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April 16, 2020

Breaking the encirclement: The story of Chinese pharmaceuticals in Ghana

By Liam Lee, Chief international desk correspondent at Ta Kung Pao Daily. First published in Chinese under the title 冲出包 一家中国制的加 in Ta Kung Pao Daily, and in Hong Kong in Wenwei Daily.

This is a typical dry and warm night in Accra. The Tang Palace Hotel, with its ceiling shaped like the Chinese character “ren”, appears magnificent. It is here that Wang Yafeng gently tells his story.

After seven years, Wang finally succeeded in breaking the encirclement of enterprises from Europe, America as well as India, and gradually began taking up a share of the local anti-malaria market.

Mr. Wang Yafeng (Photo: Liam Lee).

However, what is less known is that Wang had to also face three annoyances. The first one is that the strategy of relying on a single anti-malaria drug doesn’t always work since orders from major clients are in decline. The second one is that he must try his best to maintain the fame of Chinese medicine when there are some low credibility drugs from China in the market. And the last one is that markets in Ghana and in China are different, so he has to grasp the wisdom of the local market while transplanting Chinese experience.

When mentioning Chinese people in Ghana, locals would generally first think of the “gold rush”, and next of “construction”.

Wang spent seven years breaking this stereotype.

Throw straws in the air

He chose anti-malaria medicine as a direction to enter the pharma market in Ghana and gained huge success.

The market for anti-malaria medicine has long been taken up by transnational enterprises and world leading companies like Novartis and the French company Sanofi. The coming of Wang Yafeng and other Chinese pharma representatives disturbed the peaceful surface of the market in West Africa.

He remembers that they didn’t choose to take on European and American pharma companies directly but opted to provide the anti-malaria fluid named artesunate for injection use because the other companies were producing oral medicine. In this way, his company gradually took up market share and then imported more anti-malaria production from China.

The medicine that Wang Yafeng brought for injection use is called ARTESUN, and its annual sales volume has been growing at over 10% since 2013. Sales in Ghana included an order of US$5 million from the Global Fund, an international aid institute in the field of medicine and hygiene. The reason for their success in obtaining this large order is that their product was awarded a preliminary certification by the WHO.

Charlotte Akinnifesi is a young shop assistant at a big community pharmacy in western Accra. Standing in front of the shelves with various drugs, she picks up a box of cooling ointment without thinking when I asked about Chinese medicine.

Later after a message from Kelly Larsen, a well-dressed medical representative working under Wang Yafeng, she took out the modernly packaged anti-malaria medicine.

I thought it was from France if you didn’t tell me. It turns out to be Chinese medicine, she said.

Charlotte Akinnifesi holding the ointment oil from China (Photo: Liam Lee).

The tablet in her hand was made by Guilin Pharma, a subsidiary corporation of FOSUN Pharma which is a leading healthcare group in China.

Wang didn’t feel angry at Charlotte at all.

Globalization of our brand serves as an important marketing strategy of our company he continued, there are still many people in Africa who have an unshakeable belief in European and American pharma.

In October 2017 FOSUN Pharma invested about 63 million euros in acquiring 100% of the stock of Tridem Pharma, the third biggest medicine company in the French-speaking area of western Africa. Though they are two independent operating teams, some of the medicine imported from China would be transported to France first and then to Ghana. It is this process that makes people like Charlotte mistake them for French medicine.

Xiao Ning, a researcher at the National Institute of Parasitic Diseases at the Chinese Center for Disease Control and Prevention in Beijing, explains why Wang Yafeng chose anti-malaria as a trailblazer.

She says that the major infectious disease in Africa has been malignant malaria, the control and inhibition of which have been included in the 2015 global development goals of the UN.

On the other hand, China is set to completely root out malaria within China in 2020. However, the extent of malaria in Ghana is still grave. According to a special report on Ghana issued by the WHO, malaria is the leading cause of death among children in Ghana. Statistics provided by Xiao Ning indicates that imported cases of malaria from Ghana to China from 2013 to 2015 accounts for over 30% of the total external input, more than any other country in the world.

Wu Wenda, former vice director of the Bill & Melinda Gates Foundation said in Beijing that getting the preliminary certification means a huge market is guaranteed.

No matter if overseas governments do the purchase by themselves or through the Global Fund and other international institutes, they will not refer to Chinese standards. He continued,

Getting a preliminary certification takes a lot of money and time, and also requires the involvement of high technology. But once a virtuous circle is achieved, the company will benefit from it.

Tang Yi, a coordinator at the expanded immune project of the WHO in Beijing, provided a list of names indicating that most registered medicine from Chinese producers are anti-malaria drugs.

Global Fund windfall on the wane

Chinese companies planned to enter the western African pharmaceutical market by introducing anti-malaria medicine first, and then to introduce other products. But they soon discovered that a time came that the strategy didn’t work anymore: The amount of medicine ordered by the Global Fund, one of the major clients, started to decline.

OSON is a drug shop that started in Kumasi city, and this Ghanaian family business is now the third largest drug dealer in Ghana. Justice Kwaning is the second generation owner of the company. The buckle on the sleeve of his French T-shirt shines with a golden hue, giving him an air of a “pharma tycoon”.

Justice Kwaning, the “pharma tycoon” in front of his store (Photo: Liam Lee).

As one of the drug dealers in Ghana, he says that orders from the Global Fund for anti-malaria medicine have nearly ceased. According to the project framework (a document indicating the ratio of investment of different parties), the Global Fund accounts for 98% of the purchases of these medicines.

Statistics from the Global Fund indicate that its total funds available for anti-malaria projects have decreased from US$3.2 billion in 2017 to US$2.7 billion in 2018. In Africa, the Global Fund now devotes more efforts to popularizing the use of nets for preventing mosquito bites, and they are also giving high priority to developing an anti-malaria vaccine. In 2019, the world’s first anti-malaria vaccine approved so far, RTS, landed in three countries for testing. The designer and producer of the vaccine is the UK-based company GSK.

The process of expanding their market share has never been a smooth one for Chinese companies.

Chinese experience: The gains and losses of localization

 Due to the huge homeland market, Chinese companies were latecomers in entering foreign markets. It was only ten years ago that they began to enter African markets, in contrast to Indian pharmaceuticals who entered African markets at an earlier stage.

Praveen Pandey, an Indian specialist on the African pharmaceutical market, is now working as a country manager for a Chinese company. He is a real genius when it comes to marketing medicine. After graduating from the University of Bangalore where he studied genetics, he worked at several Indian pharmaceutical companies, including the transnational company CIPLA. His last job was as a marketing representative of Aspen of South Africa.

Praveen Pandey, country manager from India working for a Chinese company (Photo: Liam Lee).

He has his own experience in dealing with doctors, which is to "be friendly but not to be friends". He tries everything he can to recommend medicine to doctors by using few words. However, they commonly also reject the medicines he recommends.

Praveen Pandey says Indian companies have long been aiming at the African market, while Chinese companies were the latecomers. He also claimed that Chinese medicine were better than Indian ones when it comes to quality. He gave me the example of an Indian pharmaceutical company specializing in producing low quality pirated medicine called Bliss, which is so famous in Africa yet nobody knew of it back home.

In fact, the local pharma communities did not accept Wang Yafeng when he firstly came to Ghana, for they thought that his product is of low quality and low price. Many people would refuse them as soon as they heard the products were made in China.

Wang still remember his experience when he met a senior doctor.

It was an unhappy experience once we met each other. He didn’t trust the statistics from China or the effect of our medicine and drove me out of his clinic. Later on, I paid a visit to him with statistics from the locals and he began to accept me and then we became close partners.

Doctors in Ghana have a very high social status, and all professional certifications are awarded by presidents of Ghana. Wang says in Ghana, the process of diagnosis and prescription are separate, so the process might differ among doctors.

This resembles that of China. In order to take a share of the pharma market, many medical representatives try to lobby doctors to prescribe more medicine. In the meantime, they also need to build a close connection with the directors of pharmacies for whom they can suggest what medicine to use. 

In fact, it is a common marketing strategy that medical representatives give doctors brokerage for prescribing their medicine, which has been a grey market in the field. However, this not only causes overuse of medicine, but also makes it more burdensome for patients and health insurance funds.

Customer first and hospital purchases”

If I hadn’t known that I was going to a hospital, I would have thought it was a flower shop owing to the plants and flowers hanging outside. The hospital, Holy Trinity, has won many awards, and fees here are also high. Each patient needs to pay US$30 for registration and then about the same amount for diagnosis.

Holy Trinity Hospital in Accra (Photo: Liam Lee).

Praveen Pandey tells me that although he often sends friendly notices by text or by social media to doctors asking them to prescribe his medicine, a face to face meeting is still a must for pharma representatives all around the world.

It took Daniel Baptist, a representative for Mr. Wang, about half an hour to get into the house of doctor Kwawe Kebede.

Kwawe Kebede, a young doctor, behaved kindly and listened to Daniel with a smile, but gave no expressions of agreement. The most he uttered was "hmmm" and "ok". It seems that as a doctor who sees around 35 patients each day, he is now indifferent to pharmaceutical representatives’ frequent visits.

The meeting only lasted about five minutes. Then Daniel met another female doctor when he saw her going out of the house and he went to greet her.

Senior representatives like Praveen Pandey would offer to provide some treatment guidance for doctors to maintain their relationship with the doctors. They often have their own list of doctors. But he says it still remains a taboo to openly discuss whether pharma companies would fund doctors for their international meetings and travel expenses.

Daniel in the state-owned hospital Kaneshie Polyclinic in Accra (Photo: Liam Lee).

It is reasonable for him to behave so prudently. At the end of the corridor at Kaneshie Polyclinic, a state hospital in Accra, is the office of doctor Isabella. Daniel has a warm exchange with Isabella about the use of an analgesic. Isabella says that her daughter suffers a lot from period pain, and she didn’t feel better after seeing doctors at the hospital. After receiving the drugs, she was willing to answer Daniel’s questions.

Had the hospital purchased the drug?

Not yet. We need to report to apply for it.

The latest reform program of the Ministry of Health of Ghana equates safeguarding health with obtaining wealth. However, the newly built public hospital that still looks unfinished is obviously unable to fully attain this goal. In a medical system with limited drugs and prices, Isabella can only choose those drugs of low price.

What about a hospital run by Chinese people?

There is a special group of Chinese in the public hospitals of Ghana. Liu Qiuhong, a specialist at the Department of Ophthalmology at the No.1 affiliated hospital of Traditional Chinese Medicine at the University of Guangzhou, worked as the team leader of the Eighth Chinese Medical Team to Ghana. I met him under the shade of a tree in the camp in Ghana where Chinese doctors rest.

We don’t fear rough times, but we worry about getting hurt.

The China-Ghana Friendship Hospital where he works is a little far from the camp, but he is fine with the long distance; what seems really threatening to him is that they might get infected owing to the lack of professional protections. He is still frightened of power failures during an operation.

We had no choice but to light up the operation room with flashlights to finish it.

When it comes to the medical problems in Ghana, Liu says that the most critical one is the difference in quality between various medicines. Taking the Department of Ophthalmology as an example, there are many people with glaucoma in Ghana but the ability to produce the corresponding medicine is not available locally. Some patients choose to buy the cheaper Indian medicine.

However, what comes together with low price is it makes them uncomfortable; this might be because of the low technological level of Indian companies.

The lack of medical resources like doctors and medicine drives the locals to adopt some extreme methods. The local newspaper Daily Graphic published a news report on December 6, 2019 with the headline “A man claimed herb effective for curing visual disturbance”. In fact, the report states, the herb became very popular among people who are suffering glaucoma in Ghana.

Many African doctors make their Chinese peers their body doubles, while they themselves work as mobile doctors to earn more money. This, however, makes the Chinese doctors very unhappy. In November 2019, the first team leaders meeting since China started providing medical aid to Africa over the past half century took place in Ghana; Liu gave a speech at the event.

There is a strong desire to build a hospital run only by Overseas Chinese, and this problem remains the biggest one that they are worried about, he said.

Many countries have built their own hospitals in Ghana. An Israeli hospital in Ghana is about to open to the public. People who have visited the hospital say that the modern medical equipment and favorable environment made them admire it.

If the government encouraged more entrepreneurs to build hospitals in Africa, Chinese doctors would be more willing to work in them to help the locals, Liu said frankly before the end of his term of service.

Good reputation

 Justice knows a lot of the inner thoughts of Africans when they buy drugs.

In the minds of common people, medicine from Europe and America are of best quality.

But he thinks that Chinese drugs are the most reliable, which is not the case with Indian players who are a mixture of authentic and counterfeit drugs.

I wish those Chinese companies which will come to Africa in the future will maintain the good impression among local communities, he said.

He then guided me to the distribution warehouse under his office, where some of his staff was classifying various medicines, including some eye-catching bottled herbs.

However, his wish was soon put to the test in a drug store in the street.

After going to several drug stores, I found that the best seller was not the well-known Qingliang oil or cooling oil but Mr. Q, an oral liquid which is believed to be an aphrodisiac for males.

The description on the bottle identified it as Chinese herbs, but didn’t give any clear information on those herbs. I tried to search for it through the website provided, but it turned out to be a fake website. I also got no reply after sending an e-mail to a Yahoo mail box several times.

The shop assistant, Jinna (not her real name to protect the source) told me that each bottle of the medicine costs 5 cedi (About US$1.3). It’s not cheap, but people buy it. I didn’t have the necessary equipment to test the ingredients, but one pharmaceutical expert told me the product is very profitable.

Mr. Q, a product from China that cannot be traced (Photo: Liam Lee).

There are some reasons for the popularity of ‘Chinese herbs’ although Ghana also has some local herb products, for example an anti-malaria liquid made from tree root which is recognized throughout the country.

Herbs are popular in Ghana and attract Chinese investment (Photo: Liam Lee).

Dr. Hu Shuting, co-founder of Acaderma (a cosmetics company based in the USA) and a cosmetics scientist at the International Federation of Societies of Cosmetic Chemists (IFSCC) has been to Senegal to investigate herbs. She told me that West African countries possess many unknown plants. Some of these plants can be used as medicine and some are edible, and they are an inseparable part of the life of the locals over thousands of years.

She said she discovered diverse plants and their qualities when she was in West Africa. She found that many plants contained unique components, such as flavonoid and polyphenolic glycosides. Besides their traditional usage, if their potential is developed though scientific research for use in medical treatment, nutrition and skin care; their economic potential would be further developed by using them to produce medicine, health care products, tea and cosmetics.

Unfortunately, the use by locals of western African countries of these plants is still at an early stage.

The American government has funded a lot of scientific research, but we hope the locals don’t only get academic papers in the end, says Dr. Hu.

Wang Yafeng didn’t pay special attention to herbs because he needs to deal with many other things, including a case of one former representative in his company who allegedly stole some medicines.

If you file a lawsuit against them, you know it, he said with a bitter smile.

Tomorrow: A chance for local production

Facing the increasing demand for various drugs, Alan Kyerematen, the Minister of Trade and Industry of Ghana, said that Ghana is now the second largest producer of medicine in West Africa thanks to its pharmaceutical industry, but about 70% of medicines still depend on imports.

In 2016, the Ministry of Health of Ghana issued a list aimed at limiting drug imports and encouraging local production. The list reveals that most drugs are for clearing heat (a term used in traditional Chinese medicine, meaning to remove heat in the body) and require no high technology.

Wang Yafeng says that based on the development strategy of FOSUN Pharma, the company invests in Africa to realize local production. This method would not only ensure the reliable quality of the drugs produced but also make it more affordable to locals.

In the meantime, he also plans to build a distribution center to cut the cost of shipping drugs in order to enable patients to get high quality drugs at low cost and in a convenient way.

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