It was in Wenzhou that the Human Papillomavirus (HPV) vaccine – arguably the most reliable shield against cervical cancer – was first made available in China. The Zhejiang city was picked because the vaccine’s manufacturer Merck wanted to pay tribute to one of its two inventors, Zhou Jian. The scientist – who did some of his research at Cambridge University – often traced his success to the Wenzhou Medical College where he had studied.
The vaccine did not reach China until 2017, or 11 years after its international launch. And even after this lengthy delay, the country’s stocks of HPV vaccines still fall far short of demand. Around 7 million doses had been shipped to China for the most targeted demographic (females aged between nine and 14 years-old) as of March, according to The Lancet, a UK medical journal. However, at least 41 million Chinese are in need of HPV vaccination. This figure rises dramatically if you include demand from those above 14, who are not regarded as the primary target group by the World Health Organisation (but many older women want to be injected with newer variants of the vaccine that cater to them too).
The maths looks even more daunting considering that an HPV vaccine typically requires two to three doses to be effective. It was amid such a drastic market imbalance that a series of scandals linked to HPV vaccines broke out lately.
A private hospital in Hainan, known as Boao Yinfeng, was found to have sold and administered supposedly 9-valent HPV vaccines – the latest iteration of the biologic drugs and suitable for women up to the age of 26 – to 38 people since January 2018. The hospital claimed that the vaccines had come from South Korea and the US. But the police said some of them were smuggled from illegal sources or domestically produced. Last month, local authorities slapped a fine of Rmb8,000 ($1,164) on Boao Yinfeng – Rmb1,000 less than each victim paid for their HPV inoculation, although its business licence was also revoked.
Merck’s new 9-valent HPV vaccine, which can prevent the highest number of high-risk HPV strains and is marketed under the name Gardasil, is a scarce commodity in China (GlaxoSmithKline make an older 2-valent vaccine which is less in demand). Some smaller cities have suspended vaccination bookings because their stockpiles are exhausted. Bigger cities tend to use lotteries to allocate the resource. In Shenzhen, for instance, 84,615 people vied for 2,203 places in the last drawing of lots.
The shortage has given rise to a lucrative yet dubious business that preys on people’s fear of missing out. Following the debut of the 9-valent HPV vaccine in Hong Kong in December 2015, the city has seen a rising number of local healthcare centres offering vaccination services to mainland Chinese tourists. Growing in tandem are the agents that try to solicit customers on WeChat, Ta Kung Pao reports.
“A general practitioner normally acquires 30 doses serving 10 customers every month, but vaccination centres want to make a quick buck and therefore ask for 500 doses a week. That amounts to tens of thousands every year, a volume that daunts the pharmaceutical company given the tight supply,” wrote the Hong Kong-based paper. It notes that a cyber attack that disrupted Merck’s supply chain during mid-2017 and early-2018 had exacerbated the shortages and prompted many vaccination centres to scout for parallel imports or grey market goods, which mainly came from Germany and Australia.
Lately small-scale protests have broken out at AMH Medical Diagnostic Group, one of the most popular vaccination centres for mainland Chinese in Hong Kong. That followed a statement from Merck on May 9 emphasising it has “never ever” supplied HPV vaccines to AMH. While some protestors were adamant about getting a refund, most were concerned about the substance that had already been injected into their bodies.
The bad publicity in Hong Kong may lead some to look for jabs back home. One company that is set to benefit from such a dynamic is Chongqing Zhifei Biological Products. As the sole HPV vaccine distributor in China, the Shenzhen-listed company has seen the value of its purchasing agreements with Merck jump from Rmb743 million in 2017 to a projected Rmb8.2 billion in 2020.
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