The public outrage in China over the ineffectiveness of generic drugs, particularly those used in public hospitals, has sparked a rare government response, which seeks to address concerns raised by doctors and citizens alike. Doctors have voiced their belief that the country’s drug procurement system, which prioritizes cheaper generic drugs over more expensive, brand-name medicines, has resulted in cost-cutting measures that compromise patient safety. However, the Chinese government maintains that these concerns are mostly due to anecdotal evidence and subjective experiences, rather than an actual crisis in the pharmaceutical industry.
This controversy began in December when nearly 200 companies, mostly domestic producers of generic drugs, were awarded contracts to supply medicines to state hospitals. The situation escalated in January when a video interview with Zheng Minhua, a director of a hospital department in Shanghai, went viral. Zheng raised alarm about a range of issues, including antibiotics that caused allergic reactions, blood pressure medications that failed to work, anaesthetics that didn’t put patients to sleep, and laxatives that didn’t clear the bowel. His statements were quickly amplified on social media, with many people sharing their own negative experiences with the medications prescribed to them.
For instance, one Weibo user described their experience with a laxative given before intestinal surgery in 2024. Despite doubling the dosage, the medication had no effect, forcing them to turn to coffee to clear their bowel. Such experiences fueled a growing distrust of generic drugs, with some people refusing to take them and opting instead for the original brand-name versions. The issue of ineffective drugs in public hospitals has stirred public anger, particularly because of the perception that low-priced generics compromise quality.
Despite the government’s reassurances about the quality of generic drugs, many users on social media expressed frustration. One Xiaohongshu user, a popular Chinese platform similar to Instagram, claimed they had purchased brand-name antibiotics online after their doctor prescribed the generic version, claiming it tasted different and felt less effective. Posts about the issue have been censored on Weibo, suggesting that authorities are keen to minimize the conversation surrounding the controversy. Some users have expressed their desire to simply be allowed to purchase brand-name drugs privately to avoid using generics.
The root of the problem lies in China’s drug procurement system, which was introduced in 2018. The system was designed to reduce government spending on medicine by enabling local governments to hold competitive bidding processes for about 70% of the drugs required by state hospitals. Generic drugs, which are significantly cheaper than their brand-name counterparts due to the lack of research and development costs, have an advantage in these bidding processes. In fact, the country’s generic drug industry has become one of the largest in the world, both in terms of manufacturing and export.
However, to participate in the procurement process, generic drugs must meet certain criteria to demonstrate they are equivalent to the original branded drugs in terms of quality and effectiveness. While Beijing claims that the procurement system has saved citizens over $50 billion in the first five years, the system’s emphasis on low prices has led to concerns about quality control. For instance, one of the winning bids for an aspirin tablet was priced at less than one cent, raising questions about whether manufacturers could truly produce effective and safe drugs at such a low price.
Some critics argue that these low prices create an environment where manufacturers may cut corners, sacrificing the quality of drugs in order to meet the bidding requirements. Furthermore, questions have been raised about the clinical trial data used to evaluate the effectiveness of generic drugs. In one controversial case, a doctor in Hangzhou suggested that trial data for some generic drugs mirrored that of the original drugs, leading to suspicions of fraud. The National Medical Products Administration responded by attributing the issue to an “editorial error,” and the article was removed.
China is not alone in facing these challenges. The global problem of counterfeit drugs, which are difficult to detect, has affected both generics and brand-name medications worldwide. While cost-effective generics are essential to improving healthcare accessibility, experts argue that stronger quality control measures must be put in place to ensure their safety and effectiveness. This issue is particularly pressing as China’s rapidly aging population strains the country’s healthcare system, with national health expenditure skyrocketing over the last two decades.
The controversy over generic drugs comes at a time when China’s healthcare system is under immense pressure. As the population ages, healthcare costs are rising, and public medical insurance funds are becoming strained. Some provinces are already facing budget deficits, and local governments, traditionally reliant on land sales for revenue, are struggling with debt amidst a broader economic slowdown.
In addition to the mounting pressure on healthcare resources, there has been a broader erosion of trust in the healthcare system. Violent attacks on medical staff have risen in recent years, fueled by frustrations over a lack of resources and diminishing faith in doctors. The government’s response to the generic drug controversy, while acknowledging the problem, is still seen by many as insufficient to address their concerns. The National Healthcare Security Administration has stated that it is taking these issues seriously and will gather feedback to improve the procurement process.
Ultimately, the debate over generic drugs highlights a dilemma: the trade-off between affordability and quality. On one hand, the drug procurement system has saved millions of people money on essential medications, making healthcare more affordable for the masses. On the other hand, the perceived risk of substandard medications being widely distributed threatens to undermine public trust in the entire healthcare system. As China works to address these issues, the outcome will have significant implications not only for the country’s healthcare system but also for the future of global pharmaceutical practices.
