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With world-class research institutions, entrepreneurial ecosystems, a dynamic private sector, and deep pools of capital, the United States has extraordinary strengths in biomedical innovation. But America’s continued leadership cannot be assumed. Countries around the world are building their own capabilities to accelerate research and attract talent, making significant headway in closing the gap with the US. Efforts such as the HHS Operation TrialBlazer, launched in June, 2026, indicate growing recognition that the US biomedical ecosystem needs an upgrade. As science and technology advance and global competition intensifies, how can the United States build on its strengths and position itself to continue leading the next era of biomedical innovation?