Silent Threat of the Coronavirus: America’s Dependence on Chinese Pharmaceuticals
By Christine Crudo Blackburn, Andrew Natsios Gerald W Parker and Leslie Ruyle
As the new coronavirus, called 2019-nCoV, spreads rapidly around the globe, the international community is scrambling to keep up. Scientists rush to develop a vaccine, policymakers debate the most effective containment methods, and health care systems strain to accommodate the growing number of sick and dying. Though it may sound like a scene from the 2011 movie "Contagion," it is actually an unfolding reality.
In the midst of all of this, a potential crisis simmers in the shadows: The global dependence on China for the production of pharmaceuticals and medical equipment.
Chinese Dominance in the Pharmaceutical Market
We represent an interdisciplinary group of scientists and policymakers at the Scowcroft Institute's Pandemic and Biosecurity Policy Program based at the Bush School of Government at Texas A&M University who have been holding annual summits addressing pandemic-related issues for the past five years. One of our goals is to promote dialogue on potential risks related to pandemics and U.S. security, in this case the disruption of supply chains and availability of medical supplies and drugs.
Today, about 80% of pharmaceuticals sold in the U.S. are produced in China. This number, while concerning, hides an even greater problem: China is the largest and sometimes only global supplier for the active ingredient of some vital medications. The active ingredients for medicines that treat breast cancer and lung cancer and the antibiotic Vancomycin, which is a last resort antibiotic for some types of antimicrobial resistant infections, are made almost exclusively in China. Additionally, China controls such a large market portion of heparin, a blood thinner used in open-heart surgery, kidney dialysis and blood transfusions that the U.S. government was left with no choice but to continue buying from China even after a contamination scandal in 2007.
China is not only the dominant global supplier of pharmaceuticals, but it is also the largest supplier of medical devices in the U.S. These include things like MRI equipment, surgical gowns, and equipment that measures oxygen levels in the blood. Supplies of these essential products have not yet been severely disrupted by the coronavirus, but if China is no longer will or able to supply them to the U.S., thousands of Americans could die.
More concerning still are the limited options available to the U.S. and the rest of the globe to make up the shortfall. It could take years to develop the necessary infrastructure to reestablish U.S. manufacturing capacities and obtain Food and Drug Administration licensure to overcome the loss of the Chinese supply.
When a disease reaches epidemic levels, the first obligation for leaders in any country is to protect their own people. As this current crisis progresses, there may come a point when political leaders in China will face decisions on whether to prohibit the export of pharmaceuticals, medical devices and other vital medical components in order to treat or protect their own people. Such acts would be the logical outcome of an escalating situation. For the 2009 H1N1 pandemic response, for example, the U.S. was pushed to the back of the queue for vaccine deliveries even though we had existing contracts with a major vaccine manufacturer located in another country. Those vaccine deliveries were delayed.
Disruption of Global Pharmaceuticals?
While a total loss of active ingredient imports from China might seem far-fetched, we believe the increasing scale of the outbreak moves it closer to the realm of possibility.
About six weeks into international recognition of the epidemic in China, there are already shortages of vital personal protective equipment in both China and the U.S. UPS has transported more than 2 million masks and 11,000 gowns to Wuhan to help alleviate the shortage. But what happens when everyone runs out of protective equipment?
Wuhan is a significant player in the biotechnology and pharmaceutical industry, with multiple pharmaceutical companies located in the city. How many of these factories have closed as a result of the pandemic, and when will those that have closed open back up? Global supply chains could reach a crisis point if they are compromised because Hubei province, where Wuhan is located, is in quarantine and factories are shut down.
Additionally, Wuhan is the location of China's first Biosafety Level (BSL) 4 laboratory, which was opened in 2017 to research SARS and other emerging diseases. It is the only lab in China that can safely handle the world's most dangerous pathogens that pose a significant risk of transmission. Infection, death and quarantine in Wuhan and the surrounding Hubei province is restricting the ability of all types of commerce in the region. Meanwhile, the virus is already creating a significant supply chain imbalance within China. That means those medical supply companies will be under pressure to keep any products produced within the country for protection of their own health care workers, laboratory personnel and the general public.
The regulatory apparatus to insure that the Chinese manufactured pharmaceuticals being exported meet the highest standards of safety and quality control are weak or nonexistent, according to a congressional report last year. The pressure placed on supply chains by the outbreak could further exacerbate existing quality control challenges. In doing so, the virus has highlighted our reliance on China as a U.S. national security issue due to outsourcing our manufacturing capabilities and inability to ensure quality control.
As with all pandemics, the complexity of this outbreak demands international collaboration and transparency. At the same time, U.S. public health officials must acknowledge the country's vulnerability due to our dependence on Chinese production of pharmaceuticals and medical equipment. The U.S. must develop a response plan for the inevitable shortages in the near-term and take necessary actions to reclaim control of our medical supply chain. Continuing to overlook this long-known vulnerability will only lead to catastrophe.
Christine Crudo Blackburn is a postdoctoral research fellow at the Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University.
Andrew Natsios is the director of the Scowcroft Institute of International Affairs and Executive Professor, Texas A&M University.
Gerald W Parker is the associate dean for Global One Health, College of Veterinary Medicine & Biomedical Sciences; and the Director for the Pandemic and Biosecurity Policy Program, Scowcroft Institute for International Affairs, Bush School of Government and Public Service, Texas A&M University.
Leslie Ruyle is the assistant director at the Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M University.
Disclosure statement: Andrew Natsios is affiliated with the Bush School of Government, The Hudson Institute, Scowcroft Institute at the Bush School of Government at Texas A&M Univ, and Fio Corp.
Christine Crudo Blackburn, Gerald W Parker, and Leslie Ruyle do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
Reposted with permission from The Conversation.
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EcoWatch Daily Newsletter
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For centuries, the delicate silver dove has been a symbol of love and fidelity.
Biodiversity and Habitat Loss<p>Their near extinction is a symbol of the <a href="https://www.dw.com/en/global-biodiversity-outlook-targets-extinction-summit-new-york-pledge/a-54932895" target="_blank">biodiversity crisis</a> in the UK, largely driven by habitat destruction. Britain is now one of the countries with the most <a href="https://www.wwf.org.uk/future-of-UK-nature#:~:text=The%20UK%20is%20one%20of,than%20half%20are%20in%20decline" target="_blank">depleted nature</a> in the world according to the World Wildlife Fund. Half its plant and animal species are in decline and more than <a href="https://www.rspb.org.uk/about-the-rspb/about-us/media-centre/press-releases/let-nature-sing-wales/#:~:text=a%20natural%20tragedy.-,Over%2040%20million%20birds%20have%20vanished%20from%20UK%20skies%20in,unaware%20of%20the%20impending%20danger" target="_blank">40 million birds</a> have vanished in just half a century.</p><p>"[Turtle doves] are the canary in the [coal] mine because there are all these other species before it and after it," said Tree. "It's an umbrella for all the other species that are heading that way."</p><p>Turtle doves migrate south through Europe to sub-Saharan Africa between July and September, ending up in dry woodland and farmland areas of countries like Mali and Senegal for winter. </p><p>Droughts in West Africa and the Sahel region are believed to have contributed to the fall in turtle dove species recorded in northern Europe, with low rainfall reducing supplies of the seeds and insects the birds rely on for energy for the long journey home.</p>
Conservation and Farming<p><a href="https://www.operationturtledove.org/" target="_blank" rel="noopener noreferrer">Operation Turtle Dove,</a> a partnership project of charities including the Essex Wildlife trust, works with landowners and farmers to actively build turtle dove habitat.</p><p>Outten works with <a href="https://www.ebws.org.uk/birdsites/blue-house-farm-ewt-north-fambridge" target="_blank">Blue House Farm</a>, a 660-acre nature reserve in the UK county of Essex, where they have replicated weedy fallow plots. </p><p>"We work on it every year to make sure it's in the condition it needs to be with plants such as clovers and black medic," Outten said. "These plants are native to the landscape and produce the seed the birds feed on." </p><p>The birds eat a wide range of seeds from various plants that would have been abundant 50 or 100 years ago, added Guy Anderson, program manager for species recovery with The Royal Society for the Protection of Birds (RSPB). </p><p>"But it's simply true that with the gradual process of <a href="https://www.dw.com/en/farming-without-pesticides-how-can-we-make-agriculture-greener/a-52216796" target="_blank" rel="noopener noreferrer">intensifying our agricultural production</a>, the availability of those seeds has dropped and dropped," said Anderson.</p><p>Part of the project includes supplementary feeding — providing sources of food in the form of seed or grain. Under the Countryside Stewardship Scheme in England, farmers can receive financial support to create a turtle dove habitat. </p><p>Though they haven't recorded an increase in doves across the sites in the four years of working on the project, Outten said they are seeing improvements in how landowners and farmers manage habitat for the birds. </p>
A Turtle Dove Haven<p>The 3,500-acre Knepp Estate in West Sussex is another project taking a different approach and one of the few places where turtle dove numbers are increasing.</p><p>Isabella Tree and her husband Charlie Burrell converted their intensively farmed land into a rewilding project almost 20 years ago. They have let the land return to nature.</p><p>Just one year after they'd finished <a href="https://www.dw.com/en/uks-most-talented-architects-are-not-human/a-35952128" target="_blank">rewilding</a> the southern part of their property, they heard turtle doves for the first time. It's now a breeding hotspot for the birds with an estimated 19 pairs. Knepp is also home to <a href="https://www.rewildingbritain.org.uk/rewilding/rewilding-projects/knepp-estate" target="_blank" rel="noopener noreferrer">2% of the UK's population</a> of nightingales. </p><p>Tree is critical of supplementary feeding schemes that, in her view, are short term. She questions the chances of turtle doves getting to feed on scattered seeds before other mammals eat them first.</p>
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