Contributed Commentary by Avi Kulkarni, CEO, InoRx 

June 26, 2026 | India has long been called the pharmacy of the world. That reputation was earned through manufacturing scale, generics leadership, and the ability to supply medicines globally at extraordinary volume. But the next chapter for India’s pharmaceutical industry will be different. 

Recent industry discussion about India’s pharmaceutical ambitions has largely explored one question: Can India compete with China as a global pharmaceutical power? 

It is a critical — but incomplete — question. 

The better question is: How will India surpass China as a global pharma power? 

India vs. China 

The life sciences industry and media tend to compare India and China through the lens of drug discovery and innovation. China has made enormous investments in early-stage biotechnology research, novel therapeutics, advanced platforms, and innovation ecosystems. Those investments are beginning to produce meaningful outcomes, including globally relevant assets, licensing activity, and commercial success. 

India’s pharma sector is increasingly looking beyond generics, where it ranks 4th in terms of production, toward a larger role in global innovation. Sun Pharma’s proposed $11.75 billion acquisition of Organon is one signal of that ambition. 

However, for India to become a more central player in global drug development, it must move from global manufacturing strength to global R&D leadership. Clinical trials must become a strategic advantage and not simply in terms of a country where trials can be placed. India must offer sponsors reliable execution, high-quality data, ethical rigor, faster enrollment, and operating models that can support global regulatory expectations. 

This gets to one of the industry’s most significant pain points that India can help solve. 

Modern Pharma’s Bottleneck 

To understand where one of the largest bottlenecks in modern pharma actually exists, it is important to break the pharmaceutical value chain into its four interconnected domains:  

• Research and Innovation: The discovery and design of new molecules, mechanisms, and therapies.  
• Translational Science and Medicine: The process of converting scientific discovery into viable clinical applications. Often described as “bench to bedside,” this is the bridge between scientific innovation and human application. 
• Clinical Development: The process of developing therapies for real-world patient use. In other words, determining the right patient population, indication, dose, duration, safety profile, regulatory pathway, and evidence package required for approval.  
• Manufacturing and Commercialization: The operational infrastructure required to manufacture, distribute, and commercialize therapies at scale. 

Much of the recent focus on China’s capabilities centers on the first two domains, where the country excels. But the global bottleneck in the life sciences industry today increasingly occurs in clinical development. 

The challenge facing the pharmaceutical industry is not simply discovering more molecules. Scientific innovation is accelerating rapidly. AI, computational biology, precision medicine, and biotech funding have dramatically expanded the front end of the innovation engine. 

Across the industry, sponsors face mounting pressure from: 

• Rising clinical trial costs
• Longer development timelines
• Increasing protocol complexity
• Patient recruitment challenges
• Regulatory scrutiny
• Data quality expectations
• Operational fragmentation across global trials 

Meanwhile, the cost of bringing a drug to market continues to rise, while returns on R&D investment remain under pressure. Similarly, clinical trial timelines continue to lengthen across many therapeutic areas, particularly in oncology and rare disease studies, where protocol complexity and enrollment challenges have become major constraints on development productivity. 

It is clear that the global life sciences industry does not merely need more innovation; it needs a more effective development engine. 

The India Advantage 

This is where India has an extraordinary opportunity. 

India should not be framed only as a lower-cost alternative to China, the U.S., or Europe. That undersells what the market can become. Instead of replicating China’s innovation model to become globally indispensable in pharma, India is poised to lead by becoming the world’s most effective clinical development ecosystem. 

The country already possesses many of the structural advantages required: 

• Large and diverse patient populations: Almost 1.48 billion in 2026. 
• Treatment-naive patient populations: A large number of Indians have never received therapy, medication, or intervention for their diseases or conditions, making them ideal “clean-slate” candidates whose clinical trial data will be less confounded by prior drug-body interactions. 
• Significant disease burden across therapeutic areas: Including cardiovascular and metabolic, oncology, infectious, diabetes, respiratory, etc. 
• Deep physician expertise: The second-largest English-speaking scientific pool worldwide. 
• Expanding clinical infrastructure: More than 112,000 registered trials and growing. 
• Existing global pharmaceutical sector: Ranks 3rd worldwide by production volume,14th by value. 
• Growing regulatory maturity: The New Drugs and Clinical Trials Rules, 2019, streamlined India’s clinical research landscape. 
• Cost efficiency: Significantly lower personnel and operational expenses translate into up to 60% lower manufacturing costs than in many Western markets. 

Global integration across healthcare and life sciences: Government-led initiatives have created a strong foundation for the 1,800+ Global Capabilities Centers across India that offer strong English-language abilities, large numbers of STEM graduates, and hyper-specialization in life sciences, biologics, and information management, both during and after STEM baccalaureates and post-baccalaureates. 

Most importantly, India has the opportunity to combine scale with execution and become a high-quality, globally integrated clinical development partner. 

That distinction matters because the next generation of pharmaceutical leaders will not simply be organizations that discover promising molecules. They will be organizations capable of efficiently, reliably, and globally translating innovation into approved therapies. 

Meeting Sponsors’ Needs 

Biopharma sponsors need clinical trial partners that are built around quality systems, patient access, investigator engagement, data integrity, and operational accountability to help them: 

• Accelerate patient enrollment 
• Maintain high-quality data standards
• Execute complex global protocols
• Support adaptive and decentralized trial models
• Navigate regulatory requirements
• Reduce operational friction across studies 

These are development, not discovery, challenges. India can differentiate itself globally by addressing them, but only if speed and quality move in tandem.  

The question is no longer whether India has a role to play in global drug development. The question is whether India can build the clinical trial infrastructure, operating discipline, and sponsor confidence required to lead. 

China may continue to dominate portions of the discovery and innovation ecosystem, but India is poised to become the world’s most important development engine. 

And in the years ahead, that may prove even more valuable. 

As InoRx’s CEO, Dr. Avi Kulkarni leads the company’s mission to accelerate global clinical development through innovation, patient access, and operational excellence. He brings more than three decades of leadership experience across pharma, diagnostics, consulting, and clinical research. Before leading InoRx, he served as CEO of ThoughtSphere, an AI-powered clinical data and analytics company. Earlier in his career, he held senior executive roles at Syneos Health, Cognizant, IQVIA, KPMG, and Booz & Company, guiding large-scale R&D and clinical transformation programs. Dr. Kulkarni holds a doctorate degree and a master’s degree in pharmaceutics from Temple University, a master’s degree from Stanford University, and a bachelor’s degree in pharmacy from the University of Bombay. He can be reached at avi.kulkarni@inorx.com.