Given the lower labor costs and people consider drugs to be so profitable, I don't know why other countries don't do as much research and drug development. Just a few countries carry the lion share of this effort.
That would be my response. If someone else can improve R&D and lower the cost of drugs, they are more than welcome to. Interestingly, I haven't seen any takers.
Yes, many people bring their work out of academia and have much lower cost of R&D because they don't have to pay for any of the pre-work.
Reagents are getting cheaper and better as well.
Yesteryears low hanging fruit costs the same as today's low hanging fruit. They are harder to solve though.
And no, I'm not saying everyone single biotech startup is like this or every single researcher does this. And yes many fail, but that's the cost of doing business and it's something that makes things progress.