COVID-Ravaged Chinese Public Is Desperate for Paxlovid

Since December 2022, when COVID-19 overwhelmed China’s zero-COVID policy, Chinese Americans have been hotly discussing how to ship medicine to China. A devastating wave of hundreds of millions of COVID-19 infections has left pharmacy shelves bare. In a replay of the 2020 Wuhan outbreak, when Chinese Americans desperately shipped personal protective equipment to their families in China, the diaspora is trying to make up for critical medical shortages of drugs like ibuprofen and paracetamol.

One of the hottest ticket items is Paxlovid, a medicine manufactured by American pharmaceutical giant Pfizer that could stop viruses from replicating inside the body’s cells. Paxlovid can only be obtained through a prescription, and a report from Airfinity shows that physicians have only prescribed the drug in about 13 percent of COVID-19 cases in the United States, mostly to patients who are older than 65 or have underlying health conditions.

Chinese social media is full of discussion on Paxlovid. Some Chinese Americans are trying to get a supply of the drug from people who didn’t take the medicine despite receiving the prescription, whereas others are using virtual health care platforms, such as PlushCare, eMed, Truepill, and Push Health. This requires providing a fake positive test result, filling out online forms, and going through a brief online consultation session. It’s not cheap. In a WeChat group with local Chinese students, I found one individual selling a box of unopened Paxlovid for around $500: The Biden administration has paid about $530 for each course of Paxlovid, but patients can get it free of charge.

Some accounts on Red Book, a Chinese social media platform most known for practical advice, claim to be able to obtain Paxlovid, quoting me a price of 8,000 yuan ($1,181) per box. People have adopted creative methods to avoid having the drug confiscated by customs, such as sewing the pills into the pockets of mailed jackets or sticking them into the pages of notebooks. One Chinese graduate student living in Texas admitted that he got a box of Paxlovid through his friend who caught COVID-19, and then put the pills into a bottle for vitamins and mailed it to family in China.

Paxlovid was not well known in China before December 2020’s outbreak, and when it was covered, it was often treated with skepticism. In February 2022, Paxlovid received emergency conditional approval from China’s National Medical Products Administration. When Shanghai faced a wave of COVID-19 this past March, 21,200 boxes of Paxlovid arrived in Shanghai on the evening of March 17. The drug was later distributed to Jilin, Guangdong, Hubei, Hunan, Henan, and other provinces. At that time, Paxlovid was priced at 2,300 yuan ($340) for one course, and many netizens were against the usage of Paxlovid, both for its foreignness and its price.

One article stated that Paxlovid was competing against traditional Chinese medicine (TCM, a government-promoted pseudoscience) like Lianhua Qingwen, attacked the efficiency of Paxlovid, and called supporters of the drug “comprador capital.” A columnist who uses the pseudonym Yaodao Mingyue and writes for several nationalist websites attacked not only Paxlovid but also prominent Chinese scientist Zhang Wenhong, who believed that China should “coexist with the virus.”

Since the new wave of infections began to drown the country in early December 2022 though, Paxlovid has become very sought after. On the afternoon of Dec. 13, Paxlovid was listed on 1Yao.com, China’s leading online pharmacy, at 2,980 yuan ($440) a box, selling out within two hours.

A pharmaceutical sales representative who spoke on condition of anonymity told Foreign Policy that even employees of Pfizer in China can’t get Paxlovid and that manufacturing limitations meant the supply was tightly limited, shipped directly to regional distributors and later on to hospitals. The sales representative also said hospitals that are likely to have supplies of Paxlovid are United Family hospitals, an expensive private hospital chain that caters mostly to international residents and high net-worth individuals. When I called Beijing United Family Hospital, the receptionist said the drug was available only after an in-person visit and a doctor’s prescription and that the demand was far higher than supply, meaning there was no guarantee of availability.

After dragging their feet on antivirals for months, save for the limited imports to Shanghai, Chinese authorities are trying as best they can to scramble in the middle of crisis. On Dec 25, 2022, Beijing issued an “Urgent Notice on Organizing Antiviral Drug Application Training for Medical Staff in Community Health Service Institutions in the City.” Later on, community hospitals in Beijing started to receive limited amounts of Paxlovid; a report shows community health service centers in Dongcheng and Chaoyang Districts received one or two dozen boxes—still far less than the demand.

On Jan. 3, Shanghai’s government announced that Paxlovid would gradually become available in 115 hospitals and 113 community health service centers. Some online discussions indicate that to avoid reselling the drug on the black market, patients who received Paxlovid were required to take the pills in the hospital.

A Shijiazhuang resident confirmed with Foreign Policy that major provincial hospitals might have a limited supply of Paxlovid, and it could be prescribed if the person had the right connections. For example, a friend of the resident with special connections sent her to pick it up at the hospital, with special approval signed by the head of the hospital.

In the evening of Jan. 8, when medical insurance negotiations ended, the National Health Insurance Bureau immediately stated that China would not include Paxlovid into its list of medicines covered by its basic medical insurance plan, blaming the high price quote provided by Pfizer. The plan would, however, include the TMC Qingfei Paidu granules in this list despite a lack of data on its effectiveness in treating COVID-19. When Caixin published this news on its Weibo account, most of the highly liked comments are blaming the government for wasting money on purchasing medicine that isn’t that effective. The most liked comment said, “(the government) spent a lot of money doing COVID-19 testing and building quarantine centers,” implying that China had wasted money on zero-Covid but had not prepared for the outbreak.

Some people in China turn to the black market. One Shenzhen resident started to look for Paxlovid in mid-December 2022, mostly because her father-in-law had severe heart disease and was in poor health. She contacted dozens of people on WeChat, some of whom claimed they knew pharmacy owners in Hong Kong. Others said they had purchased boxes of Paxlovid in the United States and Canada and were waiting for packages to arrive; they claimed to have connections at China Customs as well. “The cheapest price quote I received was 10,000 [yuan] a box. That was mid-December, when not many people were asking about Paxlovid,” she said. She hesitated and tried to bargain but regretted her slowness later after prices surged to between 14,000 and 20,000 yuan and then, at the peak of demand in January, between 40,000 and 50,000 yuan. Right now, the price is reportedly around 16,000 yuan ($2,363), and scams are common.

Like many others, the Shenzhen resident decided to purchase the generic Indian-made COVID-19 drug named Primovir. This drug has not been approved by the National Medical Products Administration, which means selling it in China is illegal. “But we don’t care much about that,” she said. After an extensive search, she purchased Primovir for around 3,000 yuan ($443), a common price in the black market. When her father-in-law was sick in the intensive care unit, she brought it to the hospital. However, doctors decided against its use, considering his liver and kidney condition.

The Paxlovid shortage is one example of increased inequalities in China’s health resources. Data shows that Beijing’s medical and health resources are far ahead of other regions. In Beijing, the number of health workers per 1,000 people was 12.61 in 2020, far higher than in other cities. During this new wave of COVID-19, Beijing not only got more supplies of Paxlovid but the government also sent health care workers from Shandong, Jiangsu, and Hunan to Beijing—despite these regions are also seeing huge waves of COVID-19 infections.

Many rural Chinese may never have heard of Paxlovid. The 598 million Chinese living in rural regions are served by township health centers that have poorer equipment and drug supplies compared to urban hospitals as well as often undertrained and sometimes older staff.

In a township near Shangqiu, for instance, 30,000 people share one health center. When COVID-19 cases reached its peak, more than 300 people flocked into the health center every day, but the health center only had five boxes of ibuprofen; several boxes of Ganmao Qingre granules, a TCM product; and one box of cephalosporin injections, an antibiotic. Health care workers suggested stocking up on medicine to treat COVID-19 before this wave, but it seemed impractical: Due to severe underfunding, the health center still owed money to pharmaceutical companies.

A study published in Frontiers in Medicine predicted that the latest wave of infections would pass through China’s major cities like Beijing, Shanghai, Chongqing, and Guangzhou by the end of 2022. The Chinese government also announced that Beijing has been the first city to pass the peak of the pandemic, and it claims that production and life are gradually returning to normal. But as the Lunar New Year approaches on Jan. 22, millions of people living in the cities are traveling back to their hometowns in rural regions. The first wave may have passed in the cities, but in a depleted and undersupplied countryside, the worst could be yet to come.