A manufacturing plant nestled in the Appalachian Mountains in the small town of Bristol, Tennessee, was built in the 1970s and used to make enough amoxicillin to treat the entire country’s strep throat as well as ear and other infections. At its heyday, it employed more than 500 workers and pumped out billions of pills of the most commonly prescribed antibiotic each year.

But by late July, only 62 people were working at USAntibiotics LLC. Some of the plant’s equipment sat dormant, plastic draped over the machinery, and the once-bustling cafeteria was closed. Over the summer, the plant was making a mere 3% of America’s amoxicillin supply.