China’s devastating infection wave leaves pharmacies bare
Published on: Tuesday, December 27, 2022
By:
Nikkei, FMT
As customers rushed to stock up, shelves in pharmacies across China quickly emptied. (AP pic)
BEIJING: China’s abrupt end last month to the zero-Covid policy that the government had doggedly stuck to for three years and lauded as the reason it had thus far avoided the mass infections and death tolls seen overseas caught most by surprise.
Far more predictably, however, has been the outcome: the rapid spread of the virus across the country, causing untold numbers of infections and deaths and an acute shortage of everyday medicines used to treat the virus’s symptoms like fever, coughing and potentially fatal secondary bacterial infections.
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Today, hundreds of millions of people who just weeks earlier might have been confined to their apartments for months on end in the government’s attempt to stamp out every case, have been left largely to fend for themselves – at least for now – in their search for medicines like acetaminophen (Tylenol), ibuprofen (Advil) and Pfizer’s Paxlovid, which is crucial to treating the most at risk from severe illness.
In early December, shelves in pharmacies across China quickly emptied as people scrambled to stock up on medicines, according to media reports, social media posts and interviews with ordinary citizens conducted by Caixin. Many have had to wait hours in line to get strictly rationed amounts of pills, while orders placed online are taking weeks to deliver.
“My dad had a high fever for two days and had to rely on drinking hot water” to soothe his symptoms, said a resident in Liangyugang, a city in Jiangsu, whose entire family was infected.
The cause of the shortfall can be linked to the pandemic, but not for the reasons one might expect.
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China over the past three years had imposed strict controls on purchases of medicines for fevers and coughs, as well as for viral and bacterial infections, requiring people to present personal information and take nucleic acid tests in a bid to screen for possible infections. This discouraged purchases. It wasn’t until late November, that the restrictions were scrapped across the country.
Before that pharmacies only kept little of the medicines on hand, with one manager of an outlet in Henan telling Caixin that most pharmacies only kept three to four boxes of ibuprofen in stock during this period.
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‘No inventories’
“There are no inventories at pharmacies, trading companies or producers,” said Geng Hongwu, senior marketing adviser at Jointown Pharmaceutical Group Co Ltd, one of China’s largest drug suppliers.
Because of the purchase restrictions, drugmakers didn’t produce more due to concerns about stock expiring, according to Huang Xiuxiang, chairman of a pharmaceutical industry association in Hunan.
But nowhere has the hunt for drugs been more desperate than at nursing homes caring for the elderly, who are the least vaccinated and most vulnerable to serious illness.
“We lack medicine and have tried to buy it everywhere,” said Xu Yongze, head of a nursing home in Wuhan, Hubei province, which has nearly 500 elderly residents and staff members.
The remaining drug supplies at the facility are only enough for 90 people, according to Xu, who has called on employees and residents’ families to assist them in tracking down the crucial medicines.
The situation is similar elsewhere. “Our staffers have tried to stock up on medicines starting two weeks ago, but there is nowhere to find drugs,” said an employee at a nursing home in Changsha, Hunan province.
The scale of the problem is enormous. China had 358,000 elderly care facilities at the end of 2021, with a total of 8.16 million beds, according to the ministry of civil affairs. Meanwhile, the number of people 60 and older was 264.02 million, or 18.7% of the total population, with those 65 and over at 190.64 million, according to a China CDC Weekly report published in July.
Caixin interviewed a number of nursing homes in Zhengzhou, Nanjing, Wuhan, Chengdu and Changsha around Wednesday and found they all had experienced tight supplies of commonly used drugs to treat fever and coughs, as well as antivirals and antibiotics, over the past two weeks.
It didn’t have to be this way. China is the world’s largest producer of active pharmaceutical ingredients (APIs), producing and exporting around 40% of the world’s total, according to the China Chamber of Commerce for Import & Export of Medicine and Health.
It is also a major exporter of drugs such as acetaminophen and ibuprofen, as well as prescription medicines for chronic conditions like high cholesterol and blood pressure.
Under normal pre-Covid circumstances, China has ample medicine production capacity and a well-developed distribution network, multiple pharmaceutical industry sources told Caixin.
Panic buying
Panic buying might be one reason for the shortages, but the more pressing factor is the disruption to the drug manufacturing and sales industry caused by years of strict virus control policies.
Chiefly is the fact that the industry – like everyone else – was caught off guard when the Covid policy changed, according to multiple sources in drug making and sales who spoke to Caixin.
Over the past three years, demand for fever medicines and painkillers remained low as strict rules were imposed on purchases of such drugs in fear their use would mask outbreak clusters. This forced pharmacies to reduce inventories and drugmakers to slash production, Caixin has learned.
Now, with the virus raging virtually unchecked across the country, this inadvertent unpreparedness has proved to be a ticking time bomb for the tens of millions now desperate to treat the symptoms of the virus that has infected 651,918,402 around the world, killed 6,656,601, according to World Health Organization data as of Dec 12.
Although the official daily case tally in China has hovered around 3,000 to 4,000 since late November, an index developed by Baidu Inc based on people’s online searches indicates an explosive surge of infections. On Wednesday, the index showed that searches related to Covid and fever reached 298 million, more than 10 times that on Dec 1.
Baidu, the most used online search engine in China, launched the index in early December tracking people’s Covid-related searches in over 360 Chinese cities.
Grim indicators
Even based on purely anecdotal evidence, the death toll would appear almost certainly far beyond the official estimates. The sudden uptick in funeral services in recent weeks may stand as a grim indicator of the severity of the outbreak and its human toll.
Crematoriums in Beijing have been overwhelmed. The Babaoshan Funeral Parlor in the city’s west has been running at full capacity, cremating about 600 bodies every day, compared to an average of 150 before the easing of zero-Covid, a worker told Caixin on Wednesday.
Outside the Dongjiao Funeral Parlor in eastern Beijing, Caixin witnessed dozens of hearses queued up for hours waiting to deliver the remains.
It should be noted that Caixin was unable to establish a direct link between the cause of death for those being cremated and the virus. Making that determination even harder is the recent adoption of a very narrow set of parameters in assigning Covid as the cause of death, which likely explains the low official tally.
According to the new standards, the cause of death for patients who test positive for Covid-19 and die in a hospital is based on whether the virus was diagnosed as the primary contributing factor, the Joint Prevention and Control Mechanism of the State Council said in a document dated Dec 6. That could be bacterial lung infection or sudden cardiac death, regardless of whether the deceased also had Covid.
A surge of infections once Covid measures were eventually eased had long been a concern due to the inadequate national vaccination rate and the limited natural immunity from apparently low numbers of infected.
While China counts 90% of its population as being vaccinated, only around 60% have received a booster, according to China’s CDC. Meanwhile, over 9 million people over 80 years of age, among the most vulnerable to serious illness, have not had a third vaccine jab as of Nov 28.
‘Tsunami’ of infected
A “tsunami” of Covid cases was how one infectious disease doctor in Beijing described to Caixin on Dec 4 the looming crisis bearing down on the capital. This was the day the city relaxed strict pandemic controls, coming on the heels of similar moves in other major urban centres and regions across the country.
Since late November, China’s biggest cities – some with populations larger than middling nations – from Beijing to Guangzhou have scrapped the most restrictive measures as the central government pivoted from its 3-year-old zero-Covid strategy, putting the world’s most populous country on track to reopen.
On Dec 7, the State Council released the new 10-point plan for Covid control, officially moving away from zero-Covid and looking to coexist with the virus.
In the following weeks, fever clinics and emergency rooms in many major cities quickly became overwhelmed.
On a visit by Caixin on Wednesday to the Chaoyang Hospital in northeast Beijing, the emergency room was filled with mostly elderly patients in need of oxygen and their families. While health workers struggled to find enough oxygen supplies, ambulances rolled up in a seemingly endless procession, dropping off more infected patients.
“You’d better try other hospitals, as it is unclear how long you will need to wait here,” one emergency room staffer told a patient’s family.
The emergency department of the Puren Hospital in downtown Beijing had set up more than 50 temporary beds equipped with monitors and oxygen cylinders that were being used to handle the overflow of patients from the 14-bed intensive care unit, which quickly filled with the seriously ill. Every single bed was occupied when Caixin visited on Wednesday.
Health experts and authorities have called on the public to treat mild cases at home to reduce the strain on hospitals. But the difficulty in finding the most common medicines has meant infected people are still turning to hospitals to seek treatment.
Industry sources told Caixin there should have been preemptive warnings issued much earlier based on forecasts for how the pandemic was progressing, so every segment of the drug industry could have prepared accordingly. This is because it usually takes 15 to 30 days for companies to have everything in place to ramp up production, they said.
Another acute challenge facing China’s reopening drive is whether it can stock up enough effective Covid treatments to protect high-risk patients, most importantly Pfizer’s Paxlovid.
China in February approved Paxlovid for emergency use and has been dispensing the medicine in clinical treatments since March. The antiviral pill is used to treat adults suffering from mild to moderate Covid symptoms but who are at high risk of developing severe illness, such as those with underlying health issues like diabetes and cardiovascular disease.
In August, Zhejiang Huahai Pharmaceutical Co Ltd signed an agreement with Pfizer to manufacture Paxlovid in China. And in December, China Meheco Co Ltd entered a deal with Pfizer to import and distribute Paxlovid on the mainland.
Zhejiang Huahai has said it has the capacity to produce 22 billion pills annually. But Caixin has learned that Paxlovid production in China is unlikely to ramp up any time soon as many terms of the partnership remain under discussion between the two parties.
Accessing medicine is still very limited for millions of people, Caixin has learned. Meanwhile, the nearly 3,000-yuan (US$428) price tag of Paxlovid in China makes it unaffordable for many of those who can find it.
Drugmakers ramp up
Amid the growing crisis, the government has acknowledged the drug shortage and has taken action to remedy the situation.
On Dec 14, Zhou Jian, head of the ministry of industry and information technology’s consumer products division, admitted at a news conference that some places had experienced a shortfall in drugs due to a surge of patients. Zhou said the government was pushing drugmakers to boost production to maximum capacity.
Major drugmakers have heeded the call, with Humanwell Healthcare Group, CSPC Pharmaceutical Group, Shandong Xinhua Pharmaceutical Co Ltd and Hubei Biocause Heilen Pharmaceutical Co Ltd telling Caixin they started contingency production plans and have been running at full capacity over the past weeks.
The impact of this ramp-up will take time to trickle down to patients. It usually takes 30-40 days for plants to restart production lines, acquire materials and hire workers before they can begin manufacturing drugs like ibuprofen, an industry source said.
While the current situation may be dire, the outlook offers some hope for improvement, with pharmaceutical industry sources predicting an easing of the nationwide drug shortage after the New Year holiday in a month or two.
“Drug production and sales will return to normal after the latest wave of infections stabilises, which is likely to happen in March,” said Jointown’s Geng.
According to Huang Guo, deputy chief of the National Medical Products Administration, China has the capacity to produce ample supplies of drugs to treat fever.
Huang told media on Dec 20 that the annual capacity of the active ingredient in ibuprofen was 8,000 tons at Xinhua Pharmaceutical alone, enough to meet total domestic demand.
In 2021, China’s domestic consumption of ibuprofen was 1,724 tons, while the combined production capacity of the two largest producers was 11,500 tons per year, according to the NMPA.
No early warning
Considering the time it takes for drugmakers to boost production after three years of reduced output, Huang admitted that an earlier warning of at least 15 days ahead of the zero-Covid policy reversal would have been helpful in allowing the industry to prepare.
Preparation time was apparently not enough, according to Geng, but many drug-making plants are now running around the clock to expand production, even as they struggle to find enough workers in such a short time.
Another bottleneck is distribution. Years of suppressed demand have also affected the distribution of common drugs, an industry source said. But the situation is improving as production revives, the person said.
The imminent challenge for drug distribution is lagging logistics, as many delivery workers have fallen ill, Huang said. If the workforce can be secured, drugs will quickly reach all levels of retailers due to China’s well-developed drug sales network, he said.
Despite the challenges, Huang remained optimistic, saying on Wednesday that the nationwide shortage of drugs to treat fever would ease in the next seven to 10 days as all parts of the industry roll into action.
“Supply of common drugs will recover around the New Year holiday,” Huang said.
Before that, people will likely continue to take matters into their own hands and seek out supplies in cooperation with others via internet portals and online communities that have been set up to find medicines and share spare drugs.
Some pharmacies have facilitated this grassroots drive by unpacking boxes of drugs to sell in smaller portions or giving them away for free to people in need.
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