BEIJING - As Covid-19 infections soar across China, a shortage of antiviral medicine such as Pfizer’s Paxlovid appears to be spurring people to turn to the black market.

The country’s abrupt U-turn on its zero-Covid policy in early December surprised health experts and residents, as officials appear to have done little planning for the inevitable rise in cases that comes with reopening. That includes easy access to antiviral therapies that can be used by people who test positive and are at higher risk of hospitalisation, such as the elderly.

The worsening outbreak is boosting demand for such treatments, but the Chinese have found the drugs in short supply across the increasingly strained healthcare system. People are seeking out online sales channels to source generic versions of the drugs made elsewhere and not approved for sale in China, social media posts and newspaper reports show.

One user on the popular Twitter-like Weibo platform said on Sunday that she was buying generic Paxlovid made in Bangladesh because she had an elderly relative and could not get a hold of any in China.

She said in the post, which has been removed, that while she had heard that China had imported tens of thousands of boxes of Paxlovid, ordinary residents were not able to access the potentially life-saving medicine. 

The same day, another Weibo user called for easier and quicker access to the pills. The poster shared a picture of an advertisement for generic versions of Paxlovid made in India that can be shipped the same day as the payment date and arrive in two to three weeks. 

Those who can get their hands on antivirals are paying huge premiums. The 21st Century Business Herald reported that an unidentified white-collar worker in Guangdong paid 5,800 yuan (S$1,120) to a Hong Kong agent for a box of Paxlovid, more than double the official price in China.

The Paper, a Shanghai-based publication, reported that purchasing agents have sold more than 50,000 boxes of foreign generic antivirals since the government’s first tentative steps towards easing zero-Covid in November.

Mr Hu Xijin, the retired editor-in-chief of state-backed tabloid the Global Times and a vocal pro-government commentator, joined the chorus lamenting the high price and noted dissatisfaction among Chinese. 

It is unclear whether China is prepared to satisfy the huge demand, according to Dr Siddharth Sridhar, clinical assistant professor in the University of Hong Kong’s Department of Microbiology. “Even if there is enough Paxlovid for China’s large population, a distribution infrastructure to get these pills to patients in time isn’t something that can be set up overnight,” he said.

When China was still trying to keep out the virus, securing adequate supplies of antivirals was described by top health officials like Professor Liang Wannian as essential before the country would consider reopening. The sudden about-turn on Covid-19 means that the under-vaccinated elderly population that benefits most from such drugs is highly vulnerable.

The supply strain may also be intensified by heightened concern among Chinese about the dangers of Covid-19 after three years of propaganda that painted the virus as exceptionally deadly.

As the government’s official stance changes – one top medical adviser likened it to a cold – so has public messaging. State media has published articles warning that not everyone needs to take antivirals.

Earlier this week, a top infectious disease doctor said patients needing the therapies should take them under medical supervision, and the therapies are not suitable for people already taking certain medications.

Increasing supply is also complicated, and there is little transparency over how much is available in China.

Paxlovid is the only foreign Covid-19 medicine approved by China’s regulator for nationwide use, though AstraZeneca’s preventative antibody drug Evusheld can be accessed in a medical pilot zone on the southern island of Hainan.

State-owned China Meheco said last week it reached a deal with Pfizer to import and distribute the latter’s antiviral. Pfizer in August also announced a deal with Zhejiang Huahai Pharmaceutical to make ingredients of Paxlovid in the country.

Pfizer said it is collaborating with all stakeholders to secure an adequate supply of Paxlovid in China and stays committed to fulfilling the treatment needs of patients in the country and worldwide. It said it is committed to bringing medicine, including Paxlovid, and therapies that will benefit Chinese patients as soon as possible. 

As a prescription medication, Paxlovid’s purchase channel will strictly align with government regulations, Pfizer said. The company continues to evaluate options to increase capacity, including opportunities to expand manufacturing capabilities, increase supplier base for key materials and contract manufacturing options for its supply chain, it said.

Meheco did not respond to an e-mail or phone call seeking comment. Media outlet Yicai reported on Tuesday, citing a phone call in which a journalist posed as an investor, that Meheco did not expect sales of Paxlovid to surge despite the massive waves of infection.

Merck’s molnupiravir is not approved, though in September it said it struck a deal with a state-owned drugmaker to import and market the pill.

Even what China can produce domestically does not always make it to its own residents. 

As part of efforts to provide generic low-cost antivirals to developing countries, the United Nations-backed Medicines Patent Pool (MPP) programme in March authorised five Chinese companies to make Paxlovid, but exclusively for export. The group includes Huahai, which struck a separate deal with Pfizer to make Paxlovid for China’s domestic market. 

A representative in Huahai’s investor relations department said it has not started making generic versions of Paxlovid under the MPP agreement, and declined to comment on whether the company has started production of Paxlovid ingredients for the China market under the deal with Pfizer.

Some local companies are developing antivirals, too. Henan Genuine Biotech has received approval for the drug Azvudine, an HIV treatment that doctors can now prescribe for Covid-19 patients. An antibody cocktail therapy developed by Brii Biosciences has also been given the green light, but it requires infusion at hospitals.

For now, there is no end in sight to the antivirals shortage. Last Friday, a hospital in the north-eastern city of Jinan began offering Azvudine, sparking an endless stream of inquiries and buyers, Qilu Evening News reported.

While the hospital limited each person to two boxes, by Sunday it had sold all of its 5,000 pill supply. BLOOMBERG