Biotechnology is rapidly becoming a pillar of national power. The nation that can discover, test, and deploy new therapies most efficiently will not only improve the health of its citizens but also shape global standards, attract investment, strengthen military readiness, and dominate one of the most important industries of the past century.
China understands this reality. Beijing has made biotechnology a strategic priority and is investing aggressively in artificial intelligence, synthetic biology, advanced biomanufacturing, gene therapies, and precision medicine.
America retains critical advantages, but in key measures of the race, China has already pulled ahead. China now conducts more early-stage clinical trials than the United States, and in 2025, Chinese companies captured nearly half of global pharmaceutical licensing activity by dollar amount. The bipartisan National Security Commission on Emerging Biotechnology has warned that the U.S. risks losing its advantage entirely if it fails to act. In many ways, biotechnology is now a Sputnik moment — and the race is already underway.
Success in this competition depends on one factor above all: speed. Scientific discovery means little if promising therapies remain locked in development for years. The nation that can move most rapidly from laboratory benches to patients will attract scientific talent, investment capital, and manufacturing capacity while establishing the standards that others follow. Real-time clinical development is therefore much more than a regulatory innovation — it is a strategic capability.
Fortunately, the U.S. already possesses a competitive advantage that few nations can match: the Department of Veterans Affairs.
With more than 9 million enrolled veterans, the nation’s largest integrated health care system, decades of research expertise, and one of the most robust longitudinal electronic health record databases, the VA represents a strategic national asset for accelerating clinical research. With AI-enabled registries, integrated electronic records, and real-world evidence generation, the VA could become one of the world’s premier platforms for adaptive clinical trials and continuous learning.
Rather than viewing the VA solely as a health care delivery system, America should recognize it as critical biotechnology infrastructure capable of shortening development timelines, and ensuring that more breakthrough therapies are developed and tested in the U.S.
Recognizing that clinical trials are both a regulatory process and a national strategic asset, the Department of Health and Human Services recently launched Operation Trialblazer, an unprecedented department-wide effort to restore American leadership in clinical research. The initiative brings together the Food and Drug Administration, the National Institutes of Health, the National Center for Advancing Translational Sciences, the National Cancer Institute, the Office of the National Coordinator for Health IT, ARPA-H, and the HHS Office of Inspector General to modernize and accelerate clinical research. Incorporating the VA into this strategy would significantly strengthen the administration’s efforts and provide the U.S. with a competitive advantage that no rival nation can easily replicate.
HHS is promoting adaptive and decentralized trial designs, greater use of AI and real-world evidence, and closer integration of clinical research with electronic health records. The FDA has also announced policies intended to reduce the time from drug discovery to first-in-human studies and has clarified that, in appropriate circumstances, a single high-quality late-stage study supported by confirmatory evidence may provide sufficient evidence of effectiveness. This is where VA could serve as a national model for other systems to emulate.Â
Many of the capabilities envisioned by HHS are already being demonstrated by leaders across the health care industry. Technology companies are using electronic health records, digital tools, and physician networks to expand trials beyond academic medical centers and conduct real-time clinical trials that accelerate enrollment and improve patient access. Adaptive trial designs and real-world evidence can shorten development timelines, lower costs, and strengthen America’s competitiveness.
This approach should be viewed not merely as health care policy but as economic and industrial policy. Biotechnology has become one of the defining industries of the 21st century. By modernizing clinical research and reducing development delays, the U.S. can reinforce its position as the world’s leading biotechnology ecosystem.
The Department of Defense should likewise be viewed as an essential partner in this national strategy. The Military Health System and its extensive research enterprise have produced innovations that transformed civilian medicine, from trauma care to infectious disease prevention. Together, HHS, the VA, and the DOD form a strong American innovation ecosystem — one that China and other competitors cannot easily replicate. Linking these institutions into a coordinated clinical research strategy would create a powerful engine for attracting scientific talent, investment, and advanced biomanufacturing while accelerating the next generation of medical breakthroughs.
In many ways, the VA could become the equivalent of the Defense Advanced Research Projects Agency (DARPA) for clinical research. Just as DARPA accelerated technologies that strengthened national defense, a modernized VA research enterprise could accelerate discoveries that improve health while strengthening America’s strategic position. By creating a continuously learning system that integrates AI, real-world evidence, and real-time regulatory review, the U.S. could build a scientific innovation engine that accelerates its advantages over time.
The 20th century’s technological competition centered on space. The next century may likely target biotechnology. In that race, victory will belong not merely to the nation that spends the most, but to the nation that adapts the fastest.
Biotechnology leadership should remain a bipartisan priority. Scientific leadership, economic competitiveness, and national security transcend political parties. Just as previous generations united to win the space race and build the digital economy, America must now mobilize government, academia, health care systems, and industry around a common goal: ensuring that the next generation of medical breakthroughs is discovered, developed, and delivered in the United States.
The race has already begun. America has every advantage to win it.
David Shulkin, M.D., was the ninth secretary of the U.S. Department of Veterans Affairs in the Trump administration and undersecretary for health in the Obama administration.
