Generics: a missing piece in China’s Covid-19 crisis response

China’s massive Covid-19 crisis, sparked in part by the country’s rolling back its strict zero-Covid policies in early December, has seen millions of people infected with SARS-CoV-2. Making the problem worse is that supplies of name-brand Covid-19 drugs are few and far between, and generics of these drugs won’t be available in China due to failed manufacturer negotiations.

The surge in travel for the recent Lunar New Year celebration, which had been discouraged by the government since the pandemic emerged in Wuhan in late 2019, could maintain the peak of the infection for another few weeks. A top Chinese epidemiologist has estimated that about 80% of people in China, a country of 1.4 billion people, have been infected with the virus.

Caring for those hard hit by the virus has been a challenge for China’s hospitals and health systems. Adding to the problems is that Paxlovid, an antiviral drug shown to be effective at keeping early infections at bay that has been approved by China’s National Medical Products Administration, is in extremely short supply in the country.

Covid-19 is a mild infection for most healthy people. But it can be quite severe, and even deadly, for older people, those who are immunocompromised, and those who are not vaccinated. For them, access to drugs like Paxlovid can be a matter of life and death. The Covid death toll has reached 60,000 since early December, in part due to the Paxlovid shortage.

As the founder and CEO of a digital health platform company who was born in China and still has family there, I tried to help people access the medication they desperately needed. Countless Chinese friends and colleagues reached out to me, urgently looking for ways to get Paxlovid for their family members who were suffering from Covid-19, many of them elderly or with serious health conditions, like cancer. The reality of the situation became even more personal when I lost a close family member living in China to Covid-19.

I leveraged my network in the global pharmaceutical supply chain, spending days negotiating with generic manufacturers in the U.S. and Canada and nights connecting with Chinese buyers. Despite my efforts, my hands were tied: the Chinese government is not allowing Paxlovid generics to be imported, as it tends to keep its pharmaceutical supply chain in-house. Adding to this bottleneck, because China could not reach an agreement with Paxlovid’s manufacturer, Pfizer, the country will not be selling its own generic Paxlovid, only the brand-name product, meaning supplies will continue to be quite limited.

The increased demand and short supply have significantly driven up costs: in China, a single box of Paxlovid can go for up to 50,000 RMB (more than $7,000), while in the U.S. and Canada, eligible patients can get it for free.

Brand-name drugs generally have higher prices than their generic versions. In emergency situations, this reality becomes even more acute. If China had allowed the importation of foreign-made generics — or if Pfizer had been temporarily lenient in pricing for generics during this crisis — Paxlovid could be much more affordable, and access could be increased for lower-income patients, not just for the elites who can pay for high-priced black-market versions.

When drug prices are high, people desperate for solutions often take extreme measures to secure treatment for themselves or their families. That can mean seeking out drugs made in countries known to produce substandard — or even totally ineffective or harmful — versions, or seeking out “alternative” medications that have little or no evidence of effectiveness. Some health experts have also expressed concern that counterfeit drugs will prevent people from getting the proper treatment they need from licensed professionals.

It’s important to note that even the U.S. — with its fiercely competitive pharmaceutical market and aggressive lobbying tactics — allows the import of foreign-made generic drugs (with FDA oversight, of course). In fact, according to the FDA, around 40 percent of all finished drugs sold in the U.S. are manufactured abroad.

To be sure, the relationship between drug manufacturers and governments is a complicated one. Making changes requires many tactful and nuanced conversations and negotiations. What the Covid-19 crisis has made apparent to me, however, is that politics and profits need to be put aside in emergency situations to protect the lives of citizens and ensure access to life-saving treatments.

Indeed, this is a two-pronged issue: now is not the time for pharma companies to draw a firm line in the sand on high prices, and it’s also not the time for the Chinese government to value money above human lives. The voices of people in China, whose outcries led to the country loosening its severe lockdown policies, could be a powerful force in helping prevent these issues from occurring in the future, and it is my hope that I can continue to educate people on these important issues.

At a minimum, China’s current crisis will at least serve as a case study to demonstrate the important role that generic medications play in the global market and offer approaches to solve emergency crises like these in the future.

Cathy Tie is the founder and CEO of Locke Bio, a digital health platform company that streamlines the launch of branded telehealth services.

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