The label "Made in China" appears with growing regularity on all manner of products, from clothes to household appliances to office equipment. China's economy has undergone a massive expansion, churning out huge quantities of cheap consumer goods.
But almost unnoticed, the country is poised to capture another market niche as well. More than half the worldwide supply of prescription medications originates in China.
And when it comes to over-the-counter drugs, the numbers are even more striking. China manufactures virtually the entire global supply of aspirin, along with enormous quantities of other analgesics, such as ibuprofen and acetaminophen.
There's a reason we haven't heard about this. Most of the drugs sold in Canada are stamped "Made in the U.S.A."
And technically, that's true. The pills are assembled and packaged at American plants, by companies with names like Bayer and Pfizer.
But the active ingredients for these medications, called fine chemicals, are more often than not made in China.
The explanation, of course, is cheap labour. The average wage in China is a tenth of the Canadian rate.
But industry watchers are concerned that quality controls in that country are at best unreliable. They point to a series of troubling incidents.
In 2007, 81 people in the U.S. died after taking Heparin, a blood-thinning drug made from Chinese ingredients. It emerged that Asian manufacturers had used a cheap substitute to save money.
There were also deaths in several other countries, while Canada ducked the disaster more by good luck than good management.
In 2008, a Chinese firm tried to increase the protein content of its baby formula by adding a toxic contaminant. Close to 900 infants were hospitalized and several died.
These episodes are alarming enough in themselves. But they point to structural challenges that will not easily be remedied.
In China, manufacturers of drug ingredients are often small family businesses scattered far and wide. That makes them hard to regulate.
And the oversight process itself is anything but robust. After the baby-formula scandal, the federal supervisor of China's quality assurance program was fired, two individuals were executed and several others received long prison sentences.
Apparently official corruption remains a reality, and the mindsets that go with it will be hard to eradicate.
Understandably perhaps, this is an issue that our own government is reluctant to discuss. Alan Cassels, a drugpolicy expert at the University of Victoria, recently asked Health Canada how it monitors production abroad. He says the ministry wouldn't answer some of his queries because that information is proprietary.
But the real problem is scale. In 2009, there were 920 pharmaceutical manufacturing sites in China. And that number may double over the coming decade.
It is burdensome to maintain surveillance at so many distant locations, and China is only part of a broader picture. There are close to 4,000 drug plants worldwide, many in countries with serious domestic difficulties.
Yet this is a challenge that the government of Canada must face up to. Our quality-assurance systems were built for bygone realities and simpler times.
If we're going to outsource the production of these essential supplies, we require a far more aggressive monitoring program.
The cost need not fall on our shoulders alone. Industry has a responsibility to step up and other western nations must play their part.
But this feels like an issue that sneaked up all of a sudden and caught us unprepared. And unlike some of the policy dilemmas that swirl around Ottawa, this one has lethal implications.
The provinces can't help here. By law, this is squarely a federal responsibility.
When it comes to health matters, Stephen Harper has led from behind. This would be a good moment for the prime minister to step forward.
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