In The World’s Medicine Chest: How America Gained Pharmaceutical Supremacy—and How to Keep It, Sally C. Pipes explores how free markets facilitated the extraordinary pharmaceutical advances the United States has achieved over the past century — from life-saving vaccines to cutting-edge cancer treatments.

But over the last few decades, governments the world over have chipped away at — or outright eliminated — many of the incentives that lead investors, drug manufacturers, and scientists to develop new medicines. Every European nation now levies some kind of price control on prescription drugs. And Democrats during the Biden administration enacted the very first price controls on prescription drugs through Medicare.  The first tranche of price controls begins on Jan. 1, 2026, on 10 drugs under Medicare Part D.

By embracing price controls, the U.S. government risks killing the innovation engine that has made this country the world’s medicine chest.

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May 14 is not a holiday in the United States. But perhaps it should be. On that day in 1796, a British physician, Edward Jenner, successfully administered the first-ever smallpox inoculation on a dairy farm in Gloucestershire, England. By saving one life, Jenner set in motion a process that would save countless more. The smallpox vaccine is why humanity was able to eradicate a virus that has taken millions of lives worldwide.

And smallpox is only one of the many diseases tamed by vaccines. A study led by the World Health Organization and published in The Lancet in May 2024 estimated that vaccinations writ large had saved 154 million lives in the fifty years since 1974. That’s equivalent to six lives saved every minute, every year. The many vaccines we take for granted today—which protect us against everything from tetanus and influenza to measles and mumps— would not have been possible without Jenner and his barn-side experiments.

Over two centuries later, an event of similar world-historical magnitude occurred roughly sixty miles north of where Jenner performed his famous inoculation. On December 8, 2020, at a hospital in Coventry, ninety-year-old Margaret Keenan received the first-ever vaccine against SARS-CoV-2, the novel coronavirus that sparked the COVID-19 pandemic. Since then, 70% of the world’s population has received at least one dose of an approved COVID vaccine. These vaccines saved millions of lives—and largely enabled the world to open up again after the darkest days of the pandemic.

The medical science behind the vaccine that Margaret Keenan received is revolutionary. Traditional vaccines introduce weakened versions of a pathogen into a person’s bloodstream in order to prompt an immune response. The COVID vaccines developed by Moderna and the Pfizer-BioNTech corporate partnership instead use messenger RNA (mRNA) to “teach our cells how to make a protein—or even just a piece of a protein—that triggers an immune response inside our bodies,” as the Centers for Disease Control and Prevention put it. Scientists are working on adapting mRNA vaccines to fight a number of other diseases, including cancer.

The science behind vaccines may have its origins in Great Britain, but there’s little question that the present and future of vaccine science—and of biopharmaceutical innovation in general—is in the United States. It’s no accident that two American pharmaceutical companies, Pfizer and Moderna, were the manufacturers of the first approved COVID vaccines. The United States leads the world in biopharmaceutical inventions. We put more money toward life-sciences research and drug development than any other country. Around two-thirds of new drugs developed in the last decade or so originated in the United States.

There’s a clear reason why. Back in April 2020, when much of the world was shut down because of COVID-19, I made a wager. “When we beat this pandemic,” I wrote, the “primary reason” would be “market capitalism.”

Private companies have long tended to tackle complex healthcare problems better than government agencies. Think back to when the federal government struggled to test for and trace the spread of SARS-CoV-2. Dr. Scott Gottlieb, former commissioner of the U.S. Food and Drug Administration, has aptly described those efforts as “corrosive failures. . . inside an ill-prepared bureaucracy.”

In the early days of the pandemic, I also warned about the dangers of putting that ill-prepared bureaucracy in charge of America’s thriving drug development infrastructure. The Speaker of the House, Nancy Pelosi (D-Calif.), was pushing the Lower Drug Costs Now Act, a plan that would have allowed the federal government to cap the prices of 250 brand-name drugs. Implementing such a policy, I argued, would imperil our nation’s response to future public health crises. I hoped that lawmakers would end their misguided crusade to give the government the authority to dictate drug prices if American drug companies presented the world with an effective COVID vaccine.

Market capitalism did indeed bring us the vaccines that eventually got the pandemic under control. American drug companies created them. And for a while, the pharmaceutical industry enjoyed a surge in popular acclaim.

But as vaccinations continued and the threat of COVID waned, politicians got back to their old tricks. In August 2022, Democrats in Congress passed the Inflation Reduction Act (IRA), which authorized Medicare to impose price controls on prescription drugs starting in 2026.

Stethoscope with Pen, Charts and Graphs - shahrilkhmd

The IRA’s price controls are expected to siphon funding away from America’s life-sciences sector. That will not only leave us ill prepared for future pandemics but also disrupt the progress we’ve made in boosting life expectancy and beating back disease. We know exactly what happens when a global pharmaceutical powerhouse chooses government regulation over private-sector innovation.

In the 1970s, Europe led the world in medical innovation. European life-sciences firms produced 149 new drugs, while the United States introduced only 66. As recently as 1990, drugmakers invested 50% more in Europe than in the United States. But as the new century approached, more and more European countries imposed price controls and other regulations on their pharmaceutical sectors. Today, European companies make fewer drugs than their American counterparts, and European patients have less access to novel medications.

This book explains how that shift occurred—and why. We’ll look at the smart reforms the United States made to get ahead and at the disastrous regulations embraced in Europe. We’ll learn how and why price controls and similar regulations make it harder to develop drugs. And we’ll examine the often deadly impact that price controls have on patients. Then we’ll consider what the United States risks losing if our lawmakers embrace European-style price controls. Finally, we’ll look at some proposals for reducing drug costs and boosting access to cutting-edge medicines without sacrificing future innovation.

I’ve spent my career fighting to keep government-run health care out of the United States. I’ve seen what it has done to patients in my native Canada. We have decades of evidence showing just how much harm government bureaucrats can do when they’re in charge of a health-care system. If the United States follows Europe and embraces price controls on prescription drugs, the entire world will suffer the consequences. If we stop making groundbreaking drugs, no other country has the capability to pick up the slack. We are the last, best hope for millions of people around the world who are battling rare diseases and chronic conditions.

Pharmaceutical innovation, led by American companies, has elevated human well-being to heights that would have been unimaginable just fifty years ago. But we can still do more to fight and cure disease. And we will—if American lawmakers can avoid killing the goose that for decades has laid golden eggs in the form of lifesaving medicines.

Read more in The World’s Medicine Chest