemic partners for MNCs in deep early-stage R&D collaboration.

 

The underlying logic is the further deepening of global division of labor: on the R&D side, Chinese pharmaceutical companies' platform-based capabilities for developing new molecules are spilling over, while MNCs have deeper Biology expertise but lack low-cost, high-efficiency advantages — the two complement each other. MNCs select or designate targets, and Chinese pharmaceutical companies take on early research up to clinical POC.

 

In other words, the systematic advantages of Chinese pharmaceutical companies and biotechs are being internalized by MNCs, effectively replacing their early research and early clinical development platforms.

 

As Jørgensen put it: "China is becoming an important source of innovative drugs. We are very optimistic about the vitality and efficiency of China's pharmaceutical innovation ecosystem. No one can afford to ignore China and the innovation happening here."

 

From "China-first launch" to the anchoring of core production capacity, and then to the full integration of R&D systems — MNCs are writing the annotation for this judgment with their product portfolios, investment maps, and collaboration models.