Wu, a 54-year-old retiree in China’s southwest Sichuan province, struggled to get antiviral drugs when his 92-year-old mother fell ill with Covid-19 this month.
“When I found out that mom had Covid, she hadn’t eaten or drunk anything for two days,” he said.
Relatives in Shanghai rushed to send antiviral drugs by post after local hospitals and clinics ran out of supplies, but when the drugs arrived, Wu’s mother had tested negative.
Drug shortages that hit hospitals in Beijing and Shanghai last month as Covid cases surged are now growing in rural areas due to bureaucratic inefficiencies, price disputes with pharmaceutical companies and overspending on testing capacity leading to resource shortages.
Despite a promise by Pfizer, maker of the antiviral drug Paxlovid, to build a factory in China within months, there is no sign that the drug will gain permanent approval for the country’s national health insurance scheme. This is out of reach for many Chinese people.
The annual migration of urban workers to their hometowns in poorer provinces is expected to accelerate the spread of Covid to remote areas, increasing the risk of a more severe outbreak. Last week, President Xi Jinping warned that the pandemic had entered a “new phase” and that he was now “especially concerned about rural areas and rural people”.
One doctor at a district hospital in Sichuan told the Financial Times that the facility did not have access to antiviral Covid-19 drugs to treat the spread of the disease. However, practitioners relied on fever medicine to treat Covid patients until last week.
It echoed complaints from health professionals in Beijing last month, where hospitals ran out of beds, oxygen and medicines after Chinese authorities rejected a zero-Covid policy that contained the virus.
When a hospital in Sichuan finally received four boxes of Paxlovid and Azvudine, a domestic Chinese antiviral, last week, the doctor said regulatory hurdles prevented staff from easily prescribing them. Due to scarcity, hospitals must obtain approval from the local government for each prescription. “This is very troublesome,” said the doctor.
In remote areas, a lack of antigen tests and lack of access to lung imaging equipment also hinders early diagnosis, allowing the virus to spread.
“It takes more effort to distribute drugs to remote areas,” said Helen Chen, greater China managing partner at LEK Consulting in Shanghai, adding that cities tend to supply the drugs they need before rural areas gain access. .
China gave Paxlovid regulatory approval in February 2022, making it the first foreign Covid drug to enter the mainland market. But the National Health Security Administration, which negotiates drug prices for China’s national health insurance reimbursement scheme, disputed the “high prices” cited by Pfizer.
The NHSA issued an unusual statement that negotiations had failed over prices. The government may “break the silence” to “signal to the public that it has been working” but “until Pfizer delivers the product at a price that is considered reasonable”, said Chen.
Pfizer said it would build a factory in China to make Paxlovid with a local partner, but the US pharmaceutical giant indicated it could not lower the drug’s price – a requirement for permanent entry into the national reimbursement scheme. It also does not license the general version for the Chinese market.
“They are the second largest economy in the world,” Pfizer chief executive Albert Bourla said at a conference in San Francisco this month. “I don’t think they should pay less than El Salvador.”
Under the terms of the emergency agreement, Paxlovid is eligible for reimbursement until the end of March. Bruce Liu, who heads the life sciences division for China at consultancy Simon-Kucher & Partners, estimated the company could generate Rmb10bn ($1.5bn) in the deal. He estimated 5 million boxes of Paxlovid would be shipped to China in March, lower than expected.
Private buyers are looking for Paxlovid, which sells for up to Rmb8,300 in high-end hospitals. In some cases, patients have bought on the black market, paying as much as $7,000 for the drug or the same drug of lower quality.
Meanwhile, Chinese domestic products face questions about their efficacy and safety. The first Chinese antiviral, Azvudine, which was developed by the drug manufacturer Genuine Biotech and is included in the compensation list, is used again from HIV treatment.
A study by China’s pharmaceutical regulator found that the drug contained substances that destroyed genetic information in cells during animal tests. “There are questions about the toxicity of this drug, the risks are relevant for AIDS patients but not necessarily for Covid patients,” Liu said.
China’s failure to build strong defenses to prepare for the inevitable wave of Covid exits has created a legitimacy crisis for President Xi Jinping and his flagship zero-Covid policy.
“They have three years to prepare for this,” said one pharmaceutical industry insider in Shanghai. “They don’t have the right vaccine or a sufficient supply of medicine to deal with the surge in cases.”
As cases rise in China, for Wu’s mother, recovering from Covid has been long and painful.
He had a brain hemorrhage, his daughter said, and there was still a shadow on the lung scan. But because medical guidelines recommend that patients take antiviral drugs within five days of infection, they do not use them.
“We wanted to use an antivirus,” said Wu, “but we didn’t dare”.