KUALA LUMPUR - China's control of the base ingredients to make medicines gives the Asian giant leverage over the production of a coronavirus vaccine no matter who wins the global race to discover it.
A host of nations such as the United States, United Kingdom, France and Australia - even Singapore and Malaysia are on the list - are desperately pursuing a vaccine to end the pandemic that has infected nearly six million and killed more than 350,000 since it was discovered in the central Chinese city of Wuhan in December.
While there is no exact data on China's market share of the core components used in pharmaceuticals, New York-based bioethics research institute Hastings Center's senior adviser Rosemary Gibson told The Straits Times that China controls about 80 per cent of global production of the raw materials and chemicals required to manufacture generic medicines.
This could give Beijing a crucial advantage even as tensions with Washington have intensified during the Covid-19 outbreak amid a blame game over the cause of the highly infectious disease that has put more than half of humanity into various levels of lockdown.
"That certainly gives you an advantage and potential monopoly position over the manufacture of it," Ms Gibson said in an online briefing early on Wednesday (May 27) on medical supply chains by the Washington-based National Press Foundation (NPF).
She added that it was a huge problem for the US as, aside from a Covid-19 vaccine, the US "can't make antibiotics any more" for related respiratory illnesses like pneumonia and bronchitis.
"We depend on China largely for those core chemicals as does the world," she said.
On paper, China has only 13 per cent of global manufacturing facilities of active pharmaceutical ingredients (API) that are mixed to create a finished drug. While this is less than half of the US' share, its Senate Finance Committee chairman Chuck Grassley wrote last year that 80 per cent of APIs used in drugs consumed by Americans are imported, largely from China and India.
China also holds a near-monopoly further upstream on thousands of key starting materials such as chemical intermediates and ingredients from antibiotic fermentation plants and pigs. The Asian superpower's pharmaceutical industry has benefited in the past from cornering the supply chain by increasing manufacturing capacity and what Ms Gibson said were cartel-like practices such as price-fixing.
The US stopped making penicillin antibiotics in 2004, with China winning a price war that Ms Gibson said was aided by government subsidies. China dominated over two-thirds of penicillin production in 2006 before prices more than doubled in 2007.
India may appear a viable alternative supplier, but even its huge generic drugs industry relies on China for 69 per cent of its raw materials.
However, concerns over Beijing holding the world to ransom could be tempered by the interdependence on trade for healthcare goods used in fighting the coronavirus.
Senior trade policy analyst Sébastien Miroudot of the Organisation for Economic Cooperation and Development (OECD) said that, during the pandemic, there have not been similar shortages in pharmaceuticals as seen in goods such as protective gear, test kits, disinfectants and ventilators.
OECD data shows that no country in 2018 had more than 15 per cent of the global share of exports of these items. Singapore was 13th and Malaysia 17th behind global leader Germany.
"Indeed, while the United States and Germany tend to specialise in the production of medical devices, China and Malaysia are most specialised in producing protective garments," it said in a May 5 report which showed the US and China were in the world's top four of both imports and exports of medical equipment needed during the coronavirus pandemic.
Mr Miroudot added during the NPF briefing that "countries are specialised in specific types of Covid-19 goods and depend on each other".
"The top exporter of face masks is China but if we look at intubation kits, the top exporter is the US, if we look at surgical gloves it is Malaysia. It is really a world of trade interdependencies," he said.