Although India leads China in vaccine production and export, China has achieved full immunisation rates.
It has been not long since the film Dying to Survive had created a heated public debate on high medicine prices in China, and the country has been again hit by a vaccine scandal. The story was apparently made public anonymously through an article titled ‘The King of Vaccines’ (疫苗之王-Yimiao Zhi Wang) on Chinese social media platforms. Some experts described this as the worst public health crisis in China in the past couple of years.
Why should India care? Because of two reasons. First, China is one of the largest suppliers of vaccines to India in terms of value. Second, without players from emerging countries like India and China, the global vaccine production remains an oligopoly, which is good for no one. But before I delve into these issues, let me tell you what is happening in China as its vaccine scandal unfolds.
Just three weeks ago, the Chinese media was full of news, covering the latest public outrage on faulty vaccines being manufactured by one of China’s vaccine manufacturers — ChangChun Chang Sheng Biotechnology (长春长生生物科技). According to the China Food and Drug Administration (CFDA), ChangChun ChangSheng was found to be violating protocol by fabricating production and inspection records of rabies vaccine for which it holds a whopping 23% of the market share in China. On top of that, Chang ChunChangSheng’s diphtheria, pertussis and tetanus (DTP) vaccine were also found to be below standards since last year! About 250,000 doses of DTP vaccines were actually sold to the public since October 2017 when they were found to be impotent by the National Institute for Food and Drug Control (NIFDC).
Not only is the vaccine scandal serious, it is the third in a row since 2016. Unlike rabies, the DTP vaccine is compulsory for Chinese citizens and such cases of improper public health management create a panic in the general public. And unlike India, China has almost universal vaccination rates and vaccines are covered under insurance. Although it is widely believed that the ‘impotent’ DTP vaccines will not cause these diseases in the children who have taken such vaccine, the possibility, however, cannot be ruled out. Moreover, nothing is clear regarding the consequences of the faulty rabies vaccine. However, Chinese leaders have assured the public of strict action. The Chairwoman of ChangChun ChangSheng is already under arrest, the company’s license is suspended and fines were imposed along with further investigations.
India has stopped the import of such vaccines from China as of 1 August, 2018. However, nothing is available on the website of the Central Drug Standard Control Organization (CDSCO) of India in this regard. Furthermore, the Drug Controller General of India does not know how much of such vaccine has already been imported and where is it being distributed. This is unsettling because China is one of the largest exporters of vaccines (including for rabies) to India. According to the latest data by Zauba Technologies, India imported a total of $96,141,239 worth of vaccines from China, capturing more than 15% of the value share. Indian authorities should have better information regarding when and where the drugs are imported into the country to ensure the safety of public health.
The second reason to learn more about the vaccine scandal in China is to understand the potential of emerging players to become the next biggest producers of vaccines. Currently, vaccines production is heavily dominated by MNCs, with five companies acquiring an astronomical market share of 80% globally. Although companies in India and China have emerged to increase competition, they have been either merged with or acquired by big MNCs. Since scale matters a lot in vaccine production, such mergers and acquisitions have further strengthened the position of such oligopolies.
However, Indian companies are doing well in giving a tough fight to established players and acquiring global market share. Serum Institute of India Ltd., a leading vaccine manufacturer in India, has acquired a global reputation for vaccine production and R&D. It also acquired two international companies in 2012 and 2017 respectively.
The Chinese example is a good case for India to make sure that such incidences of improper vaccine management and production don’t happen in the country, as it will give a major blow to the reputation. As seen in the Chinese case, the vaccine manufacturers have not only lost trust domestically but also internationally.
Although China began to give tough competition to India in terms of exporting vaccines to other countries since its entry into the global vaccine market in 2014, these domestic cases have slowed down this race and stifled the development of Chinese firms internationally. While this is good for Indian firms in some respect, such cases of mismanagement in the pharmaceutical sector also taint the image of manufacturers from developing countries in general (represented by the Developing Countries Vaccine Manufacturer Network — DCVMN). This would not be good in-turn for the overall vaccine market which is already highly concentrated. If the aim of providing affordable vaccines to all has to be achieved, Indian and Chinese companies need to be more vigilant about their practices and keep up their goodwill.
In this regard, the Indian vaccine manufacturers can contribute on two fronts. First, given the exceptional track record of Indian companies in delivering low-cost high-quality vaccine to the world, Indian companies can collaborate with their Chinese counterparts to provide them with the necessary expertise in return for access to the vast Chinese market. In general, as one study points out, India and China have the lowest number of firms which collaborate with developing countries on the health biotech front and hence more collaboration between developing countries is needed. Second, given China’s success in expanding vaccine coverage to its entire population, the Indian firms can learn ways in which they can work with the government to expand coverage of their vaccines in India. This will improve their market penetration and at the same time help India achieve the much needed universal immunisation target.
China and India are two of the largest players in DCVMN. Although India leads China in vaccine production and export, China has achieved full immunisation rates. Who will be the (true) ‘King of Vaccines’ is yet to be seen!