Ireland now has the second-largest trade imbalance with America, lead only by China. The outsized trade imbalance is fueled by soaring demand for the hormone ingredients, produced in Ireland, that are used to produce  the wildly popular GLP-1 weight loss drugs, and by drug companies’ feverish rush to get the goods into the United States ahead of President’sTrump tariffs. 

An estimated $36 billion worth of peptide- and protein-based hormones that are used for weight loss and diabetes drugs like Zepbound and Mounjaro have been produced in Ireland and exported to the United States, according to a Wall Street Journal report. These shipments, weighing 23,400 pounds in all, accounted for roughly half of the $71 billion in goods imported into the United States in the first four months of 2025. 

Almost all of the pharmaceutical ingredients were sent to Indiana, the state where Eli Lilly, maker of diabetes and weight loss drugs Zepbound and Mounjaro, is headquartered.

Ireland has established itself as a major manufacturing hub for United States drug companies, more than a dozen of which have capitalized on the country’s business-friendly climate and low tax rates. The pharmaceutical industry employs roughly 2 percent of the workforce in Ireland, according to Reuters. 

President Trump has been critical of Ireland’s stronghold on pharmaceutical manufacturing and wants to return drug production to the United States and reduce trade deficits. In April, the Trump administration launched a Section 232 investigation into the effect of imports of pharmaceuticals and pharmaceutical ingredients on national security. This investigation, which is part of the Trade Expansion Act of 1962, could take more than 270 days to complete.

Global businesses rushed shipments of goods into the United States in advance of Trump’s “Liberation Day.” Now, Ireland has the second-largest US  trade imbalance in the world. 

“This beautiful island of five million people has got the entire United States pharmaceutical industry in its grips,” Mr. Trump said during a White House meeting with the Irish prime minister, Micheál Martin, on St. Patrick’s Day this year.

He’s spent months threatening to impose major tariffs on imported pharmaceuticals for months, saying last week that they will be coming “very soon.” 

“It’s going to bring most of them back into, at least partially back in,” he said. 

Until then, demand for GLP-1s continues to grow unabated. Eli Lilly, which makes the ingredients for its GLP-1 drugs at its facility  in County Cork, is expected to double its sales of Mounjaro and Zepbound to nearly $30 billion, according to the Journal. 

Earlier this month, Ireland was put on the Treasury Department’s monitoring list for currency manipulation as a result of its growing trade imbalance.

The peptide- and protein-based hormones used in GLP-1s help regulate appetite and metabolism by mimicking an intestinal hormone that makes people feel fuller. 

The overwhelming demand for GLP-1s resulted in a drug shortage in 2022, forcing the Food and Drug Administration to put semaglutides (Ozempic and Wegovy) and tirzepatides (Mounjaro and Zepbound) on the FDA drug shortage list. Drug compounding pharmacies were able to help meet patient demand by offering more affordable versions of brand-name GLP-1s, which can cost more than $1,000 a month without insurance coverage. 

The FDA removed both tirzepatides and semaglutides from its drug shortage list in 2025, a decision the compounding pharmacy industry group Outsourcing Facilities Association disputed in court. Last week, a federal judge ruled in favor of the FDA. Patients who grew accustomed to paying between $129 and $497 out of pocket per month will now have to pay significantly more for brand-name GLP-1s.