Delays in accessing life-changing or life-saving drugs are leading many Chinese patients to make risky purchases from the internet or from middle-men. The possibility of encountering counterfeit or unsafe products encourages patients who are unwilling to take such risks (and who have the necessary disposable income) to find alternative ways to get the care they need, including travelling overseas for drug therapies and treatments.
Asia is at the centre of a growing medical tourism industry. People from within Asia and beyond are being attracted to ‘hubs’ of medical excellence in Malaysia, Thailand, India and South Korea. This burgeoning trend is a reversal of historical flows of medical tourists from low- to high-income countries.
There is growing attention to intra-regional medical travel within Asia for reasons of cost, quality and availability. A major flow took place from mainland China to Hong Kong, particularly in the form of so-called ‘birth tourism’. This flow — in which mainland Chinese women give birth in Hong Kong so that their children have the right of abode there — was encouraged by Hong Kong’s stronger legal framework and higher quality services. Hong Kong has denied obstetric services to Mainland Chinese pregnant women since 2012. Many Chinese patients also travel to Hong Kong to purchase drugs from small pharmacies without a prescription.
2018 has seen a huge rise in demand from Chinese patients for the Human Papillomavirus (HPV) vaccine administered at private clinics. The vaccine protects girls and young women against a number of cancers caused by HPV, including cervical cancer.
Estimates suggest that two million women travelled to Hong Kong from China for HPV vaccinations in the last two years. The latest HPV vaccine, Gardasil 9, is not currently available in most of China. But approval of earlier and less effective vaccines (Gardasil 4) has raised awareness about cancer prevention and the risks of HPV in China, leading to an exodus of Chinese medical tourists to Hong Kong to receive the best available protection.
Prices of Gardasil 9 have doubled in Hong Kong due to the increased demand and shortages of the vaccine have meant that some Chinese patients are turned away mid-way through their course of injections. The Family Planning Association of Hong Kong announced in April 2018 that it would only vaccinate local residents, causing anger among Chinese women and prompting many to look further afield. Alternative destinations — New Zealand, Singapore and Malaysia — are themselves reporting shortages after a cyber-attack interrupted the production of Gardasil 9 in 2017.
Cancer is the leading cause of death in China and a major public health problem, and the HPV infection is the world’s leading cause of cervical cancer. For Chinese women aged 15 to 44, cervical cancer is the third leading cause of cancer deaths. Current estimates suggest that 62,000 women are diagnosed with cervical cancer annually in China and 30,000 die from the disease each year. Yet no national HPV immunisation program exists in China.
The Chinese pharmaceutical market faces many structural problems and requires concerted reform efforts. New drugs are slow to be approved in the Chinese health system, with products making it into the market up to seven years later than in Europe or the United States. The China Food and Drug Administration (CFDA) is responsible for granting approvals but burgeoning applications and a limited number of government reviewers have led to a regulatory backlog.
By 2014 applications for pending drug registrations stood at 18,597, prompting the CFDA to improve approval timeframes and increase capacity. Chinese authorities have now relaxed regulations that required manufacturers to conduct secondary trials in China after running their global trials, which will bring drugs to the Chinese market quicker.
Despite these changes, the popularity of medical tourism among affluent Chinese is unlikely to decline. For these customers, getting out of China is a matter of life or death. Many will seek help at China’s newly developed private hospitals in pilot zones such as Boao in Hainan province or continue to go abroad for privacy, quality and high-tech interventions.
Meanwhile, the majority of Chinese citizens will continue to experience long waits and poor service quality in the domestic health care system, including for life-saving preventative therapies such as HPV vaccination.
Neil Lunt is Professor in the Department of Social Policy and Social Work, University of York.
Ka Wo Fung is Post-Doctoral Researcher at Hong Kong Baptist University.