Getty images
Public anger in China concerning the concerns raised by doctors that the generic drugs used in public hospitals are increasingly ineffective have led to a rare government response.
Doctors say they believe that the country’s medication supply system, which encourages the use of inexpensive generic drugs compared to original brand pharmaceuticals, has led to cost reduction at the expense of people’s safety .
But those responsible, cited by several state media on Sunday, claim that the question is that of perception rather than reality.
A report indicates that different people simply had different reactions to drugs and that affirmations about their ineffectiveness had “mainly come from the anecdotes of people and subjective feelings”.
The official response did little to appease public fears concerning the reputation of drugs in public hospitals and pharmacies. This is the last challenge to a health system which is already under enormous pressure due to a rapid aging population.
How all it started?
The debate surrounding the use of generic drugs began in December, when the authorities announced the list of nearly 200 companies that had won contracts to sell medicines to Chinese state hospitals. Almost all were domestic manufacturers of generic pharmaceutical products.
This intensified in January, when, in a video interview which became viral, the director of a hospital department in Shanghai, shared his concerns about the drug supply system.
Zheng Minhua has cited “antibiotics that cause allergies, the blood pressure that will not drop, the anesthetized patients who do not sleep” and the laxatives who have not erased the intestine as among the problems that had been encountered.
The words of Dr. Zheng immediately touched a sensitive string and were condensed in a social media slogan which was considered by millions in the last month – although a large part of the discussion of the subject has since been censored on Weibo. Many people showed up to share their own bad experiences with alleged lower quality drugs.
“I underwent intestinal surgeries in 2024, which forced me to consume laxatives in advance,” wrote a Weibo user. They said that the drugs given to them had “no effect”, even after the dose was doubled and that they had to turn to coffee to help clean their intestine.
EPA-EFE / REX / Shutterstock
The majority of drugs in public hospitals and pharmacies are stored through the supply process
The concerns raised regarding the effectiveness of generic drugs caused mistrust and made some people who did not want to use them.
A person on Xiaohongshu, the Chinese Instagram type application, said that when hospital doctors prescribed the generic version of an antibiotic, they immediately put themselves online to buy the “” real “” real ” , because the generic version “had a different taste”.
“There have been many people who catch colds recently. Many of them could have bought this medication. Enjoy reminders to your friends quickly and force the brand before buying,” warned the user .
Some of the most popular articles discussing the controversy on supply have been deleted, although it is not clear by whom. Internet strongly monitored in China has a strong culture of censorship by the authorities and users themselves.
In a scathing position and now remunerated by the host of the popular podcast Meng Chang Chang, he castigated the lack of imported drugs in the public sector: “If it is not a net result, I do not know what it is . “
Public anger has also focused on the difficulties of accessing imported drugs that people believe in better quality.
In response to the authorities’ attempt to reassure people of the quality of generic drugs, a Weibo user wrote: “As long as we are allowed to buy brand drugs ourselves, I have no other complaints . “
How does the drug supply system work?
It was introduced in 2018 as a means of reducing state spending on medication and implies that local governments issuing tenders for approximately 70% of the annual requirements of public hospitals.
Various drug manufacturers are then competing to offer the lowest prices so that drugs earn these lucrative contracts.
This gives an advantage to generic drugs produced at the national level, which contain the same active pharmaceutical ingredients as original patented drugs but are often several times cheaper to do because they do not include high costs of research and development .
China has become one of the world’s largest players in the world generic pharmaceutical market, exporting the two finished products to consumers abroad and key ingredients to foreign companies. At home, thousands of generic drug manufacturers are competing to sell their products at competitive expansion internal market prices.
In order for generic drugs to be eligible for the supply process in China, they must be tested and determined as sufficiently similar to the brand’s brand version.
Beijing has credited the drug supply system to save millions of residents more than $ 50 billion (40 billion pounds sterling) in its first five years.
But the supply process has seen certain drug manufacturers offer drugs at incredibly low prices. One of the winning offers last December was an aspirin tablet selling less than a hundred.
“The drug tablets that cost less than a edible penny?” became a trendy subject on Weibo at the time.
“Manufacturers who win the offers have often set prices so low that they may have trouble producing high -quality medicines with correct ingredients, which led to ineffective drugs,” said Stacy Zhang, Associate Professor At Nyu Langone Health, at the BBC.
She added that even if the supply system “was not designed to restrict access to imported brand medicines”, he may always have “affected their accessibility”.
Data and efficiency questions
A proposal submitted by 20 doctors, including Dr. Zheng, to Shanghai authorities last month said that “there are general concerns in the industry that purchase prices are too low, which encourages companies contrary to Ethics to reduce corners to reduce costs, affecting the effectiveness of drugs. ”
“Doctors are helpless because they have no choice, and there is no channel to increase comments.”
A recent article by Xia Zhimin, a hangzhou doctor, added to the meticulous exam. He pointed out what he said was questionable data for generic drug trials on the purchase list – it was identical to the data of the original medication on which he was based. Dr. Xia suggested that this could be proof of fraud.
The National Medical Products Administration replied by saying that its results were due to an “editorial error”. His article has since been deleted.
Quality concerns are counterfeit drugs, which have infiltrated the generic markets and brand drugs around the world and are notoriously difficult to detect. The World Health Organization has described this a global health problem.
“To improve affordability, the introduction of profitable generics is essential,” said BBC Kevin Lu, an associate professor at the College of Pharmacy at the University of South Carolina.
He added that the supply process required “reinforced quality control” and “continuous improvements in the standards of approval and manufacturing of drugs”.
Getty images
China’s rapid aging population exerts increasing pressure on its health system
A sector in crisis
The controversy comes at a time when the Chinese health system is already under assembly pressure.
An aging rapid population has noted that the country’s total health expenses have almost 20 times in the past 20 years, reaching 9 yuan billions (1.25 billion of dollars; 1 billion of sterling books) in 2023.
Throughout the country, public medical insurance funds are thin. The deficits have already appeared in certain provinces, where local governments which were based heavily on land sales for income is now struggling with debt while a real estate crisis engulfs the Chinese economy.
At the same time, the health system has experienced a crisis of confidence. Violent attacks on medical staff have increased since the 2000s, fueled by anger against the lack of resources and the erosion of faith in doctors.
Unlike questions that have been judged politically sensitive and strongly censored by the authorities, such as the persecution of political dissidents or the abolition of Uighurs in Xinjiang, the in progress controversy surrounding the purchase of drugs has at least been recognized by the State as a problem with a problem to a problem to a problem to a problem with a problem to a problem to a problem to a problem to a problem to a problem to a problem to a problem to be a problem to a problem To a problem to be a problem with a problem to a problem to be a problem with a problem with a problem with a problem to a problem to a problem with a problem to a problem to a problem to a problem to be a Problem to problems with problems with problems with a problem to be a problem with problems with problems with a problem of problem to be addressed.
The National Healthcare Security Administration said in a statement on January 19 that the authorities “attached” great importance “to these security problems and would ask for comments on the policy of supplying medication.
“It is undeniable that national centralized purchases are still in its infancy. There are many pharmaceutical companies with a variable quality of production,” said a scholar in public health. Other experts cited in the article have called for the improvement of drug assessment standards.
While the authorities are trying to remedy the faulty image of the supply system, all control now eclipses a system designed to be a win-win: save lives and save money.
As a Weibo user argued, the savings in the drop in drug prices are just a “drop in a bucket” of Chinese national health costs. On the other hand, they wrote, allowing potentially defective drugs to be widely used are like “drinking poison to quench thirst”.
