Coronavirus and public health, the Chinese lesson
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The alarm coronavirus led to the erection of a new Great Wall for China and its population, 1 in 5 inhabitants of the planet earth. In a historical period that is characterized, coincidentally, by the trade tensions unleashed by the administration of Donald Trump towards the Middle Empire. Beyond the collective hysteria, the coronavirus it will probably claim fewer victims than those caused each year by the zoonoses that plague the agri-food chain in the United States.
The Chinese Lesson on public health, in hindsight, goes beyond the brilliant management of an emergency in cities and provinces with a high population density. Instead, it concerns the extraordinary public investments to guarantee the Universal Health Coverage (UHC). That is to say universal health coverage, in a country that is home to nearly 1,5 billion people. (1) And a drug and treatment policy that will certainly benefit the global health system.
Universal health coverage, the Chinese lesson
The Chinese government - the only one capable of planning long-term policies - has established a commitment to improve the effectiveness, efficiency and accessibility of the public health service. Investments in public health quadrupled between 2008 and 2017 to reach € 197,4 billion. With an annual growth rate of 150% compared to GDP (+ 12,2% vs. + 8,1%). The share of GDP destined for healthcare thus increased, from 4,5% (2008) to 6,4% (2017).
'Ensure healthy lives and promote wellbeing for all at all ages' (SDG 3).
Funding of hospitals which have doubled in the last five years, now amount to € 34,3 billion / year. With the aim of doubling its capacities, by 2030, for a total expected value of € 2,1 trillion. The hospitalization rate rose from 7,4% in 2010 to 13,5% in 2016, with no significant differences linked to the income of the population. In this way, both the renunciation of hospital care and the differences between provinces in terms of maternal mortality decreased significantly (with marked reduction in the poorest areas.
Public commitment to finance universal health coverage, it involved a radical change in the composition of overall health expenditure. Its coverage is currently guaranteed (in primis) from public insurance (42%) and public health expenditure (30%). With a drastic decrease in the component of expenditure borne by citizens (from 50 to 28% between 2008 and 2017), which is currently being further reduced. (2)
Drug prices
Achievement of goals it required and still involves extraordinary investments in infrastructure, technology, human and professional resources. But the Chinese government has also intervened on the control of drug costs, by imposing a Big Pharma a drastic reduction in their prices to ensure their access to the largest population on the planet. Thanks to this policy - which also translates into an unparalleled economy of scale, in a logic win-win - the same drugs now cost less than half in China than in the US.
Some examples (source Drugs.com):
- Entecavir (drug used to treat hepatitis B), 0.5mg, 28 tablets. US price CNY 83,16 (€ 10,81), China price CNY 17,36 (€ 2,26),
- Atorvastatin (for the treatment of hypercholesterolemia), 20mg, 7 tablets. US price CNY 58 (€ 7,54), China price CNY 6,6 (€ 0,86).
China's impact on the global health system
The prices of drugs generics are more than halved in China compared to those in force in the USA (-52% on average), those of some pharmaceutical companies (eg Pfizer, Roche, Merck) reduced by up to 70% and sometimes even more. Thanks to government collective purchasing programs. The pharmaceutical giants have registered a growth rate and an overall volume of sales in the Middle Empire that cannot be overlooked. In an unprecedented balancing process, which will have a sure impact on the global market.
Beijing it also revamped its new drug approval system, which is now faster than in many other countries. Among other things, attracting new venture capital loans - which have quadrupled in the last 4 years to reach € 15,9 billion - in favor of start-up in the biotechnology sector (source ChinaBio LLC). Investments (private as well as public) in research are therefore added to medicines at fair prices.
'The stakes it is not just the well-being of millions of Chinese people, but the future of the global health sector. China has set its sights on creating a Holy Grail healthcare system that meets patient needs and controls costs while encouraging cutting-edge research - and the world is watching. ' (3)
Dario Dongo
Note
(1) And China will in fact be the first, perhaps the only one, of the 194 WHO Member States (World Health Organization, or WHO, World Health Organization) to achieve Sustainable Development Goal no. 3, in the UN Agenda 2030. A brief summary of the Sustainable Development Goals (SDGs) in the UN Agenda 2030 on https://www.egalite.org/category/sdgs/.
Regarding SDG 3, see https://sustainabledevelopment.un.org/sdg3
(2) For further information see Gavino Maciocco. China: 10 and 70. International Health, 16.10.19,
(3) Dong Lyu, Rachel Chang and Adrian Leung. China Is Striving for the World's Best, Cheapest Healthcare. Bloomberg News, 20.10.19
Dario Dongo, lawyer and journalist, PhD in international food law, founder of WIISE (FARE - GIFT - Food Times) and Égalité.
