GLOBAL HEALTH UNDER ATTACK: China has caused immense damage to global health by engineered viruses and pandemic disinformation; fake drugs; dangerous food adulterants; defective masks, personal protective equipment (PPE) and diagnostic kits; ineffective vaccines; substandard health equipment; manipulation of WHO, scientific experts and publications; and now ransomware attacks on health facilities. Our health is also affected by pollution and climate change for which China is the biggest contributor. The Chinese wet markets are a source of zoonotic infections and a cause of destruction of biodiversity by extinction of endangered species. Traditional Chinese medicine now being promoted by the Chinese government contains parts of 36 animal species, of which several are endangered including the tiger, rhinoceros, black bear, musk deer, and seahorse.

FAKE DRUGS WITH FAKE LABEL: The opening statement of an article in Canadian Medical Association Journal, titled “China’s counterfeit medicine trade booming” says it all: “It was a cringe-worthy moment for China when 600,000 counterfeit antimalarial tablets were intercepted by the Nigerian government in June 2009. Produced and shipped from China, they bore an unexpected label: ‘Made in India.’ Even the fakes were being faked. It was a new low.” The then head of Nigeria’s National Agency for Food and Drug Administration and Control (NAFDAC), Dr Dora Akunyili, said “Drug counterfeiting is mass murder; it is one of the greatest atrocities of our time. It is a form of terrorism against public health as well as an act of economic sabotage.” A research team of the American Enterprise Institute found China largely responsible for the fake drugs attributed to India in 20 countries where samples were collected. 80% of HIV drugs for the developing world and nearly half the antimalarials and antibiotics are made in India and popular brands are counterfeited by the Chinese. NAFDAC found extensive Chinese criminal counterfeiting drug networks employing local people have infiltrated the entire supply and distribution chains across continents. A fake copy of an Indian antimalarial drug called Lonart DS sourced from the Chinese Shenzhen free-trade zone was just one example. Fake drugs lead to death instead of a cure.

ADULTERATED INFANT MILK AND BAKED FOODS: Echo Huang reported about China’s infant milk tragedy in 2008, causing kidney stones in which “chemical compound called melamine, used in plastic and fertilizer production that had made its way into baby formula. A total of 22 companies were involved in the tainted-milk scandal, including state-owned dairy company Yili, a supplier to the Beijing Olympics, and Sanlu, which began as a state-owned company based in northern Hebei province in 1996, and had formed a joint venture in 2005 with New Zealand dairy company Fonterra.” “The level of melamine in the powder was found to be as high as 2,560 mg/kg—the tolerable daily intake for the chemical compound is 0.63 mg/kg of body weight, according to the level set by America’s Food and Drug administration.” The adulterant was “traced to ‘protein powder’ supplied by local farmers, who were adding melamine to their milk to boost protein levels and pass nutritional testing.” Cyanuric acid a structural analogue of melamine, also increases apparent protein content in milk products and has been used as an adulterant. Many countries halted all imports of Chinese dairy products. Later in Japan and South Korea melamine was found in Chinese origin eggs and frozen fried chicken due to its use as animal feed. Malaysia and Taiwan found baked foods contaminated with melamine in baking ammonia (ammonium bicarbonate) imported from China.

CYBER ATTACKS ON HEALTH CARE: In May this year, a federal grand jury in San Diego, California, returned an indictment charging four nationals and residents of the People’s Republic of China with “hacking into the computer systems of companies, universities and government entities in the United States and abroad between 2011 and 2018 focused on information that was of significant economic benefit to China’s companies and commercial sectors, including information of lengthy and resource-intensive research and development processes on infectious diseases, vaccines and biopharmaceuticals. The defendants and their Hainan State Security Department (HSSD) conspirators sought to obfuscate the Chinese government’s role in such theft by establishing a front company, Hainan Xiandun Technology Development Co., Ltd., since disbanded, to operate out of Haikou, Hainan Province.” Confidential health data is of immense commercial value on the dark web and also strategic value like the 2018 targeted SingHealth data breach of 1.5 million patients including those of the Prime Minister Lee Hsien Loong. China has been accused of illegally accessing US health and genomic data to precisely target important individuals for potential surveillance, manipulation, or extortion. Last weekend Chinese cybercriminals were accused of attempted Deep Blue Magic ransomware attacks on ten Israeli medical facilities.

INDIA, THE PHARMACY OF THE WORLD, IS IN A CHINESE TRAP: Medicines are formulated by mixing pharmaceutical excipients (additives to enhance stability, or for bioavailability or patient acceptability) and Active Pharmaceutical Ingredients (API), synthesised from raw materials via a series of pharmaceutical intermediates. India, the pharmacy of the world, was self-sufficient in producing its own API and intermediates till the 1990s. In the last two decades, import of cheap Chinese APIs and intermediates has led to closure or low capacity (approximately 30%) utilisation of Indian factories. India now imports almost 68% of APIs and intermediates from China as per official estimates in a reply to a question in the Lok Sabha. During the pandemic there was a sudden short supply and massive price hikes by China leading to drug shortages in India. Any shortages or quality issues will affect both Indian health and our reputation abroad. India also imports 80% of medical devices from China, US, Germany and others. Our big trade deficit with China is mainly due to import of electrical and electronic items ($18 billion), machinery ($12 bn) and organic chemicals ($8 bn), plastics ($2 bn), optical and medical apparatus ($1.5 bn). All these five categories of imports are needed by the health sector also, and self-reliance or decoupling in these industries will have major benefits for the health of the nation. During the pandemic we realised the impact on our health services due to this heavy dependence on imports of medical devices, disposables, drugs and vaccine ingredients. The famous proverb “Self-help is the best help” is as relevant to our health security as it is to our food security, as well as strategic and security needs.

 

Dr P.S.Venkatesh Rao, MBBS (Vellore), MS (Vellore), DNB, FRCS (Glasg), FACS, FICS, FMAS, FAES is Consultant Endocrine, Breast & Laparoscopic Surgeon.