The 8th China International Import Expo (CIIE) opened in Shanghai on November 5 under the theme "New Opportunities for Open Innovation, Shared Future Through Cooperation." This year's event attracted participation from 155 countries, regions, and international organizations, with 4,108 overseas exhibitors covering a record exhibition area exceeding 430,000 square meters.

The Medical Equipment and Healthcare Products exhibition zone at CIIE remains a critical window into global medical advancements. As a premier platform for multinational pharmaceutical companies to showcase their innovations in China, this year's expo has become a focal point for product debuts, localized collaborations, and increased investment commitments—reflecting how MNCs leverage "China speed" to drive global growth.

Beyond CIIE, MNCs continue to advance their China strategies. On October 27, Astellas announced the establishment of its first China Innovation Center in Beijing's BioPark, complementing its global R&D network spanning Tokyo, San Francisco, Boston, Chicago, and Cambridge. This marks Astellas' first such center in China after 31 years in the market. "China has become a global hub for drug innovation and one of Astellas' most vital markets," said Zhao Ping, President of Astellas China.

This move exemplifies MNCs' strategic upgrades in China. In 2024 alone, AstraZeneca (AZN.US) and Boehringer Ingelheim unveiled new investment plans totaling $2.5 billion and over RMB 5 billion, respectively. Boehringer launched local production of its blockbuster diabetes drug Trajenta (linagliptin) in October, alongside a five-year RMB 5+ billion R&D commitment. Similarly, Eli Lilly China invested RMB 1.5 billion last October to upgrade its Suzhou plant for expanded production of diabetes and obesity treatments.

Concurrently, MNCs are accelerating acquisitions of innovative drug assets in China. Takeda (TAK.US), Pfizer (PFE.US), and others have set record-breaking business development (BD) deal values, signaling China's evolution from a consumer market to an innovation powerhouse integrated into global R&D, production, and commercialization chains.

**Localization Push** China's rising prominence is underscored by data: - 20% of Nature Index's top 100 life science institutions are now Chinese—a fivefold increase since 2015. - Nearly 2,000 clinical trials were initiated in China in 2024, quintuple 2015 levels. - 38% of globally first-approved novel drugs originated from China, a tenfold jump. China also contributes nearly 20% of global First-in-Class (FIC) pipelines and matches international peers in breakthrough ASCO abstracts.

Song Ruilin, Chief Expert of China Pharmaceutical Innovation and Promotion Association, noted that China's innovation capacity is reshaping global pharma history, with MNCs increasingly relying on Chinese pipelines. Former FDA Commissioner Scott Gottlieb revealed that over 50% of FDA-approved IND molecules in 2024 came from China.

In response, at least eight MNCs—including Eli Lilly, Pfizer, Bayer, AstraZeneca, and Medtronic (MDT.US)—announced new R&D centers in China this October. AstraZeneca activated its second Chinese strategic R&D hub as part of a $2.5 billion investment, while Medtronic launched its inaugural digital healthcare innovation base. "China is not only a key market but also an engine for global medtech innovation," said Medtronic CEO Geoff Martha.

**BD Boom: $100B+ Licensing Deals** China's innovative drug out-licensing surpassed $100 billion by October 2024, with H1 transactions hitting $60.8 billion—already exceeding 2023's full-year total of $57.1 billion. Over 70 outbound deals were signed in H1, with upfront payments nearing $3 billion and total potential values reaching $53.1 billion.

Landmark transactions include: - Pfizer's $1.25 billion upfront ($6B total) deal for 3SBio's (01530.HK) PD-1/VEGF bispecific antibody SSGJ-707 ex-China rights. - Takeda's $1.2 billion upfront ($11.4B potential) collaboration with Innovent Biologics (01801.HK) on three cancer therapies, featuring a novel Co-Co (co-development/co-commercialization) model for PD-1/IL-2α-bias drug IBI363.

Other active players include Novo Nordisk (NVO.US), Merck (MRK.US), and Roche (RHHBY.US), targeting therapies across oncology, immunology, and metabolic diseases.

Industry experts predict sustained BD momentum. A Morgan Stanley report estimates $115 billion in revenue gaps from patent cliffs by 2035, driving MNCs to seek cost-efficient Chinese pipelines. UBS China Healthcare Analyst Chen Chen noted that China accounts for one-third of global drug candidates, offering abundant and affordable options as MNCs face 2026-2028 patent expirations.

Song Ruilin added that China's innovation impact is already visible in depressed Nasdaq biotech valuations, projecting Chinese-origin drugs to comprise 35% of FDA approvals by 2040.

Through CIIE and beyond, multinational pharma is doubling down on China's dual role as both a strategic market and innovation source—a shift that promises to redefine global healthcare dynamics.