Growing Public Outrage in China Over Drug Quality and Accessibility

Public discontent is rising in China over the availability and quality of medications, with prominent doctors in Beijing and Shanghai voicing concerns about the country’s volume-based procurement (VBP) system. Critics argue that while the system has reduced costs, it has also compromised drug quality and accessibility, fueling widespread frustration.

Introduced in 2018, the VBP system centralized pharmaceutical bidding, allowing the government to negotiate lower prices through bulk purchasing. This has led to significant savings—630 billion yuan ($86.7 billion) to date—and provided greater access to affordable medications. However, the policy has largely sidelined international pharmaceutical brands, with 96% of drugs procured through the system being Chinese generics, according to the National Healthcare Security Administration (NHSA).

Doctors and patients have reported troubling issues with some generics, including reduced efficacy and adverse side effects. Zheng Minhua, a prominent surgeon at Shanghai’s Ruijin Hospital, highlighted problems like allergic reactions to antibiotics, ineffective anesthetics, and laxatives that fail to work. Zheng, along with 19 other Shanghai doctors, has submitted a proposal urging authorities to allow patients more choices, including imported drugs with varied reimbursement rates.

Similarly, Lu Changlin, a doctor at Beijing’s Chaoyang Hospital, has advocated for reforms. “Extremely low prices under the VBP system sometimes fall below production costs, undermining drug quality,” he told local media.

Although the NHSA asserts that hospitals can purchase non-selected drugs outside the VBP program, doctors and patients say this is often not the case. Some hospitals avoid stocking imported medications due to financial constraints or fear of penalties for failing to meet VBP volume requirements.

This has left many patients seeking imported drugs through private hospitals, e-commerce platforms, or pharmacies, often at significant personal expense. For instance, cancer patients have reported severe side effects from domestically produced chemotherapy drugs, while parents in Hangzhou struggled to find imported antibiotics for children with severe illnesses.

Adding to the controversy, allegations of fraud have surfaced regarding the regulatory approval of Chinese generics. Medical professionals discovered inconsistencies in clinical trial data, with some drugs showing identical results across multiple parameters. While the National Medical Products Administration (NMPA) attributed the errors to “editing mistakes” and claimed they were corrected, social media users identified further discrepancies, leading to the removal of the data from public access.

“This reflects a systemic problem,” said a Shanghai doctor. “When issues are uncovered, authorities often target the whistleblowers instead of addressing the root cause.”

The funding crunch at local governments, worsened by the COVID-19 pandemic, has exacerbated the issue. With limited budgets, officials prioritize sectors like education over healthcare, further straining resources for drug procurement.

Doctors have noted that imported medications are often reserved for long-term patients due to limited supplies. “We need a balanced approach,” said a doctor from Jiangsu province. “Allowing hospitals to stock imported drugs, even at higher out-of-pocket costs, could address the issue—but it risks public backlash over unequal access and affordability.”

As public anger grows, pressure is mounting on authorities to reform the VBP system and ensure access to higher-quality drugs. While the NHSA maintains that the system does not prohibit imported drugs, the reality on the ground tells a different story.

Doctors and analysts are calling for increased transparency, stricter oversight of generic drug evaluations, and policies that enable broader access to imported medications. However, balancing cost savings with public health priorities remains a significant challenge.

For now, many Chinese patients continue to navigate a system where affordability often comes at the expense of quality, fueling a broader debate about the future of healthcare in the world’s most populous nation.