All the CAR-T in China

In 18^th century China, tea was capital. China had it, and the world wanted it.

Controlling the cultivation, infrastructure and production of such a coveted commodity gave China preeminent global standing. Its monopoly on tea gave rise to the phrase ‘all the tea in China’ — shorthand for something vast, immensely valuable and difficult to rival. That dominance created structural leverage over global trade. Western powers, particularly the UK, grew dependent, tensions escalated, and the trade conflict ultimately sparked war.

Fortunately, in biotech, the ‘war’ is still metaphorical. As China’s biotech industry surges, U.S. policymakers have increasingly framed the dynamic between the U.S. and China as a competition to be won. It’s a convenient narrative. It’s also an oversimplification.

Geopolitics make messy storylines. As a journalist focused on science, it’s not a space I want to enter. But as U.S.-China relations deteriorate and political rhetoric hardens, biotech has been pulled into the conversation.

Opinions differ on who is ‘winning.’ But one point is clear: U.S. dominance is no longer uncontested.

Over the past decade, China has invested heavily in its biotech ecosystem, working with industry to build capacity across research, clinical development and manufacturing. By contrast, the U.S. shows signs of strain: Federal research funding has stagnated, early-stage biotechs face tighter capital conditions, and developers must navigate a regulatory system often seen as slow, fragmented and unpredictable.

This has driven a visible shift in cell and gene therapy. Clinical trial activity in China has surged, outpacing the U.S. Multinational pharma companies now have boots on the ground, actively licensing early-stage assets, while capital-constrained biotechs are turning to China for early development. The appeal is straightforward: faster timelines, lower costs and access to large, concentrated patient populations.

Currently, all eyes are on China’s investigator-initiated trials (IITs), which can offer a faster, more cost-effective path to first-in-human data than a traditional IND route. EsoBiotec, a Belgian biotech developing in vivo CAR-T therapies, said it accelerated its development timeline by almost 18 months by running an IIT in China. That kind of head start can be existential for a small company. It can also be decisive in attracting partners. AstraZeneca ultimately acquired EsoBiotec in a deal worth up to $1 billion. But the implications extend beyond dealmaking.

CGTs are notoriously difficult to bring to market. Development costs are estimated as high as $2.5 billion per therapy, and most programs never make it. Those that succeed must traverse a second valley of death: High prices and reimbursement challenges mean that even approved therapies can fail on the market. The result is constrained access — even in high-income countries, only about one-third of eligible patients receive CAR-T.

Through its IIT, EsoBiotec was able to report positive clinical data on an in vivo CAR-T therapy. In vivo approaches could transform CAR-T from a complex, weeks-long manufacturing process into a simpler, scalable treatment delivered directly in patients, potentially reducing costs, shortening timelines and expanding access.

If IITs in China are allowing innovative therapies to generate early clinical data, the question isn’t whether that benefits one country over another. It’s whether it helps close the gap between scientific potential and patient access. No single country will control CGT innovation outright. The field is inherently global, built on shared science, distributed infrastructure and cross-border collaboration.

The real risk is not that one country pulls ahead. It’s that friction — political, regulatory or economic — slows the system as a whole. Because in the end, the measure of success is not who leads the pipeline, it’s whether the therapies in it reach the people who need them. And that should be everyone’s cup of tea.