Worth a shot?

If Google was around in the eighteenth century a search for ‘inoculation’ and ‘Shandong’ would have yielded the name Zhang Yan, an energetic doctor who immunised thousands against small pox in the pre-vaccine era. His method might have been a bit stomach churning – it involved blowing small pox scabs up patients’ noses – but it worked.

Toward the end of his life Zhang wrote a book chronicling his successes. The most important thing, he said, was to store the scabs correctly. “The container must not be exposed to sunlight or warmed by a fire. The best material is that which has not been left too long,” he cautioned.

Nearly 250 years on and Zhang’s wisdom seems to have been lost on the people of Shandong.

A Google search for the same terms today will show the eastern Chinese province to be the epicentre of a $48 million vaccine scam involving the resale of outdated and badly stored medicines.

At the heart of the scandal is a mother-and-daughter team who had built up a countrywide network of pharmaceutical reps and vaccine procurement officials.

Their role was essentially that of a vaccine ‘launderer’, or a person who facilitates the offloading of soon-to-be expired vaccines or the procurement of cheap new ones.

“She was very influential in the national vaccine market. She even had close connections with bosses of some pharmaceutical companies. Industry people knew her as Aunty Pang,” a report in the Global Times said of the senior member of the duo.

But Pang’s five-year stint as the nation’s ‘vaccine queen’ ended last year when police in Shandong began cracking down on illegal drug sales.

When police raided her warehouse her 21 year-old daughter – surnamed Sun – was preparing a load of vaccines for dispatch. According to the police, 25 types of vaccine were stocked in the facility, and were stored at insufficiently cool temperatures.

Given the size of the inventory and Pang’s sales network, the assumption is that millions of Chinese –  many of them children  – have been given spoiled jabs, undermining years of public health work.

China has one of the highest rates of infant immunisation in the world – 99% for measles – but after the age of one it is parents, not the state, that are responsible for vaccinating their children. Luckily Pang’s products were all so-called ‘type two’ vaccines – meaning they couldn’t have made their way to newborns vaccinated under the National Immunisation Programme.

But in the wake of the scandal finally becoming public last week some parents said they would hold off from arranging further shots until the situation was clearer. Others said they would travel to Hong Kong to get their children inoculated or pay more money for imported vaccines.

In Hong Kong this has already led to a surge in ‘vaccine tourism’. Local parents now complain their own city faces vaccine shortages as a consequence, prompting the territory’s healthcare authority to introduce a quota system this week, capping the vaccinations available at clinics to 120 jabs per month for non-local children.

Back in mainland China, the mood is gloomy. “What future is there for a country which doesn’t even care for its own children,” asked one disgusted weibo user.

“The air is toxic, the milk is toxic and even the vaccines that are meant to protect us are toxic,” another netizen fumed, referencing the 2008 scandal in which dairies added the ‘protein booster’ melamine to their products to disguise the fact they were watering down their milk. Over 300,000 children fell sick, mainly with kidney problems, and at least six died.

This time, however, the immediate threat to people’s health appears less severe, with Chinese and international health authorities categorising the  risk of illness as “very low”.

“An improperly stored or expired vaccine is highly unlikely to cause a toxic reaction,” the World Health Organisation’s China office said on its weibo account. “The WHO encourages Chinese parents to continue vaccinating their children in order to prevent disease resulting from non-vaccination,” it added.

Indeed, one of the interesting things about the scandal is that the Chinese government appears to have asked the WHO for help in reassuring the public.

Whether that has had any effect is debatable. Nevertheless the WHO’s weibo account has been inundated with accusations that it is also a fake. “How do we know you are real? Does the head of the WHO know you are saying this?” were among the questions asked online.

Meanwhile the Chinese government is being criticised for not disclosing the scandal soon enough – it was 10 months between the raid on Pang’s dodgy warehouse and the story coming out – and for withholding detailed information, such as where the faulty vaccines were sent.

On March 24 Li Guoqing, the head of Drug Supervision at China’s Food and Drug Administration department, said 29 drug companies and 16 vaccination agencies across 24 provinces and cities were involved with Pang’s company.

The assumption is that the outdated drugs travelled from places of higher regulation – such as Shanghai – to places where standards were lower. Even so, residents in cities which don’t appear on the list are still being cautious.

Li also offered an explanation for how Pang was able to slip through the net not once but twice – in 2010 she received a three-year suspended sentence for the same offence.

“At present our country has 12,000 drug wholesalers, 5,000 production firms and more than 400,000 drug retailers. Regulatory targets are many, but there are few people on the ground. There aren’t even 500 people with the aptitude to inspect drugs. There are dead spaces and blind zones for regulation and inspection,” he said.

The media too came in for criticism primarily because it appeared to give the vaccine scandal and the Bali wedding of actors Nicky Wu and Liu Shishi equal billing.

The normally supportive Global Times answered back, saying the problem was far greater than that: past bans on reporting sensitive issues had weakened the media’s ability to pursue public interest stories. “The scandal [has] exposed the weakness of Chinese mainstream media in the face of a public crisis, ” it said.

On Tuesday Xinhua reported that the government was forming a special investigative group to get to the bottom of the case. Netizens still seemed unimpressed and called for more practical advice. “Let’s start with the basics. How do I know if my baby has immunity? Is there a test?” asked one mother.

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