Parents’ Fears Are the Chinese Communist Party’s Biggest Nightmare

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A child receives a vaccination shot at a hospital in Huaibei in China's eastern Anhui province on July 26, 2018. - China's drug regulator said it has launched a nationwide inspection of vaccine production as authorities step up the response to a fraud case that has re-ignited public fears over the safety of the country's medicines. (Photo by - / AFP) / China OUT (Photo credit should read -/AFP/Getty Images)

he Chinese party-state seemed quick to respond this month after a major pharmaceutical company was found to have sold over 250,000 substandard vaccines for children. The revelations, based partly on a viral social media post that sparked a frenzy among millions of worried Chinese parents, were called “serious and appalling” by Communist Party Chairman Xi Jinping, who pledged a crackdown on unsavory practices in the industry. Premier Li Keqiang said the company’s behavior had “crossed a moral line,” and a normally throttled press was permitted to cover the topic. The China Food and Drug Administration (CFDA) opened an investigation and the firm’s chairwoman, “vaccines queen” Gao Junfang, was detained along with 14 others.

But in a country repeatedly hit by regulatory scandals, these measures may not be enough to assuage public anger. China goes through regular cycles of safety-failure revelations, promises from the top of crackdowns and reform, and a rapid return to the norms of faked data and bribed personnel. Even as individual malefactors face punishments, the system is already moving to stop public rage from spreading beyond a single company. And it is unlikely that further arrests and investigations will curb the deeper malaise felt by many, who believe breakneck economic growth and social upheaval has left China with an amoral get-rich-quick culture that puts profits above everything else, even children.

Changsheng Biotechnology, the company at the center of the scandal, is the country’s second-largest maker of rabies and chickenpox vaccines. A week after state regulators announced the firm had outright faked production data about its rabies vaccine, it was revealed that a 2017 batch of 250,000 diphtheria, tetanus, and whooping cough vaccines had failed safety inspections. Tens of thousands of the vaccines had already been administered to children by public health authorities. While there’s no indication the substandard vaccines have directly caused any injuries or deaths, they may leave some children improperly vaccinated and thus vulnerable to diseases.

The outcry from parents has been huge. One Chinese-trained doctor was babysitting her niece in Zhejiang province when news of the scandal broke. She told Foreign Policy her cousins immediately started panicking and feeling guilty that they, like many other Chinese parents, had chosen domestic vaccines for their children instead of pricy ones from Europe or the United States. “Now there’s a huge shortage of imported vaccines and everyone wants foreign ones,” the doctor, who requested anonymity, said.

The panic was heightened by the already uneasy relationship Chinese parents have with vaccines, which are compulsory for school attendance.

The panic was heightened by the already uneasy relationship Chinese parents have with vaccines, which are compulsory for school attendance.

Unlike the United States, China does not have a large and organized anti-vaccine movement, while its mass vaccination campaigns have been major public health success stories.

However, distrust of China’s partially privatized health care system runs high, with lots of anger toward overprescribing doctors and corrupt medicine manufacturers. One study found Shanghai parents reluctant to get more vaccines other than free government-provided ones due to a belief doctors were promoting them just to make a quick buck. In 2013, an unsubstantiated report that children were killed by hepatitis B vaccines caused vaccination rates in some areas to plummet. In 2016, a criminal ring was found to have stored about 2 million vaccines in a rundown, unrefrigerated storeroom.

Meanwhile, Chinese food and drug safety remains tarred by the tainted milk formula scandal of 2008, which led to mass recalls, six infant deaths and the hospitalization of more than 50,000 others, and widespread panic by parents. (A few years later, government officials in Beijing enjoyed the exclusiveuse of a purpose-built organic farm.)

This troubled history meant when the latest vaccine scandal hit, all the official reactions and bluster fell flat for some Chinese. As documented in a Council on Foreign Relations blog, one Weibo user commented that China has “no rule of law. Only party governance,” while a viral post pointed out that Li Keqiang had used similar wording to describe the previous vaccine scandal from 2016. Even the reliably pro-government state media news anchor Wang Guan called the scandal a “disgrace” on Twitter, saying that “Without sound institutional design on rule of law/supervision, history will keep repeating itself.”

The problem is deeply rooted, said Bill Hsiao, a Harvard professor of economics specializing in public health who has spent decades analyzing and advising China’s health care system. Starting in the 1990s, China encouraged domestic production of modern vaccines and drugs partly to alleviate a lack of foreign exchange reserves, but the thousands of private companies this effort spawned were prone to colluding with local governments to skirt potentially costly regulations.

“For you to become a mayor and generate the revenue needed to lubricate different corrupt officials, the first thing you do is establish a tobacco manufacturing plant, and second a pharmaceutical plant,” said Hsiao, recalling a “common country saying” he’d heard among officials and others in China. “That’s how powerful stakeholders and various interest groups became so widespread in pharmaceuticals.”

Vaccines became a highly lucrative business; in 2016, Forbes estimated the net worth of Changsheng Biotechnology chairwoman Gao Junfang and her family at $1 billion. But corruption made Chinese pharmaceuticals exceedingly difficult to reform. In 2007, China executed the former head of the CFDA for exchanging state licenses for payments from pharma companies. One government-ordered self-assessment reportedly saw over 80 percent of companies withdraw their new drug applications due to faulty or fraudulent clinical trial data. Chinese media recently reported that Changsheng sales staff had been subject to more than 10 bribery convictions since 2010 for paying off hospital workers.

Yet it wasn’t supposed to be like this. When Xi Jinping became party chairman in 2013, he pledged to prioritize public health and consumer safety, saying that “if our party can’t even handle food safety properly while governing China, and this keeps up, some will wonder whether we’re up to the job.”

In March, the government announced a major reform proposal for the China Food and Drug Administration, which will merge with other regulatory ministries and create within the new agency a bureau to focus solely on drug inspection. Xi also oversaw the passage of a revised food safety law in 2015 and has regularly insisted on implementing the “strictest” controls on product safety in his speeches. Faking clinical trial data is now punishable by execution in the most extreme cases. China hadn’t seen such high-level attention toward consumer safety in years, and Xi’s moves seemed like an implicit message that he would tackle the problem more seriously than prior administrations.

But the flurry of activity was not enough. The party has a history of pledging reform in the wake of product-safety scandals without changing its culture of secrecy or allowing more freedom for civil society, meaning issues that could have been caught earlier by the press or activists often covertly metastasize before spiraling out of control in full public view.

That’s what happened in the 2016 scandal over the improperly stored vaccines. Local authorities suppressed news of the discovery for months until it was finally revealed in the press, as reported by the New York Times. Such suppression was par for the course. In 2010, the editor in chief of a Chinese daily newspaper was fired for publishing a report alleging that poorly stored vaccines had killed four children.

Even if Xi has a genuine desire to reform China’s beleaguered institutions and stop local-level corruption, the system he’s built isn’t amenable to the reforms needed. The extent of direct control amassed in Xi’s hands–who is widely viewed as the most powerful Chinese leader since Mao Zedong–makes it difficult for regulatory agencies to act independently and transparently, according to Yanzhong Huang, a senior fellow for global health at the Council for Foreign Relations.

“There’s so many things competing for [Xi’s] attention: economic problems, the trade war, the environment, pollution, now regulations and food safety. He can only focus on a couple things at a time,” said Huang. “In a centralized state, within the hierarchy, you just have so many things that will have to wait for the top leader to make the decision.”

The state’s harsh punishments for those who violate food and drug laws don’t always reach those in positions of power.

The state’s harsh punishments for those who violate food and drug laws don’t always reach those in positions of power.

While a farmer and a milk salesman were both executed for their roles in the 2008 milk scandal, the official in charge of food safety at the time, Sun Xianze, was eventually promoted to deputy director of the CFDA, after being suspended for just two years for his role in the scandal. And as Human Rights Watch documented, the government has previously imprisoned lawyers of families who claimed their children were injured by vaccines and even charged one alleged victim’s grandmother for “provoking trouble.”“The pervasive lack of transparency and accountability of the Chinese government contributes directly to these recurring vaccine scandals,” said Maya Wang, a senior China researcher at Human Rights Watch.

This long history clearly touched a nerve in China, helping the latest scandal explode on social media. China’s censors have closely monitored the discussion, allowing most posts but deleting those considered too radical, including the original WeChat post detailing Changsheng’s allegedly shoddy practices. One article that called for senior officials to resign was scrubbed, and so was another that urged mainland China to adapt the freer political systems of Hong Kong and Taiwan to avoid such scandals in the first place.

The pattern is clear enough: One can criticize Changsheng Biotechnology but not attack the Communist Party or the regulatory environment it’s largely responsible for creating. (Some netizens attempted creative ways to circumvent this censorship, such as placing the viral post on the blockchain.)

But such measures may breed further distrust in the state, and possibly give further air to China’s own nascent anti-vaccination movement. Hong Kong clinics are already preparing for a wave of mainlanders coming to get their kids vaccinated anywhere outside the party’s direct control. Censorship hasn’t stopped some deeper soul-searching from taking place, either, with one Chinese columnist writing in English-language media explicitly blaming the scandal on China’s “spiritual vacuum” caused by the Communist Party’s historical destruction of traditional values and the “dog-eat-dog capitalism” it subsequently imported.

Chinese censors can’t control the narrative outside China either. The Changsheng scandal has caused heavy reputational damage to a high-tech industry Xi was hoping to be a key part of its Made in China 2025 plan to build up more advanced Chinese exports.

On Changsheng’s website, which was recently hacked and is no longer visible, an announcement from September 2017 in broken English read that former Croatian President Stjepan Mesic, whose name is misspelled as “Stephan Messi,” paid a visit to Changsheng’s headquarters in Jilin province after Croatia inaugurated a business pavilion in the area.

According to the release, chairwoman Gao Junfang made a speech in which she lauded the company’s achievements and said its products would soon “enter the international mainstream vaccine market.” She also noted that it was the 25th anniversary of China-Croatia relations and of Changsheng’s founding: “Both parties have good fates and opportunities.”

By Charles Rollet
ForeignPolicy

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