China is winning the race to remake medicine, and Washington is running out of time to catch up. That is the signal emerging from a convergence of data points that individually might seem unrelated but together form a clear arc: Chinese biomedical output has tripled since 2018 while American output has flatlined; China now runs more CAR-T cell trials than the United States; and Beijing's government is on a trajectory to surpass U.S. public research spending within two to three years, according to a forecast by the Foundation for Science and Innovation Policy at UC San Diego. Meanwhile, a NIH policy shift announced in September 2025 has severed the funding pipeline that kept American researchers plugged into the global scientific community, accelerating a transfer of momentum that was already underway. (https://www.nature.com/articles/d41586-026-00618-5) (https://www.statnews.com/2026/03/19/american-gene-therapy-leadership-challenged-speedy-china-trials/)
The numbers are stark. China added $59 billion in public R&D spending over the preceding decade, reaching $133 billion in 2023, while U.S. government R&D spending rose only 12 percent to $155 billion over the same period. (https://www.nature.com/articles/d41586-026-00618-5) If current trends persist, China will overtake the United States in public research spending by 2028 at the latest, according to the FSIP forecast. Robert Conn, a specialist in research policy and science philanthropy who co-leads FSIP, said the earliest realistic date is roughly 2028, plus or minus one year. (https://www.nature.com/articles/d41586-026-00618-5)
In the clinic, the consequences are already visible. CAR-T cell therapy, a form of genetic engineering in which a patient's own immune cells are reprogrammed to attack cancer, was invented in New York City. Today there are more CAR-T cell trials running in China than in the United States. (https://www.statnews.com/2026/03/19/american-gene-therapy-leadership-challenged-speedy-china-trials/) Michel Sadelain, a pioneer in the field, put it plainly: CAR-T cells were born in the U.S., actually here in New York City, but today there are more CAR-T cell trials in China than in the U.S. Since 2018, investigator-initiated trials in China for cell and gene therapy products have enrolled over 30,000 participants, twice the number enrolled in typical trials overseen by China's national regulatory body. (https://www.statnews.com/2026/03/19/american-gene-therapy-leadership-challenged-speedy-china-trials/) The Stony Brook University analysis that underpins the drug discovery comparison is equally unambiguous: since 2018, China's output in terms of new drug discovery has tripled, while output by American sources has remained comparatively flat. (https://www.statnews.com/2026/03/19/american-gene-therapy-leadership-challenged-speedy-china-trials/)
Into this moment of accelerating Chinese momentum, the NIH introduced a policy that economists and lab directors say will widen the gap further. On September 12, 2025, the agency announced it would no longer accept new applications requesting funds for foreign components using the traditional grant subaward and consortium structure. (https://research.washu.edu/upcoming-federal-changes/) The agency's stated rationale was transparency: it needed to reliably track every dollar spent on foreign collaborations, and the existing subaward structure did not allow for consistent reporting. (https://research.washu.edu/upcoming-federal-changes/) A replacement mechanism called the PF5 opened for submissions on April 25, 2026, with the first standard deadline on May 25, 2026 and awards expected to begin issuing around April 2027. (https://research.washu.edu/upcoming-federal-changes/) The gap between announcement and solution spans roughly 18 months. Active research programs with foreign components did not survive it.
Under the new PF5 structure, the NIH disaggregates foreign components into separate awards with independent grant numbers, issuing them directly to the foreign institution rather than routing funding through a domestic principal investigator. (https://grantedai.com/blog/nih-pf5-grant-foreign-subawards-international-research-strategy-2026) The domestic PI no longer holds the budget or bears scientific accountability for the foreign site. Researchers call this a fundamental shift in the power dynamic. From my point of view, from somebody that has had a lot of these foreign subawards, it really removes my ability, from year to year, to adjust the budget or hold the foreign site scientifically accountable because the money no longer comes through me, one researcher told STAT. (https://www.statnews.com/2026/03/27/nih-funding-national-researcher-survey-foreign-subaward-ban-impact/)
The policy's effect on American researchers is documented and measurable. A STAT/MassINC poll of 989 NIH-funded researchers conducted between January 28 and February 18, 2026 found that 25 percent said their research had been significantly affected by the move away from foreign subawards. Twenty-eight percent moved international collaborators' work to U.S. institutions. Seven percent shut down non-clinical work outside the United States and returned funds to the NIH. Eight percent wound down, paused, or altered the scope of clinical trials with foreign sites. (https://www.statnews.com/2026/03/27/nih-funding-national-researcher-survey-foreign-subaward-ban-impact/) Those figures describe a research establishment that is becoming structurally isolated from the global networks it once anchored. Christopher Sassetti, a tuberculosis researcher at UMass Chan Medical School, had spent years building patient cohorts in Peru and South Africa. When his grant renewal came up before the PF5 system existed as a continuation mechanism, his subawards were simply cut. His cohorts are gone. If our non-competing renewal would have been after the new system, potentially there would have been a mechanism to continue it, Sassetti said. But because these were disallowed before there was a new system, they were just all removed. And that is permanent. (https://www.statnews.com/2026/03/27/nih-funding-national-researcher-survey-foreign-subaward-ban-impact/)
For specific research communities, the losses are concrete. FlyBase, the consortium that maintains the primary genetic database for Drosophila research, operates with contributions from four U.S. institutions and the University of Cambridge. After an NIH grant supporting the consortium became caught in the White House funding freeze to Harvard, eight FlyBase employees were laid off. Then, separately, support for the University of Cambridge team was removed as a result of the foreign subaward ban. The consortium is now asking the wider fly research community to contribute roughly $500,000 annually to keep the Cambridge team curating. (https://www.statnews.com/2026/03/27/nih-funding-national-researcher-survey-foreign-subaward-ban-impact/) Andres Vidal-Gadea, a molecular neuroethologist at Illinois State University studying Duchenne muscular dystrophy, was building a collaboration with scientists in the Netherlands when the subaward ban collapsed it. He spent years developing that partnership and became a U.S. citizen in early 2026 after 23 years in the country. He is now directing that momentum toward advocacy. (https://www.statnews.com/2026/03/27/nih-funding-national-researcher-survey-foreign-subaward-ban-impact/)
The survey data captures compounding disruption across the research enterprise. More than a quarter of respondents have laid off lab members, more than two out of every five canceled planned research, and two-thirds have counseled students to consider careers outside the ivory tower. (https://www.statnews.com/2026/03/19/nih-funding-national-researcher-survey-finds-cutbacks-disruptions/) Steve Shoptaw, a researcher at the UCLA Center for Behavioral and Addiction Medicine, put it bluntly: this is like the Titanic hitting the iceberg. People are still eating at the table, music is still playing, and yet the ship is sinking. (https://www.statnews.com/2026/03/19/nih-funding-national-researcher-survey-finds-cutbacks-disruptions/) Only 35 percent of respondents whose grants were cut or delayed said their government funding had been fully restored by the end of 2025. (https://www.statnews.com/2026/03/19/nih-funding-national-researcher-survey-finds-cutbacks-disruptions/)
The NIH is simultaneously navigating other structural pressures. The agency awarded 5,564 fewer grants in fiscal year 2025 than in fiscal year 2024, an 8.6 percent drop, driven partly by a shift toward forward funding that locked appropriated dollars into future-year commitments rather than distributing them as current-year awards. (https://cen.acs.org/policy/research-funding/nih-research-grants-funding-challenges/104/web/2026/03) The forward funding share of new NIH grants jumped from 5 to 15 percent in fiscal year 2024 to 40 percent in fiscal year 2025. (https://cen.acs.org/policy/research-funding/nih-research-grants-funding-challenges/104/web/2026/03) The NIH budget for fiscal year 2026 is $47.2 billion, a half-percent increase over fiscal year 2025 that amounts to a real-dollar decrease after inflation. (https://cen.acs.org/policy/research-funding/nih-research-grants-funding-challenges/104/web/2026/03) If the forward funding trend holds in fiscal year 2026, the NIH will award an estimated 970 fewer new grants than if it had reverted to 2024 proportions. (https://cen.acs.org/policy/research-funding/nih-research-grants-funding-challenges/104/web/2026/03)
Sassetti's specific timing is, in his words, a fluke. The policy gap that destroyed his TB cohorts is now closed in the sense that PF5 submissions are open. But the partnerships he built over years are gone. The disease does not wait. And neither, apparently, does the next grant cycle. Meanwhile, in Shanghai and Beijing, the trials continue.
