Frustration is rising over Covid drug shortages in China, and there are no easy answers

Editor’s note: Editor’s note: A version of this story appeared in CNN’s Meanwhile in China newsletter, a three-times-weekly update that explores what you need to know about the country’s rise and how it affects the world. Register here.

Hong Kong CNN –

As Jo Wang, an event planner in Beijing, watched her family members fall ill with Covid-19 one by one late last month, she had one goal: to find antiviral pills to protect her grandfather from old when it was his turn.

After three days of trying and failing to buy a box of Pfizer’s Paxlovid on an e-commerce platform, she got lucky, scoring the Covid treatment through an official channel on the fourth day and getting it in the mail on the sixth. But Wang, who was breaking the rules by proactively seeking the prescription — before her grandfather got sick — was also wracked with guilt.

“I felt very bad at that time… you don’t know how many days it will take to buy this medicine, it’s completely unknown. And you don’t know how long people in your family can take,” she said, stressing her fear that if she waited until the 92-year-old was sick, it would be too late to take the pills, which they are. more effective at the beginning of the disease. “It’s a very desperate situation.”

Wang is not the only resident struggling to secure Western medication as a wave of Covid-19 sweeps China, increasing demand for treatment — especially for the country’s large under-vaccinated elderly population.

In recent weeks, many have turned to the black market where hawkers claim to sell Covid treatments ranging from illegal imports of Indian-made generics of Pfizer’s Paxlovid and Merck’s molnupiravir to the bonafide product – up to nearly eight times as much market price.

Growing frustration over shortages was exacerbated by an announcement on Sunday that the government had failed to reach a deal with Pfizer to include Paxlovid in its national insurance plan, with officials saying the asking price was too high. The decision could mean that after March 31, the drug will only be available to those who can afford to pay full price, with current fees reported to be around 1,900 yuan ($280) per course.

Paxlovid has been shown to reduce the risk of death and hospitalization in high-risk patients when used soon after the onset of symptoms. Last February, the drug, widely used in developed countries, became the first oral pill specifically for Covid to be authorized in China.

China agreed to cover two other treatments used for Covid-19 in recent talks – the traditional Chinese medicine Qingfei Paidu and the home-grown antiviral pill Azvudine. There is limited data on how well Azvudine protects against serious diseases.

The price trap and shortages, nearly a year after the pill was first authorized and months after Pfizer used a domestic drugmaker for domestic production, show the challenges China faces as its government grapples with demand for treatments for its population. of its 1.4 billion people, after suddenly lifting Covid controls last month.

Currently, Pfizer’s imported pill is available in community hospitals in several cities, including Beijing, Shanghai, Tianjin and Guangzhou, according to state media. It is also sold on some e-commerce platforms, where there are some hints in local reports that supply constraints are easing.

But there are questions about how widely the pills will be distributed across China and whether there are enough medical resources to prescribe them — a pressing issue as the outbreak shifts from urban centers to smaller towns and rural China. Experts say procurement appears to be decentralized, with the pills most readily available in hospitals in major cities with better resources and harder to find elsewhere.

On Monday, Pfizer CEO Albert Bourla said the company had increased exports, shipping millions of courses of Paxlovid to China in the past two weeks, and was working with its domestic partner Zhejiang Huahai to produce Paxlovid made in China in the first half. of this year. year, according to Reuters.

But Bourla, speaking at a conference in San Francisco, also dismissed hopes that the company could reach a deal with China for domestic drugmakers to produce a generic version of the drug to be sold in the country – denying a report by 6 Reuters in January that such a deal was being discussed.

US-based Merck, known as MSD internationally, said on Wednesday on its WeChat account that it will take legal action against several manufacturers who are supplying unauthorized versions of its Covid drug. The company said it will also partner with domestic firm Sinopharm to supply China with its pill, which is sold under the brand name Lagevrio. Neither Western firm currently has a patent for the drug in China, according to a database linked to the WHO, although both have applied for one.

But as the immediate shortages — and cost issues — emerge in one of the world’s biggest generic drug-producing countries, they also shine a spotlight on global issues related to intellectual property rights, according to experts who examine access to drugs.

Two Chinese companies slated to make generic versions of Paxlovid have already submitted their products for evaluation by the World Health Organization (WHO), according to the WHO-related drug patent group (MPP) — a signal that they are ready to start producing the drug. .

Those companies, Zhejiang Huahai and Apeloa Pharmaceutical, along with two others in China, were granted sublicenses in 2022 to make the full generic pill to supply 95 low- and middle-income markets — excluding China — according to of a previous agreement between Pfizer and MPP. an organization that facilitates access to treatments for people in the poorest countries.

“At the scale of the health crisis going on (in China), the most logical next step (would be) for these licenses to be expanded to include allowing domestic supply in China, including from other producers (in the region),” Ellen said. ‘t Hoen, a former MPP executive director and current head of the Drug Law and Policy project.

However, if the drug developer was unwilling to take that step — as Bourla indicated Pfizer was on Monday — there are measures China could take, such as pledging to protect companies that make generic supplies or importing generics from elsewhere, using legal measures permitted by law. World Trade Organization rules during health emergencies, said ‘t Hoen.

This potential has been discussed in public forums in China. Commentators there point out that the country has no history of using these flexibilities, which are often used cautiously by countries given their potential to irritate foreign pharmaceutical companies and the countries where they are based.

In China’s case, concerns about the impact on the domestic economy – in which foreign pharmaceutical firms are major employers – are likely to be a major reason for the government’s reluctance to use such measures, said Yanzhong Huang, a senior on global health at the Council on Foreign Relations. in New York.

Beijing this month called on authorities to step up oversight of online drug sales and crack down on price gouging, false advertising and intellectual property infringement.

China may hope that more domestic antiviral pills in development will be able to fill the void. Throughout the pandemic, its regulators have largely opted for domestically produced tools to tackle the virus – with Beijing yet to approve a foreign Covid vaccine.

Health officials have recently sought to reassure the public of affordable access to treatments and minimize the potential impact of the government’s failure to include Paxlovid in its national insurance scheme. A top health official said on Wednesday that hundreds of pills to ease Covid symptoms were already covered by insurance and new viral treatments were in the pipeline.

The nationalist state-run Global Times tabloid published an article on Monday blaming “US capital forces” for China’s inability to strike a deal with Pfizer to include the pills in national insurance.

“Over the past few days, an increasing number of US politicians and media outlets have issued pointed ‘warnings’ about the epidemic in China … If they care about it, why doesn’t Pfizer give up chasing profit and cooperate with China with less more honesty?” the article said.

Bourla said on Monday that the talks broke down after China had demanded a lower price than Pfizer is charging for most lower-middle-income countries.

In a separate statement to CNN, Pfizer declined to comment on what price it had offered, but said the company “will continue to cooperate with the Chinese government and all relevant stakeholders to ensure an adequate supply of Paxlovid in China” and remained “dedicated to meeting the Covid-19 treatment needs of Chinese patients.”

But for those who have faced the immediate problems of getting medicine for themselves and their families, like Wang in Beijing, there is a sense — for now, anyway — that the system isn’t working.

“It’s cruel … no matter how we feel, there’s nothing we can do,” she said. “It is not the case that your effort or expectation can improve the situation.”