The VA's 9 million patients could decide the US-China drug race

China overtook the United States in the number of new early-stage clinical trials started in a year in 2025, and Chinese-linked deals captured a record share of global pharmaceutical licensing in the same window. A STAT opinion is now arguing that the country's most underused counterweight is the Department of Veterans Affairs (VA), the nation's largest integrated health system, with longitudinal electronic health records on roughly nine million patients.

The trial gap is the easier half of the story to verify. GlobalData told the OCT West Coast 2025 conference that China now starts more early-stage trials annually than the United States, and that more than 70 percent of China's ongoing trials are single-country studies run by Chinese-based sponsors. That single-country share matters: it lets Beijing's biotech sector iterate inside its own regulatory and patient population, without the multi-jurisdiction friction that still shapes US trial design. Medpath and Life Science Daily have run the same GlobalData finding in plain language.

Cross-border licensing has moved the same direction. PharmCube's 2025 tally of deals involving Greater China hit $137.7 billion, up from $13.9 billion in 2021, with 2026 on pace to break the record and average deal sizes up 76 percent year-over-year. The STAT opinion goes further, claiming Chinese companies captured "nearly half of global pharmaceutical licensing activity by dollar amount" in 2025, a related but distinct figure that the underlying trade-press data doesn't independently confirm.

The mechanism the opinion is selling is straightforward. Adaptive, continuous-learning trials work best inside a single, integrated patient population with deep longitudinal data; these are studies whose protocols change in real time as patient responses come in. The VA has that population. More than nine million enrolled veterans move through one electronic record system, one set of formulary rules, and one research apparatus. Run the trials inside the VA, the argument goes, and the United States regains a fast-cycle evidence engine that private health systems, split across dozens of EHR vendors and insurance contracts, cannot match.

The pitch, however, runs ahead of what the VA actually does. The agency's research arm runs trials, but adaptive platform studies at the scale the argument requires aren't currently a documented VA competency; they exist mostly in bespoke academic and industry collaborations. Turning the VA into clinical-trial infrastructure on the scale China has built would mean new authority over protocol design, faster institutional review board cycles, and a deliberate policy choice to treat evidence generation as strategic national capability rather than a regulatory side issue. The opinion quantifies none of those requirements, and no public cost estimate has been published.

The race the argument is trying to win is not just about which country approves a drug first. China's named strategic priorities, including AI, synthetic biology, advanced biomanufacturing, gene therapies, and precision medicine, all sit upstream of the clinical-trial pipeline the United States still largely dominates. The bipartisan National Security Commission on Emerging Biotechnology has warned that the United States risks losing its lead, framing biology the way the chip industry treated lithography a decade ago: the country that moves fastest from bench to patient attracts the talent, the capital, and the manufacturing, and writes the standards everyone else follows.

The VA counter-pitch is a serious argument with a real asset behind it, but it is also a five-year build dressed up as a counter-move. The watch item is whether the next budget treats clinical-evidence generation as infrastructure worth paying for, or leaves it where it has been for the last twenty years.

If the United States is going to fight the next biotech race the way it fought the last chip race, the asset is already in the building. The next budget will show whether Washington knows it.