Negative Side of Panda Blood
Nearly four million people in China have Rhesus-negative blood, yet crucial drugs to counteract the complications which can arise in expectant mothers are illegal in China. People are turning to smugglers to source life-saving injections
Xi Xi (pseudonym), a mother who lives in southern China's Shenzhen, commutes between the city and Hong Kong at least once a month. Unlike other purchasing agents from the Chinese mainland who return laden with infant formula, cosmetics or luxury goods, Xi Xi's mission is more crucial, and a vital one for thousands of pregnant women. She visits drugstores in Hong Kong to buy injections of Rhesus immune globulin – commonly referred to as RHIG – for pregnant women with Rh-negative blood, which because of its relative rarity in China, is widely known as “panda blood.”
RHIG is a biological blood product given to pregnant women with Rh-negative blood to prevent hemolytic disease in newborns with Rh-positive blood (which would ordinarily mean the mother would produce antibodies that could attack the fetus). This can cause anemia or jaundice in babies, and without immediate blood transfusions, the infant may die. The solution is life-saving RHIG in- jections – given twice at 28 weeks and one 72 hours after birth, but because they are still not approved for use on the mainland, mothers-to-be often have to resort to lessthan-legal channels to access them.
Xi Xi, who has Rh-negative blood, became aware of the problem when she fell pregnant more than four years ago. To ensure her son's safe birth, she also had to obtain RHIG from Hong Kong, which led to her becoming a purchasing agent. Now she has a group on Chinese social media chat
application with nearly 400 people.
In July 2018, Dying to Survive, a film about a man who went to India to buy cheap generic drugs for Chinese leukemia patients, was a smash hit. Based on a true story, the film struck a chord with people who have Rh-negative blood.
“In the film, the drugs from India to cure leukemia are genuine, even though a majority of [poor] patients still can't afford them,” one mother who has Rh-negative blood said. “RHIG is totally unavailable in China, which is even sadder.”
Unavailable Treatment
Yu Jingjing, an expectant mother, realized that her blood was Rh-negative only when she went to register at a community hospital in Hefei, capital of Anhui Province, 26 weeks into her pregnancy. Before that, she had checkups at a local major hospital and was never told of the issue of Rh-negative blood and pregnancy.
After a sleepless night, Yu and her husband went to another major hospital, where they were told she needed the two injections of RHIG. But the shots were “unavailable in Anhui and the easiest solution was buying them in Hong Kong,” the doctor said.
“We'd never been to Hong Kong and we didn't know where to get the medication. On top of that, we knew nothing about how to go about doing the injections,” Yu said. After seeking help online, the couple contacted chinarareblood.cn, a private platform dedicated to helping mothers-to-be with Rh-negative blood. After sending a hospital report and filling in a letter of authorization, the couple received two injections in low-temperature packaging.
Yet when they rushed to the hospital, the couple was told that according to regulations, the hospital cannot inject medicines for patients that are not sold at the hospital. The couple tried several other hospitals in the city, but were turned away from all of them.
“I was really in despair, weeping alone at night,” Yu said. As the 28th week drew near, she went to her hometown, two hours from Hefei. She begged doctors at a small community clinic, and was relieved when they agreed to give her the injection. Yu later safely gave birth to her child and received her two shots on time.
“I think I'm the lucky one. I heard that some expectant mothers had to inject themselves after gleaning what information they could online,” she told our reporter.
On July 9, 2018, Ji Lianmei, a former pharmacist at the private Beijing United Family Hospital, posted an update on Weibo, China's Twitter-like social media platform, after watching Dying to Survive. She said that three out of 1,000 people have Rh-negative blood in China, meaning that the total number is almost four million. She called on doctors, pharmacists, patients, hospital management staff and media to make more public awareness to bring the medication to the mainland as soon as possible.
Chinese health authorities have not published figures about the number of people estimated to have Rh-negative blood, but academic studies have put the figure at roughly 0.3 percent, in line with Ji's figure. It also means that people with Rh-negative blood struggle if they need blood transfusions or operations.
Duan Tao, founder of Spring Field Hospital MGMT and former director of the Shanghai First Maternity and Infant Hospital, told Newschina that because of the relatively small number of Rh-negative blood carriers in China and the lengthy process to introduce medications, particularly overseas ones, pharmaceutical enterprises are not motivated to bring RHIG to the mainland market.
Duan added that a few years ago, a few foreign hospitals in China had been using RHIG secretly, but alongside the tightened medical policies and management, it is completely prohibited. Duan had tried to contact overseas pharmaceutical producers, but there was no progress.
In 2008, Lin Feng, founder of chinarareblood.cn, contacted Johnson &
Johnson, one of the main producers of RHIG, over the introduction of the drug but received a negative response instantly. “Back then, the manager in charge of the North American market told me that the Chinese market is so small and the Chinese government did not have a requirement to import it. Even if the company was willing to bring it to China, the profits would be low and the price would be very high,” he told Newschina.
Lin added that hemolytic disease in newborns mainly occurs in the second baby, and over the past dozens of years, there was low demand for RHIG because of China's family planning policy. After the one-child policy was abolished, having Rh-negative blood has become more of an issue for expectant mothers. They have started forming alliances to help each other, including purchasing the drug from Hong Kong.
It is not plain sailing. In February 2017, a woman surnamed Wang and her husband were detained and questioned at the Luohu port of entry in Shenzhen. The couple was fined 4,000 yuan (US$580) for illegally carrying 54 RHIG injections without having made a customs declaration.
Risks and Costs
Since 2015, when every couple in China was allowed to have two babies, Lin Feng has found that more and more purchasing agents have become involved in the business. He said the temperature needed to safely preserve RHIG is 2 to 8 Celsius, so some purchasing agents are unable to keep it within the safe range.
“There is virtually no threshold for purchasing agents. There will certainly be problems when anyone can cash in on the business,” he said, adding that his team began buying for people with Rh-negative blood on the mainland in 2006, and so his process is secure. Lin said that each year chinarareblood.cn has offered advice to 3,000 to 5,000 people and purchased medicines for many of them, but he warned “that is not the only challenge for people with panda blood.”
Yu Jingjing was ready to give birth to her child at a private hospital but after the hospital learned that she had Rh-negative blood, it decided not to admit her. Duan understands the difficulties hospitals have. “If there is hemolytic disease in newborns, there's a high likelihood they will need a blood transfusion. The risks and costs will be very high, and few hospitals in the country are capable of doing it,” he said. “Without medicines and blood, what hospital would dare take on the responsibility?”
In 2008, the Chinese Academy of Medical Sciences and Peking Union Medical College conducted research on rare blood banks in China, discovering that the reserves of rare blood are scattered nationwide and most blood banks are plagued by supply shortages and homogeneous types. When there are emergencies, it is difficult for hospitals to source enough blood on time, so some Rhnegative mothers-to-be even prepare blood for themselves in advance.
To make matters worse, many doctors know little about panda blood and related medical diagnosis and treatment. According to Duan, China lacks a complete set of diagnostic and treatment rules for women with Rh-negative blood. “The diagnosis and treatment for them is a yardstick to measure the comprehensive management capabilities of hospitals,” he said.
In his opinion, diagnosis and treatment for Rh-negative mothers involves cooperation between various departments, including postnatal care, pediatrics, anesthetics and blood banks. If RHIG were available on the mainland, he added, the entire medical process could be restructured.
In June 2017, the National Health Commission, the Ministry of Industry and Information Technology and the China Food and Drug Administration issued the second R&D priority list for 39 pediatric drugs, among which RHIG was listed.
In the second half of 2017, Lin partnered with a small pharmaceutical enterprise which is willing to produce RHIG for the Chinese mainland market. Not long ago, he received a notice from the company: On January 1, 2018, the introduction of RHIG has passed the clinical phase of national authorization and it is expected to hit the market in three to five years.
“RHIG is a very mature medicine with a very mature regulatory environment, and it's suitable for fast-track administrative approval,” Duan said. “Cancer drugs have already been given priority access and pricing in the Chinese mainland market. Medications for Rh-negative blood carriers should follow the same pattern and enter the market as soon as possible.”