China’s Abrupt Covid Pivot Leaves Many Without Medicines

When demand for fever-reducing drugs more than quadrupled the price of ibuprofen, a city in eastern China began rationing sales by selling the pills individually.

When a popular Chinese online pharmacy offered the antiviral drug Paxlovid, it sold out within hours.

And when word of the medicine shortages in China reached friends and relatives in Hong Kong and Taiwan, they quickly bought vast quantities of drugs from local sellers to ship to the mainland.

As Covid rips through parts of China, millions of Chinese are struggling to find treatment — from the most basic cold remedies to take at home to more powerful antivirals for patients in hospitals. The dearth of supplies highlights how swiftly — and haphazardly — China reversed course by abandoning its strict “zero Covid” policies about two weeks ago.

The whiplash of change has caught the nation’s hospitals, clinics and pharmacies off guard. Across many cities, pharmacies have sold out of the most common fever and cold medicines. Many health facilities were unprepared for the onslaught of demand from patients after they were given little to no notice about needing to stockpile drugs. The shortages are fueling anger and anxiety among Chinese who until recently had been warned by the government that an uncontrolled spread of Covid would be devastating.

“The doctor told me there was no fever medicine,” said Diane Ye, a 28-year-old Covid patient in Beijing, who lined up outside a hospital for hours with a fever only to be sent home with a bottle of sore throat medicine.

For nearly three years, the country maintained some of the toughest pandemic controls in the world, mandating mass testing and locking down cities such as Shanghai for months. Then, with little warning, the government announced a broad easing of restrictions on Dec. 7, seemingly bowing to economic pressure and rising social discontent following widespread protests in late November.

In many cities, signs of outbreaks have emerged. China reported only seven deaths from Covid so far this week, but reports of crowded crematories and funeral homes have raised concerns about the accuracy of government data. Lines of people have formed at hospitals, and medication has flown off drugstore shelves.

“Opening up is great, but it happened too fast and without preparation. People don’t have these common medicines stocked up at home,” said a pharmacist working at a public hospital in Beijing who only provided his last name, Zhang, given the political sensitivity of the issue.

The Communist Party cast aside restrictive “zero Covid” policy, which  set off mass protests that were a rare challenge to the Communist leadership.

Even before the policy pivot, stocks of fever medicines had already been low, he said, because the government had strictly controlled the sale of cold and flu medication under “zero Covid.” The policy had required buyers to register their names, a rule aimed at preventing residents from using over-the-counter drugs to reduce fevers and avoid detection by the country’s pervasive health tracking system.

“If you ease these restrictions first, say for two months, and open up once people have stuff prepared, then this rush wouldn’t have happened,” Mr. Zhang said.

Many Chinese are now confronting the specter of a massive Covid outbreak that could stretch through the winter, and have been forced to improvise to fill in the gaps. Some are turning to folk remedies like canned peaches, believing they can ward off illness. One group of volunteers organized a social media campaign to deliver aid to older adults in rural areas. The group received plenty of cash donations, but little medicine because of shortages.

In recent days, some Chinese have ventured across the border to Macau to receive the one thing they have less chance of finding than ibuprofen: a foreign-made mRNA vaccine. China has failed to approve such vaccines despite their availability, in an apparent effort to protect the domestic industry. (Earlier this month, Beijing said China would allow German vaccines — but only for German nationals in the country.)

A data analyst in southern Shenzhen, who asked to be identified only by her last name, Fan, traveled to the nearby gambling destination last week to receive an mRNA booster. She believed that the mixture of the booster plus two doses of the Chinese Sinovac vaccine she received at home would strengthen her immunity.

She said she began stocking up on cold medicine, saline nasal sprays and masks as early as mid-November, when cases were climbing in Guangzhou, a neighboring city. When regions across China saw shortages this month, she mailed packages with supplies to dozens of relatives in Shanghai, the northern city of Xi’an and the eastern province of Fujian.

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Social media users have resorted to dark humor to cope with crisis, twisting a government slogan under “zero Covid” that reminds people that “Anyone who should be transferred for quarantine will be transferred for quarantine.” The new version? “Anyone who can have Covid will have Covid.”

The government has tried to reassure the public, saying it is prioritizing efforts to increase the nation’s medicine stocks.

State media reports called the shortages temporary and highlighted a recent push by Chinese drugmakers, under the direction of the central government, to increase supplies. China is one of the world’s largest producers of pharmaceuticals, making roughly one-third of the world’s supply of ibuprofen, a painkiller and fever reducer.

Local governments are also pledging to procure more drugs and distribute them to pharmacies. In the eastern city of Nanjing, officials announced they would add two million tablets of fever-reducing medicine to the market each day, starting on Dec. 18. To stretch out supplies, pharmacies were instructed to unseal packages to sell the tablets individually and to limit purchases to six pills per person.

In the central city of Wuhan, the Hubei provincial government said it would supply three million ibuprofen tablets a week mostly to medical facilities. And in the northeastern city of Jinan, more than a million tablets of ibuprofen were distributed to clinics and pharmacies, state media reported.

China’s rush to address the shortfalls in medicine mirrors the flurry of last-minute deals to bring more vaccines and foreign-made treatments onto the market.

The authorities have approved four domestic vaccines in the past two weeks alone, and the state-owned pharmaceutical company China Meheco Group announced last week it had struck a deal to import and distribute Pfizer’s Paxlovid, an oral treatment found to significantly cut the risk of hospitalization and death. (In April, Pfizer had also signed a separate deal with another Chinese pharmaceutical company, Zhejiang Huahai, to manufacture Paxlovid for the China market.)

The approval of Paxlovid contrasts with China’s treatment of foreign Covid vaccines. The difference in this case is that China has several domestically produced alternatives for Covid jabs, but no antiviral substitute as effective as Paxlovid.

“Paxlovid fills a large gap for China to treat Covid patients with severe conditions,” said Xi Chen, a health economist at the Yale School of Public Health. “There is no clear competitor among China’s domestic antiviral drug producers.”

In a sign of Paxlovid’s high demand in China, boxes of the drug were quickly snapped up last week through a Shanghai-based health care company called 111, Inc. on the first day China allowed the antiviral treatment to be sold online. There have been no reports of online sales since, as the drug remains scarce.

The clamor for medicine has even spilled out of the mainland. In Taiwan, the self-ruled island, the government has urged people to moderate their purchases for China. In the Chinese city of Hong Kong, some pharmacies are limiting how much customers can buy, while others are helping mail medicine across the border.

Wonderful Dispensary on Hong Kong Island charges customers roughly $15 for staff there to ship a package of pills to the mainland. Tony Ng, a clerk who has worked at the store for more than two decades, said the pharmacy was cleaned out of a popular brand of acetaminophen recently.

“The customers told me that they are buying for their family and friends,” said Mr. Ng, 50. “People cannot buy fever medicine in mainland now. They really need it.”

At the Xiehe Hospital in the city of Wuhan, an anesthesiologist who spoke on the condition of anonymity because he was not allowed to speak to the foreign media said his hospital was rationing fever reducers and pain relievers to patients so it wouldn’t run out.

The shortages could have been avoided with proper planning had the government taken a more gradual approach in shifting out of its “zero Covid” phase, the doctor said.

“I never thought a 180-degree change in policy was possible. I thought it would take at least half a year to gradually relax Covid controls,” he said. “We are totally unprepared.”

The growing lengths people must go to in order to secure a box of medicine are sparking anger among some who blame the government for not ensuring a smooth transition out of “zero Covid.”

“When I see the news calling for folks to help each other, I feel it is stupid,” said Simon Zhang, a 24-year-old Beijing resident whose girlfriend is recovering from Covid. “They are asking us not to stockpile and suggesting dividing a box of ibuprofen into several pieces to sell … Why are Chinese people always rescuing ourselves?”

Zixu Wang and Amy Chang Chien contributed research.