China is witnessing an unusual wave of public anger over the effectiveness of generic drugs used in its healthcare system. Concerns have been raised by doctors and patients alike, suggesting that cost-saving measures have led to a compromise in drug quality, thereby impacting patient outcomes. This controversy has forced the Chinese government to address an issue that could erode confidence in its medical institutions and policies.
The debate gained momentum in December when the government released a list of nearly 200 companies that had won contracts to supply drugs to public hospitals. Most of these firms were domestic producers of generic medicines, sparking concerns over quality.
In January, a viral video interview featuring Dr. Zheng Minhua, a hospital department director in Shanghai, intensified the issue. Dr. Zheng cited numerous instances where generic drugs failed to perform as expected, such as antibiotics triggering allergies, ineffective blood pressure medications, and anaesthetics that did not properly sedate patients. His statements resonated with many patients and healthcare professionals, fueling an online discussion that quickly spread across social media platforms like Weibo and Xiaohongshu.
However, discussions about the issue have since been censored on several platforms, limiting public debate while failing to quell growing concerns.
Public hospitals in China source the majority of their drugs through a procurement process that prioritizes cost reduction. This system has led to widespread use of domestically produced generics, which, while similar in composition to brand-name drugs, are often perceived as less effective.
Social media has been flooded with anecdotal accounts of ineffective medications. One patient undergoing intestinal surgery in 2024 reported that prescribed laxatives had “no effect whatsoever,” even after doubling the dose, forcing them to resort to alternative methods like drinking coffee to induce bowel movements. Another user refused to take a generic antibiotic, opting instead to purchase the brand-name version online, citing concerns over taste and effectiveness.
The procurement system’s cost-cutting approach has raised questions about whether pharmaceutical companies are prioritizing profit over quality. A widely discussed topic on Weibo revolved around an aspirin tablet sold for less than one cent, with users questioning whether such low-cost drugs could meet quality standards.
Introduced in 2018, China’s drug procurement system aimed to reduce medical costs by inviting pharmaceutical companies to bid for supply contracts. The system has saved Chinese citizens an estimated $50 billion in its first five years. However, this cost-saving measure has come under scrutiny as some manufacturers, in a bid to secure contracts, may be compromising on quality.
Experts have voiced concerns that companies winning bids at ultra-low prices might struggle to maintain high manufacturing standards. Stacy Zhang, an associate professor at NYU Langone Health, warned that low-cost production might lead to ineffective medications, undermining patient safety. Additionally, despite government assurances, some argue that the procurement process has made access to imported drugs more difficult, further fueling distrust in generics.
A group of 20 doctors, including Dr. Zheng, submitted a proposal to Shanghai authorities highlighting suspicions of data manipulation in generic drug trials. According to Dr. Xia Zhimin, a physician in Hangzhou, some generic drug trial data appeared identical to those of their brand-name counterparts, suggesting potential fraud. His findings were swiftly dismissed by the National Medical Products Administration as an “editorial error,” and his article was subsequently removed from public platforms.
China’s healthcare system also faces the threat of counterfeit drugs, a global issue recognized by the World Health Organization. Fake medications whether generic or brand-name pose serious health risks, further complicating the trust crisis in China’s pharmaceutical industry.
This controversy comes at a time when China’s healthcare system is grappling with mounting challenges. A rapidly ageing population has driven healthcare costs to new heights, with total health expenditure reaching $1.25 trillion in 2023. At the same time, many local governments, heavily reliant on land sales for revenue, are struggling financially due to the country’s real estate crisis.
Adding to the strain is a growing trust deficit between the public and healthcare institutions. Violent attacks on medical staff have increased in recent years, driven by frustration over poor hospital conditions, limited resources, and expensive treatments.
The government’s response to the generic drug controversy has been to downplay the issue, arguing that drug effectiveness varies by individual. However, these reassurances have done little to ease public concern. The National Healthcare Security Administration has pledged to address safety concerns and improve the drug procurement policy. Some experts have suggested strengthening quality control measures and improving drug approval processes to ensure greater transparency.
The generic drug procurement system was designed to balance affordability and accessibility, yet its credibility is now in jeopardy. While saving billions in healthcare costs, it may also be inadvertently putting patients at risk. The Chinese government must find a way to rebuild public trust whether through stricter regulation, greater transparency, or allowing more choice in drug selection.
For now, many Chinese citizens remain skeptical. As one Weibo user put it, “Saving money on drug prices is just a drop in the bucket for China’s healthcare system. But allowing ineffective drugs to flood the market is like drinking poison to quench thirst.”
