First-in-Class, or Fast Follower?

Every brief in this section describes a Chinese advance, so this one asks the sceptic’s question directly: is China genuinely innovating in medicine, or fast-following: taking known drug targets and developing them faster and cheaper than the West? The honest answer is that it is doing more of the former than critics allow, over a real history of the latter.

The innovation case is strong and getting stronger. China’s first-in-class pipeline, drugs pursuing genuinely new mechanisms, grew from about 9 clinical candidates in 2015 to some 120 by 2024, roughly a quarter of the world’s total and second only to the United States.^[1] By 2025, on some counts, 46% of all new drug molecules entering human trials originated in Chinese companies, and China led the world in whole modalities such as antibody-drug conjugates and cell therapies.^[1] The best examples are concrete: Akeso’s ivonescimab beat Merck’s Keytruda, the world’s best-selling drug, on progression-free survival in a head-to-head Chinese trial.^[4]

A new format on a known target is real engineering. Whether it is real invention is the argument the whole sector is having.

The sceptic’s file

The counter-case has substance too. Critics note that much of China’s “first-in-class” work is novel formats built on already-validated biology, ivonescimab’s PD-1×VEGF target was known, which is real engineering but contested as invention.^[1] And the quality history is genuinely troubling: a 2016 regulator-ordered self-inspection led companies to withdraw about 73% of the drug applications under review rather than face data audits, and as recently as 2025 a scandal over identical data in generic-drug filings prompted tighter oversight.^[2][3]

One number deserves precision, because it is so often mangled. The widely repeated claim that “80% of Chinese trial data were faked” was disputed by the regulator itself; the defensible, documented figure is the roughly 73% voluntary-withdrawal rate, damning enough without the exaggeration, and a baseline against which today’s improvement should be measured.^[2]

What we do with this

This is the frame for the entire sector. The bull case, a surging first-in-class pipeline, modality leadership, Western pharma paying up, and the bear case (novelty that is sometimes format-deep, and a real if improving data-quality history) are both true, and the discipline is to hold them together. The single most useful question to ask of any Chinese asset is whether its novelty is in the target or merely the format, and whether its data would survive a Western regulator’s audit. China is unmistakably moving from copying to creating; it has not fully arrived, and pretending it has, or that it never will, are equal and opposite errors.