This study analyzed pharmaceutical trade data classified under Harmonized System (HS) Code 30 (pharmaceutical products), as defined by the World Customs Organization (World Customs Organization, 2022), covering the period from 2012 to 2023. Data were retrieved from the United Nations Comtrade database (United Nations, 2025) via the ComtradePlus portal (https://comtradeplus.un.org/TradeFlow), where trade values are reported in current U.S. dollars (USD). Extraction parameters included “HS (as reported) Commodity Codes” set to “30”; “Periods” set to 2012–2023; “Reporters” as each BRICS10 country (Brazil, China, India, Russian Federation, South Africa, Egypt, Ethiopia, Indonesia, Iran, United Arab Emirates); “Partners” set to “All”; and “Trade Flow” including both “Export” and “Import”. The dataset is presented in Supplementary Table 1.

Iran (2012, 2023) and Russia (2022, 2023) did not report HS Code 30 trade data to Comtrade because of geopolitical sanctions and reporting limitations. For the missing years, partner-reported data were extracted, reclassified (imports as exports and vice versa), and compiled into Supplementary Table 2, which served as a source for completing both the reporter–partner and global trade panels.

To analyze global trends, global trade aggregates were constructed by setting “All” as Reporters and “World” as the Partner (Supplementary Table 3). The data on world exports to each BRICS10 country from 2012 to 2023 were retrieved by setting Reporters to “All,” Partners to BRICS10 members, HS (as reported) Commodity Codes to 30, and Trade Flows to Export, aggregated by reporting country (Supplementary Table 4). World exports to the BRICS10 group as a whole were derived by summing the annual exports to all the ten BRICS10 countries.

All data used in this study, including those in Supplementary Tables 1, 3, and 4, were extracted from ComtradePlus on 24 June 2025. Partner-reported data for Iran and Russia in non-reporting years were downloaded on the same date, reclassified, and compiled into Supplementary Table .

All data processing and analysis were conducted using R version 4.5.1 within RStudio 2025.5.1.513. R and RStudio were selected for their robust data wrangling and visualization capabilities.

All visualizations were produced using the ggplot2 package version 3.5.1 in R to ensure consistent design and labeling across figures.

Between 2012 and 2023, the trajectories of BRICS10 countries’ pharmaceutical imports diverged significantly (Fig. 1). As shown in Fig. 1A, China’s imports rose steadily from $12.99 billion to $43.08 billion, with faster growth after 2016, peaking in 2023 at $43.08 billion. Russia’s imports peaked in 2013 at $14.55 billion, dropped in 2015 to $8.69 billion, rebounded in 2021 to $13.78 billion and ended in 2023 at $11.93 billion. Brazil’s imports remained flat until 2020, then jumped to $11.38 billion in 2021, dipped slightly in 2022 and closed at $11.24 billion in 2023. UAE’s imports increased gradually to a 2021 high of $6.57 billion, ending at $6.17 billion in 2023.

Figure 1. 

Pharmaceutical Products Import Value by BRICS10 Countries (2012–2023). Panel A displays total annual import values for all BRICS10 members, highlighting China’s dominant trajectory. Panel B zooms in on smaller importers—including most Newcomers and selected BRICS5 countries—to allow comparative visualization.

As shown in Fig. 1B, India experienced fluctuations, reaching a high of $3.30 billion in 2021 and dropping to $2.60 billion in 2023. South Africa’s imports decreased to 2016 levels, then increased to $2.48 billion in 2018, reached a peak of $3.06 billion in 2021, and decreased again to $2.41 billion in 2023. Egypt rose strongly to $4.04 billion in 2021 before decreasing to $3.62 billion in 2023. Ethiopia showed an upward trend, peaking at $0.81 billion in 2021 but then fell to $0.68 billion in 2023. In Iran, a sharp decrease was observed, from $1.93 billion in 2021 to $0.83 billion in 2023. Indonesia saw a surge to $4.36 billion in 2021 before dropping to $1.28 billion in 2023.

To provide a normalized comparison of long-term import dynamics, Table 1 summarizes the CAGR of pharmaceutical imports for each BRICS10 country across selected sub-periods and the full 2012–2023 range.

Collectively, these patterns highlight the diverse policy responses, underlying economic inequalities, and pandemic-related disruptions that have shaped BRICS10’s pharmaceutical import dynamics over the past decade. The diversity of trajectories further emphasizes the need for customized policy instruments and coordinated regional frameworks to ensure the resilience of pharmaceutical trade and continuity of supply.

Between 2012 and 2023, exports of pharmaceutical products across the BRICS10 countries exhibited distinct trends, as shown in Fig. 2.

Figure 2. 

Pharmaceutical Products Export Value by BRICS10 Countries (2012–2023). Panel A displays China and India’s dominant trends. Panel B magnifies smaller exporters. Across countries, export trajectories varied widely, shaped by vaccine surges and manufacturing capacity.

Fig. 2A shows that China’s pharmaceutical product exports surged from $5.89 billion in 2012 to a peak of $38.55 billion in 2021, before sharply declining to $11.28 billion in 2023. India’s pharmaceutical exports grew steadily from $9.60 billion in 2012 to $21.30 billion in 2023, despite minor fluctuations in some of the years.

As illustrated in Fig. 2B, Brazil’s exports peaked at $1.57 billion in 2014, declined to $1.08 billion in 2020, rebounded to $1.43 billion in 2022, and slightly dropped to $1.24 billion in 2023. Russia peaked at $2.52 billion in 2021 before a sharp decline to $0.66 billion in 2023. South Africa’s exports remained stable before peaking at $0.75 billion in 2021 and declining to $0.45 billion in 2023.

Among the Newcomers, as can be seen from Fig. 2B, the UAE’s exports experienced rapid growth, peaking at $2.33 billion in 2021 before declining to $1.87 billion in 2023. Egypt’s exports exhibited slow but steady growth from 2015, reaching $0.35 billion in 2023. Ethiopia and Iran had minimal fluctuations, with Iran peaking at $0.19 billion in 2017. Indonesia showed slow growth, reaching $0.66 billion in 2023. These trends reflect varying economic and market dynamics in BRICS10.

To complement these trajectory-based insights, Table 2 presents the CAGR (Compound Annual Growth Rate) of pharmaceutical exports for each of the BRICS10 countries over multiple time periods, including the entire 2012–2023 timeframe.

Overall, the BRICS10 countries exhibited highly heterogeneous export dynamics. India sustained a consistent upward trajectory, while others, such as China, Russia, the UAE, and South Africa, experienced vaccine-driven surges followed by postpandemic contractions. These fluctuations reflected shifting global demand, supply chain disruptions, and uneven manufacturing capacities.

Pharmaceutical trade balance trends across BRICS10 between 2012 and 2023 reveal marked disparities between exports and imports (Fig. 3).

Figure 3. 

Pharmaceutical Products Trade Balance by BRICS Countries (2012–2023).

India consistently posted a substantial trade surplus ranging from $7.85 billion to $18.7 billion, reflecting its dominant position in generic and robust pharmaceutical manufacturing capacities. In contrast, China had persistent deficits, although the gap narrowed to $3.32 billion in 2021 amid a surge in vaccine exports during the COVID-19 pandemic. However, it widened again to $31.79 billion in 2023 because of rising domestic demand.

Russia has maintained a stable trade deficit of around $11 billion, indicating limited success in its efforts to reduce import dependence, despite policy interventions. Brazil showed a sustained deficit between $5.30 billion and $10.28 billion, driven by its reliance on imported medicines.

Among the Newcomers, the UAE recorded a widening deficit, peaking at $4.30 billion in 2023, in line with its high-income and import-oriented profile and regional distribution role. The deficit in Egypt ranged from $1.37 billion to $3.71 billion, with a peak in 2021, highlighting structural reliance on imports.

South Africa had a relatively modest deficit, ranging from $1.48 billion in 2016 to $2.31 billion in 2021. Iran showed a moderately balanced profile, with the deficit improving from $1.83 billion in 2022 to $0.75 billion in 2023, which probably reflected both domestic substitution policies and volatility in mirror trade data.

Ethiopia reported smaller but persistent deficits between $0.38 billion and $0.81 billion, with 2021 as the peak year. Indonesia’s deficit rose sharply to $3.80 billion in 2021 owing to pandemic-induced demand, before dropping to $0.62 billion in 2023, thus returning to pre-pandemic levels.

Fig. 4 visualizes annual bilateral TII (Trade Intensity Index) trajectories for each of the BRICS10 countries’ pharmaceutical exports to their nine intra-bloc partners from 2012–2023, revealing pronounced asymmetries in the plots: Indonesia consistently recorded elevated TII values toward India (TII > 15 in multiple years) and the UAE maintained strong TII levels with Iran and Egypt, especially in earlier years. In contrast, countries such as South Africa and Russia mostly had weak bilateral trade relations, with only occasional spikes.

Figure 4. 

Dyadic TII for Pharmaceutical Exports: BRICS10 (2012–2023).

Fig. 5 highlights the small subset of exporter–partner–year dyads with very high TII scores (TII ≥ 15). As summarized in Table 3, only 33 out of the 1 080 dyads (3.1%) fall into this category, which primarily involves Indonesia → India, UAE → Iran, and UAE → Ethiopia. Another 109 dyads (10.1%) were classified as high (5 ≤ TII < 15); 242 (22.4%) showed medium intensity (1 ≤ TII < 5); 177 and 519 (totaling 64.4%) with low values (TII = 0 and 0 < TII < 1, respectively) indicated under-trading or no recorded exports. This distribution indicates that there is very little significant pharmaceutical trade within BRICS and highlights the prevalence of weak or non-existent trade ties among the member countries.

Figure 5. 

Top Bilateral TII Relationships for Pharmaceutical Products Among BRICS10 (2012–2023).

Fig. 6 shows the trajectories of the TII of pharmaceutical exports of individual BRICS10 countries to the bloc from 2012 to 2023. The figure reveals significant crosscountry differences in the export patterns of these countries. Russia, South Africa, and Egypt remained persistently marginal exporters, with TII values consistently below 1.0, except for Russia’s temporary spike in 2021 that can be attributed to COVID-19 vaccine shipments. Ethiopia also exhibited weak export engagement, briefly surpassing a TII of 1.0 only in 2019 because of its exports to India.

Figure 6. 

TII of BRICS10 Countries’ Pharmaceutical Products Exports to BRICS10 Bloc (2012–2023).

Brazil demonstrated a gradual upward trend, reaching a peak TII of 2.24 in 2022 before declining below 1.0 in 2023. China maintained relatively stable TII values, hovering slightly above 1.0 throughout most of the period, with a notable increase to 1.67 in 2021, possibly linked to pandemic-related vaccine exports.

The UAE recorded the highest annual TII towards the bloc (2.71 in 2014), but this figure steadily declined over time, reaching 0.49 by 2023. India’s TII also followed a downward trend, declining from a high of 1.60 in 2013 to nearly parity (1.01) by 2023.

Iran’s TII increased intermittently, notably in 2012, 2014, and 2019, primarily thanks to consistent exports to Russia. Despite a downward trend in recent years, Indonesia maintained one of the highest levels of TII within the bloc. This reflects sustained export flows from Indonesia to India.

Fig. 7 shows the trajectories of TII exports from the BRICS group to individual member states in 2012–2023. It reveals significant variation in the level of engagement on the importer side across countries.

Figure 7. 

TII of BRICS10 Pharmaceutical Products Exports to Individual Member States (2012–2023).

Ethiopia consistently recorded the highest import-side TII (ranging from 5.43 to 10.52) values, indicating a structural dependency on pharmaceutical imports from other BRICS members, with only a temporary decline in 2021. South Africa also showed sustained and elevated TIIs, maintaining levels of around 5.0 throughout most of the period, peaking at 6.61 in 2019.

India’s TII peaked at 4.29 in 2014, but fell to 2.80 by 2021, probably because of the pandemic-induced disruptions to domestic pharmaceutical production and logistics, and then rebounded to 3.76 in 2023. Indonesia demonstrated a clear upward trajectory, with TII increasing from 1.88 in 2012 to 3.76 in 2023 and a notable spike to 7.13 in 2021, also driven by vaccine imports during the COVID-19 pandemic.

Iran’s TII remained moderate overall, gradually increasing after 2015 and reaching 3.09 in 2020 before declining to 1.80 in 2021 amid pandemic-related constraints. The UAE moved from consistent under-trading (TII < 1.0) before 2018 to sustained over-trading in subsequent years, reaching 4.27 in 2021 and settling at 1.80 by 2023.

Brazil’s TII rose from 0.93 in 2013 to a peak of 2.07 in 2020, before moderating to 1.75 in 2023. Egypt remained close to trade parity throughout the period (TII ≈ 0.93–1.51), with a temporary increase to 2.17 in 2021. Russia exhibited relatively low TII values, ranging between 0.79 and 1.19. China recorded the lowest import-side TII values within the bloc, consistently between 0.042 and 0.23, suggesting minimal pharmaceutical import dependence on its BRICS10 partners throughout the entire period.

Taken together, Fig. 4–7 reveal an asymmetrical pattern of intra-BRICS pharmaceutical trade. Only some of the trade relations, such as those between Indonesia and India, the UAE and Iran, and the BRICS suppliers and Ethiopia, have consistently high TII values registered. In contrast, the vast majority of dyads demonstrated weak or negligible trade intensity. This uneven configuration underscores the limited degree of regional trade integration, with a few relatively active corridors standing out against a backdrop of generally underdeveloped and fragmented intra-bloc pharmaceutical trade.

Between 2012 and 2023, Global Import rose from $455.24 billion to $860.10 billion, with a notable spike in 2021 amid the COVID-19 pandemic and persistently high levels through 2023 (Fig. 8A). BRICS10 Global Import showed moderate growth until 2020, surged to $91.09 billion in 2021, then declined to $83.85 billion in 2023 (Fig. 8B). By contrast, the BRICS5 share in BRICS10 global import fell to 80.6% in 2021, but then rose again, and in 2023 reached over 85% (Fig. 8A).

Figure 8. 

Global and BRICS Pharmaceutical Products Import (2012–2023). Panel A presents global pharmaceutical import values and situates the contributions and global shares of BRICS10, BRICS5, and Newcomers, as well as the internal composition of BRICS10 in terms of BRICS5 and Newcomers. Panel B magnifies the low-value portion of Panel A, allowing clearer comparison of subgroup import volumes and their shares in both global and intra-BRICS10 totals.

The Newcomers’ Global Import remained modest, rising from $6.35 billion in 2012 to $17.71 billion in 2021, before falling to $12.58 billion in 2023 (Fig. 8B). The BRICS10’s share in Global Import ranged between 9.3% in 2016 and 11.0% in 2021, declining to 9.7% in 2023; the BRICS5’s share peaked at 9.4% in 2019 and dropped to 8.3% in 2023; Newcomers’ share peaked at 2.1% in 2020 and dropped to 1.5% in 2023 (Fig. 8B).

The BRICS10 Intra-Import peaked at $10.22 billion in 2021, then dropped to $3.81 billion in 2023. BRICS5 Intra-Import showed a similar trend, falling from $4.30 billion to $2.67 billion over the same period (Fig. 9A). BRICS5-from-Newcomers Import fluctuated, with a low of $0.083 billion in 2020 and a peak of $0.16 billion in 2015 (Fig. 9B). Newcomers-from-BRICS5 Import rose from $0.33 billion in 2012 to a peak of $5.52 billion in 2021, then declined to $0.97 billion in 2023 (Fig. 9A). Newcomers Intra-Import were volatile, peaking at $0.33 billion in 2013 and falling to $0.064 billion in 2023 (Fig. 9B).

Figure 9. 

Intra-BRICS Pharmaceutical Products Import (2012–2023). Panel A shows intra-group imports among BRICS10 countries, highlighting the contributions of BRICS5 and Newcomers, along with Newcomers’ imports from BRICS5. It also indicates each subgroup’s share in total BRICS10 intra-import. Trade peaked in 2021, driven by a surge in Newcomers’ imports from BRICS5. Panel B magnifies the low-value portion of Panel A to show Newcomers-related flows in greater detail. Newcomers Intra-Import was volatile and declined after 2021, while BRICS5-from-Newcomers Import remained minor throughout.

The share of BRICS10 Intra-Import in BRICS10 Global Import fluctuated between 4.9% and 6.2% before the pandemic, surged to 11.2% in 2021, and declined to 4.5% by 2023 (Fig. 10). The BRICS5 Intra-Import share in BRICS5 Global Import dropped from 4.7% in 2012 to 3.7% in 2023. The Newcomers Intra-Import share in Newcomers Global Import declined steadily, reaching a record low of 0.51% in 2023. The share of BRICS5-from-Newcomers Import in BRICS5 Global Import decreased from 0.30% in 2012 to 0.16% in 2023 (low: 0.14% in 2020; high: 0.42% in 2015). In contrast, NewcomersfromBRICS5 Import in Newcomers Global Import rose from 5.1% in 2012 to 7.7% in 2023, peaking at 31.1% in 2021, most probably reflecting pandemic-related supply distortions (Fig. 10).

Figure 10. 

Intra-BRICS Pharmaceutical Products Import Share in Related Global Imports (2012–2023).

From 2012 to 2023, the CAGR for global imports was 5.95%. BRICS10 and BRICS5 recorded similar rates at 6.07% and 6.01%, respectively, while Newcomers grew faster at 6.42% (Table 4).

Global Export grew from $438.30 billion to $813.52 billion, with a notable surge during the COVID-19 pandemic in 2020–2021 (Fig. 11A). BRICS10 Global Export rose from $19.55 billion to $37.90 billion, peaking at $65.70 billion in 2021 (Fig. 11B). BRICS5 Global Export followed a similar path, rising from $18.06 billion to $34.93 billion, with a peak of $62.38 billion in 2021, consistently accounting for 91.9%–95.0% of BRICS10 Global Export (Fig. 11A). In contrast, Newcomers Global Export remained marginal, increasing from $1.50 billion in 2012 to $3.32 billion in 2021, and settling at $2.98 billion in 2023, representing just 0.24%–0.41% of Global Export (Fig. 11B).

Figure 11. 

Global and BRICS Pharmaceutical Products Export (2012–2023). Panel A presents global pharmaceutical export values and situates the contributions and global shares of BRICS10, BRICS5, and Newcomers, as well as the internal composition of BRICS10 in terms of BRICS5 and Newcomers. Panel B magnifies the low-value portion of Panel A, allowing clearer comparison of subgroup export volumes and their shares in global totals.

BRICS10 Intra-Export rose from $1.99 billion in 2012 to $8.98 billion in 2021 before falling to $3.49 billion in 2023 (Fig. 12A). BRICS5 Intra-Export followed this trend, increasing from $1.46 billion to $3.89 billion in 2021 and declining to $2.47 billion in 2023. Its share in BRICS10 Intra-Export declined from 73.4% in 2012 to 70.9% in 2023, hitting a low of 43.3% in 2021 (Fig. 12A). BRICS5-to-Newcomers Export rose from $0.34 billion in 2012 to $4.74 billion in 2021 (52.8% of BRICS10 Intra-Export), before dropping to $0.84 billion in 2023 (Fig. 12A). Newcomers Intra-Export remained negligible, ending at $0.082 billion in 2023 (Fig. 12B), while Newcomers-to-BRICS5 Export fluctuated narrowly, from a low of $0.069 billion in 2020 to a high of $0.12 billion in 2014, and reached $0.096 billion in 2023.

Figure 12. 

Intra-BRICS Pharmaceutical Products Export (2012–2023). Panel A shows intra-group exports among BRICS10 countries, highlighting the contributions of BRICS5 and Newcomers, along with BRICS5’s exports to Newcomers. It also indicates each subgroup’s share in total BRICS10 intraexports. Intra-BRICS export peaked in 2021, driven by a surge in BRICS5-to-Newcomers flows. Panel B magnifies the low-value portion of Panel A, allowing clearer comparison of Newcomersrelated flows, including Newcomers Intra-Export and exports to BRICS5, as well as their respective shares in BRICS10 Intra-Export.

The share of BRICS10 Intra-Export in BRICS10 Global Export fluctuated between 9.1% in 2016 and 13.7% in 2021, ending at 9.2% in 2023, near the 2012 level of 10.2% (Fig. 13). BRICS5 Intra-Export share in BRICS5 Global Export declined from 8.1% in 2012 to 6.2% in 2021, with a slight rebound to 7.1% in 2023. Newcomers Intra-Export share in Newcomers Global Export dropped more sharply—from 6.4% in 2012 to 2.8% in 2023—despite a temporary peak of 7.1% in 2021. BRICS5-to-Newcomers Export share in BRICS5 Global Export rose from 1.9% to 2.4%, peaking at 7.6% in 2021. Conversely, Newcomers-to-BRICS5 Export share in Newcomers Global Export declined from 6.5% in 2012 to 3.2% in 2023 (low: 2.7% in 2020; high: 9.5% in 2013) (Fig. 13).

Figure 13. 

Intra-BRICS Pharmaceutical Products Export Share in Related Global Exports (2012–2023).

Between 2012 and 2023, the compound annual growth rate (CAGR) of Global Exports was 5.78%. The BRICS10, BRICS5, and Newcomers recorded slightly higher growth of 6.20%, 6.18%, and 6.46%, respectively (see Table 5). Yet, the share of BRICS10 in Global Export remained limited, ranging from 4.5% to 8.2% with only 4.7% in 2023 (Fig. 11B). Notably, the BRICS10 countries’ Intra-Export accounted for only 0.43% of Global Export in 2023 (4.7% for the BRICS10’s share of global pharmaceutical exports × 9.2% share of Intra-Export in the BRICS10 Global Export).

This study presents the first longitudinal, countrylevel assessment of pharmaceutical trade among the enlarged BRICS10 group. By integrating CAGR trajectories, tradebalance dynamics, and the TII measures over 2012–2023, we show that the group’s collective footprint in global pharmaceutical commerce remains modest and intraBRICS trade is highly asymmetric. Since the first BRICS health ministers’ meeting in 2011, subsequent cooperation frameworks have not produced measurable deepening in intra-bloc pharmaceutical integration. Prior descriptive snapshots of the BRICS5 provided by Kostin (2019), covering 2001–2018 and predating most healthtrade cooperation initiatives in the BRICS, report long-run market growth but remain at an aggregate level. They do not disaggregate bilateral flows or use integration metrics such as TII. Our study therefore moves beyond descriptive aggregation to a dyadlevel, indicatordriven assessment. We extend the evidence base by tracking 1 080 exporter–partner–year observations (2012–2023) and by distinguishing endogenous national growth from bloclevel interaction, thereby clarifying whether observed changes stem from cooperation or from countryspecific factors (Joseph & Kumar, 2022).

Import and export trajectories across BRICS10 reveal marked heterogeneity that mirrors divergent industrial capacities and policy frameworks. China’s sustained growth in imports after 2016 was aligned with a number of pro-importer reforms, including the 2015 revision of the State Council’s drug and medical device approval process that cleared backlogs and introduced priority pathways (State Council of the People’s Republic of China, 2015); the 2016 Guidance on the healthy development of the pharmaceutical industry that endorsed “innovation-driven, open collaboration” (General Office of the State Council of the People’s Republic of China, 2016); and the decision in 2018 to eliminate tariffs on 28 imported medicines (Customs Tariff Commission of the State Council of the People’s Republic of China, 2018). Together, these measures reduced regulatory and financial barriers and accelerated the entry of foreign therapies. In contrast, India continued to maintain a significant surplus, which is in line with global value chain research, positioning the country as a key supplier of generic medicines (Löfgren, 2017). Upper-middle-income members, such as Brazil and Russia, failed to reverse their chronic trade deficits. This underscores structural gaps in their formulation capacity, despite periodic localization initiatives. Among the Newcomers, Egypt and Indonesia experienced pandemicera import spikes followed by retrenchment, reflecting temporary surges in vaccine and therapeutic demand that subsided once acute COVID19 pressures eased, whereas Ethiopia’s lowvolume but steady trajectory reflects limited absorptive capacity rather than integration gains. Taken together, these patterns suggest that country-specific industrial capabilities, demand shocks related to pandemics and policy environments, such as the UAE’s pro-trade logistics incentives and Iran’s sanctions-constrained import regimes, shape pharmaceutical trade patterns, rather than BRICS membership alone.

Export performance is equally uneven. India’s incremental export growth has been boosted by continued access to heavily regulated markets and a growing finished-dosage pipeline. China’s exceptional vaccinedriven surge in 2021 proved temporary, highlighting the episodic nature of its export engagement with the BRICS partners. Most other members, including South Africa and the majority of Newcomers, remained peripheral exporters. During the 2012–2023 period, the BRICS10 countries maintained modest shares in global pharmaceutical trade. Exports consistently trailed imports (Figs 8B and 11B). These muted figures underline how internal asymmetries continue to limit the group’s collective strength.

As shown in Table 3, TII trajectories confirm that intra‐BRICS10 pharmaceutical exchange is selective rather than systemic. Only a small fraction of export–partner–year dyads reached a high intensity (TII ≥ 5), with the majority showing weak or non-existent trade engagement. This skewed profile reinforces the view that genuine regional integration is limited to a few bilateral corridors, rather than being broadly embedded across the group.

The import‐side perspective further supports this view. Ethiopia and South Africa were the only members that consistently registered high bloc‐wide import TIIs, signaling structural reliance on BRICS suppliers. In contrast, China and Russia showed persistently low values of importer-side TII — China’s remained below 0.23 in all years observed — highlighting their marginal role as pharmaceutical importers within the group. This discrepancy may reflect a combination of factors, including domestic production dominance, preferential sourcing from their non-BRICS partners, such as the EU, the US, and Japan, or regulatory divergence which limits integration with other BRICS countries.

These patterns underscore the asymmetric and selective nature of intra-BRICS trade engagement (Fig. 7). The pandemic temporarily boosted trade shares within the bloc, with BRICS10 Intra-Import and Intra-Export shares peaking in 2021, before falling back towards pre-pandemic levels in 2022 (Figs 10 and 13).

Two robustness checks buttress confidence in the empirical patterns. First, inflation-adjusted series displayed the same directional trends as the nominal values (Appendix 1, Supplementary Fig. A1). Because indicators such as the TII and intra-bloc shares are ratios of values expressed in the same currency, their qualitative trajectories are theoretically not affected by general price level shifts over the time period under study. Second, sensitivity analyses using mirror statistics show that they reliably capture the turning points when applied to entire time series. However, they can distort the CAGR estimate when confined to the end points, for example, the missing data for Iran in 2012 and 2023 (Appendix 2 and Supplementary Fig. A2). Accordingly, the Results section reports full series mirror-based CAGRs and shorter span CAGRs only for Russia (2012–2021) and Iran (2013–2022), demonstrating how long-run growth rates can vary depending on the underlying data source.

Nonetheless, there are three limitations. Mirror data typically capture directional trade patterns during fully reported periods but may underrepresent informal or evasion transactions, especially in sanctioned years such as the post-2014 period in Russia, thereby potentially biasing reported export values downwards. Besides, HS Code 30 focuses on finished pharmaceutical products, but excludes medical devices and many upstream intermediates or bulk APIs. While this aligns with our scope of “pharmaceutical products”, it also means that upstream supplychain dynamics lie outside the present analysis. Finally, researchers concerned about welfare or price level effects should interpret nominal growth with caution, especially during the period of high inflation from 2021 to 2023.

Shortterm progress hinges on data transparency and regulatory convergence. Establishing a group-wide pharmaceutical trade data dashboard, coupled with mutual recognition of Good Manufacturing Practice (GMP) inspections and harmonised dossier formats, would reduce compliance duplication and increase supplychain visibility.

Over a mediumterm horizon, a pooledprocurement mechanism modeled on the Pan American Health Organization’s Strategic Fund (Pan American Health Organization, n.d.) could aggregate demand, stabilize prices, and incentivise intrabloc sourcing, with particular benefits for Newcomers that currently have limited bargaining power. Parallel investment in crossborder logistics corridors and shared qualitycontrol laboratories would lower transaction costs and shorten delivery lead times.

Long-term strategies should use the New Development Bank to fund greenfield plant development, advanced biologic manufacturing clusters, and bloc-wide digital regulatory infrastructures in low-capacity member states. Joint R&D initiatives focusing on complex generics, biosimilar drugs, vaccines, innovative therapies, alongside establishment of shared clinical trial and pharmacovigilance networks, would further strengthen scientific collaboration. Together, these measures could transform episodic collaboration into an institutionalized, innovation-driven healthsecurity architecture.

Moving forward, at least four areas deserve attention. First, the pronounced growth in imports among the Newcomers, despite their modest export bases, suggests a latent capacity that can be unlocked through targeted investment in formulation plants and regulatory systems. Comparative research on regional regulatory harmonization, such as the ASEAN Pharmaceutical Regulatory Framework (Association of Southeast Asian Nations, 2023) or the African Medicines Regulatory Harmonization initiative (African Union Development Agency–NEPAD, n.d.), may offer practical design lessons. Second, the observed discrepancy between trade intensity scores and actual volumes (for example, between India and Ethiopia)—as analyzed through our combined Trade Intensity Index (TII) and volume-based quadrant framework—demonstrates the usefulness of such multidimensional approaches. Future research could build on this basis by applying panel gravity models that incorporate BRICS membership, timevarying policy, or sanctions dummies, where longitudinal data are available. Third, reliance on mirror statistics for sanctioned members highlights a transparency gap. A BRICS Pharmaceutical Trade Observatory could provide nearrealtime dashboards and earlywarning tools for supply disruptions, while building the governance and technical capacity needed to curate and maintain firmlevel customs microdata once stakeholders agree to share them. Finally, the post-COVID retreat of intra-BRICS trade has encouraged research into joint contingency procurement schemes, pre-approved cross-border logistics corridors, and regional pharmacovigilance networks. These topics are best explored through a combination of methods that include econometric evidence and the process tracing of initiatives such as the 2024 Memorandum on medical product regulation.

To evaluate the impact of inflation on BRICS10 pharmaceutical trade trends, both nominal and real values of total imports and exports were analyzed for the period 2012–2023. Nominal trade values—representing total pharmaceutical imports and exports by BRICS10 countries—were extracted from the United Nations Comtrade database via the ComtradePlus portal (https://comtradeplus.un.org/TradeFlow) on 24 June 2025. Extraction parameters were as follows: “HS (as reported) Commodity Codes” set to “30”; “Periods” set to 2012–2023; “Reporters” as each BRICS10 country (Brazil, China, India, Russian Federation, South Africa, Egypt, Ethiopia, Indonesia, Iran, United Arab Emirates); “Partners” set to “All” and “Trade Flow” including both “Export” and “Import” (Supplementary Table ).

To ensure completeness, missing data for Iran (2012, 2023) and Russia (2022, 2023)—which did not report trade statistics to Comtrade—were imputed using partner-reported mirror statistics. These mirror data were reclassified (imports as exports and vice versa) and incorporated into the nominal trade vectors (Supplementary Table ). Aggregated annual import and export values across all BRICS10 countries, using this filled dataset, constitute the nominal values analyzed in this supplementary material.

Real values were derived by deflating nominal values using the US GDP deflator (World Bank indicator: NY.GDP.DEFL.ZS), with 2015 set as the base year (index = 100). The deflator index values used for conversion (95.75 for 2012; 97.38 for 2013; 99.08 for 2014; 100.00 for 2015; 100.95 for 2016; 102.76 for 2017; 105.11 for 2018; 106.85 for 2019; 108.27 for 2020; 113.21 for 2021; 121.28 for 2022; and 125.65 for 2023) were downloaded from the World Bank Open Data platform on 6 June 2025, as shown in Supplementary Table .

Real values were calculated using the formula: Real USD = (Nominal USD / Deflator Index) × 100. These values were plotted to visually compare inflation-adjusted (real) versus nominal trends for both imports and exports.

Between 2012 and 2023, both nominal and real pharmaceutical trade values for the BRICS10 bloc showed an upward trend, though nominal values increased more sharply (Fig. A1). The divergence between nominal and real values became especially pronounced after 2021, reflecting a period of accelerated global inflation.

Figure A1. 

BRICS10 Pharmaceutical Products Trade Trends: Nominal vs Real Values (2012–2023). Nominal and inflation-adjusted (real) import and export values for BRICS10 are shown from 2012 to 2023, using constant 2015 USD (US GDP deflator). Solid lines represent nominal values; dashed lines show real values (red for import, blue for export). Nominal trade values spiked after 2020, especially in 2021, but real values indicate a lower trajectory—revealing inflation’s impact on absolute scale but not structural trends.

Nominal import values rose from approximately $43.8 billion in 2012 to $83.8 billion in 2023, while the inflation-adjusted import value for 2023 was only $66.7 billion. Similarly, nominal export values increased from about $19.6 billion in 2012 to $37.9 billion in 2023, whereas the real export value for 2023 stood at roughly $30.2 billion.

These findings confirm that inflation in recent years has significantly inflated the absolute scale of pharmaceutical trade values, without distorting the underlying dynamics. The overall trends observed from 2012 to 2023—such as the timing and direction of shifts—remain consistent across both nominal and real terms.

To assess the reliability and potential biases of mirror statistics, we empirically compared Iran’s and Russia’s official pharmaceutical trade data from 2013 to 2021 with corresponding mirror-based estimates. Mirror statistics refer to trade flows reported by partner countries; for example, a partner country’s exports to Iran are interpreted as Iran’s imports, while imports from Russia by other countries are used as proxies for Russia’s exports.

Official trade data for Iran and Russia from 2013 to 2021 were retrieved from the United Nations Comtrade database using the same methodology described in the main text (HS Code 30; Reporters set to Iran and the Russian Federation, Partners set to All; Trade Flow including both Export and Import), and are included in Supplementary Table . Corresponding mirror data for these same years were constructed by identifying relevant trading partners and reclassifying their reported flows (imports as exports and vice versa). These mirror-based values are compiled in Supplementary Table 6.

All datasets used in this analysis—including both official and partner-reported flows—were downloaded from the ComtradePlus portal on 24 June 2025. The years 2013 to 2021 were selected because both countries submitted complete records, enabling a direct comparison between officially reported and mirror-estimated trade values. Insights from this comparison informed the broader methodology used to impute missing values for Iran (2012, 2023) and Russia (2022, 2023) in the main analysis.

Fig. A2 presents a comparison of official and mirror pharmaceutical trade data for Iran and Russia between 2013 and 2021. Four trade flows are shown: Iran’s exports, Iran’s imports, Russia’s exports, and Russia’s imports. Solid lines represent official values, and dashed lines correspond to mirror estimates.

Figure A2. 

Iran and Russia’s Pharmaceutical Products Trade: Official vs Mirror Data (2013–2021). Official (solid) and mirror (dashed) trade values are shown for Iran and Russia across four flows: exports and imports for each country, in billions of USD. Mirror data consistently underestimate official values, especially for exports, yet broadly reflect trade movement trends. This supports their cautious use in imputing missing values and trend analysis.

Across all flows, mirror data consistently underestimated official trade values—particularly for exports. This underestimation is most notable in Russia’s exports, where the 2021 peak is recorded in the mirror series but at a lower magnitude. Nonetheless, the mirror data align well with overall trade movement directions such as surges and turning points, supporting their utility in capturing the general trajectory of trade trends even where absolute values diverge.

For imports, mirror estimates were systematically lower than official values for both countries. This pattern aligns with established valuation differences: official import data are typically reported on a CIF (Cost, Insurance, and Freight) basis, while mirror import values—based on partners’ export data—reflect FOB (Free on Board) values, which exclude shipping and insurance. For Iran, the official-to-mirror import ratio ranged from 1.14 to 1.81 (mean: 1.33); for Russia, from 1.07 to 1.17 (mean: 1.11), indicating a relatively stable level of discrepancy.

Export data showed wider divergences. Iran’s official-to-mirror export ratios ranged from 0.93 to 2.36 (mean: 1.54), and Russia’s from 1.09 to 1.67 (mean: 1.39). Since mirror export values are derived from partners’ import records, which are CIFbased, they would theoretically exceed the corresponding FOB-based official exports. The reverse trend observed here—where mirror export values are lower—points to potential issues such as underreporting, data coverage gaps, or asynchronous reporting cycles. Despite these limitations, mirror export data successfully reflect the broad patterns of trade evolution, including the surge in Russia’s exports in 2021.

However, caution is warranted when using mirror data to impute terminal-year values, particularly in analyses involving compound annual growth rate (CAGR) calculations. When the final year of a time series is based on imputed mirror data, even small distortions can compound over the entire calculation period, potentially overstating or understating long-term trends. In this study, the use of mirror data for Russia’s 2022–2023 and Iran’s 2012 and 2023 trade values was deemed preferable to assigning zeros or omitting data entirely, but the potential for bias in derived indicators such as CAGR must be acknowledged. Future research and interpretations should account for this limitation, especially when comparing country-level trends with uneven data availability.