A California congresswoman plans to hold a hearing in about a month to explore the national-security risks posed by China’s dominance of the U.S. pharmaceutical supply chain, escalating concerns raised by the Pentagon.

Democratic Representative Anna Eshoo is warning fellow lawmakers that if the trade war between Washington and Beijing were to intensify, China could throw the U.S. into chaos by cutting off the vast supply of important drug components made in the Asian nation.

“This would be one hell of a card for them to play,” Eshoo said in an interview in her office in Washington. “It would bring America to her knees.”

About 80% of the active pharmaceutical ingredients, or API, used in drugs that end up in Americans’ medicine cabinets come from manufacturers in China and India. Drugmakers have embraced those suppliers as a way to hold down costs. A Defense Health Agency official told a U.S.-China advisory panel this year that the risks from China’s stranglehold on the business “cannot be overstated.”

Eshoo, who is chairwoman of a House panel with jurisdiction over the nation’s drug supply, has influential colleagues in her state delegation. She’s talked about the topic with one she counts as a good friend, House Speaker Nancy Pelosi.

“She was stunned,” said Eshoo. She said Pelosi asks her again and again, “‘When is that hearing?”’

Eshoo plans to hold a hearing along with another California Democrat, Representative Adam Schiff, chairman of the House Permanent Select Committee on Intelligence, around the end of October. She wants to hear from drugmakers, the Food and Drug Administration and defense officials on how to better protect the drug supply and potentially bring medication manufacturing back to the U.S.

Eshoo said she has been reading up on the issue and feels a sense of urgency. Last Wednesday, she nearly called Schiff, only hours before his committee would grill acting Director of National Intelligence Joseph Maguire about a whistleblower complaint against President Trump, in one of the most closely watched hearings on Capitol Hill in recent memory.

“I almost called Adam last night and I thought: ‘Are you out of your mind?”’ Eshoo said.

Contamination Concerns

Contamination is also a concern. Since last year, health officials have overseen recalls in about 30 countries of millions of blood-pressure pills made with tainted active ingredients from China and India. The key drug components from overseas contained a probable carcinogen called NDMA, a chemical once used in rocket fuel. Bloomberg News has reported on the Chinese company at the center of the contamination and failures by the industry and the Food and Drug Administration that led up to the recall.

Health officials worldwide are now investigating NDMA levels in some versions of the popular stomach drug Zantac, known in generic form as ranitidine. Recalls or distribution halts have been announced by multiple drug manufacturers.

Eshoo has been attempting to educate House members on her Energy and Commerce Committee panel about the origin of active ingredients, starting with listing the topic as one of her priorities. Most members didn’t understand.

“When I put this on the list, it was as if I spilled alphabet soup on the memorandum,” she said.

Pharmaceutical companies say that where they buy active ingredients is a trade secret. Often, the only time U.S. consumers find out such information about the pills they consume is when there’s a crisis. Eshoo hopes the hearing will raise awareness among Congress and the public.

“I think, collectively, we haven’t kept our eye on the ball,” Eshoo said.