Don’t put all your eggs in one basket!

“don’t put all your eggs in one basket!” That the advice that our parents drove home when they were trying to prepare us to face the real world.

Great advice and most of us follow their advice, wherever it would be buying stocks, money funds, real estate. Unfortunate when some of us became political leaders we drove the train off the track.

Because I am a news juncky I am aware of the dummies thing that congress and the white house have done in the Pass. But never in my wildness immigration would I have ever believed that they would let China have such a big share of our medical market. You know letting them have such a big piece of the ie make no sense at all. When I started hearing they had fifty % I said”That can’t be true.” I thought maybe thirty to forty. and that would be a nightmare.

Now according to information from Yanzhong Huang a blogger we get 97% of our antibiotics from china, can you imagine if we went to war with them or one of there puppet government what would we do,i don’t think that we could have a few days of truth to get medicine from china to give our wounded troops.

I have taken the time to coppy and ast the articla please read and tell me and my readers what youthnk with respect cowboy ron and that the way i see it

U.S. Dependence on Pharmaceutical Products From China

Blog Post by Yanzhong Huang

August 14, 2019

A technician works at a product line of the Inactivated H1N1 Influenza Vaccine in Sinovac Biotech Ltd., a Chinese vaccine making company, in Beijing, September 3, 2009.
A technician works at a product line of the Inactivated H1N1 Influenza Vaccine in Sinovac Biotech Ltd., a Chinese vaccine making company, in Beijing, September 3, 2009. REUTERS/Jason Lee (CHINA BUSINESS HEALTH)

Last month, the U.S.-China Economic and Security Review Commission held a hearing on the United States’ growing reliance on China’s pharmaceutical products. The topic reminded me of a spirited discussion described in Bob Woodward’s book, Fear: Trump in the White House. In the discussion, Gary Cohn, then chief economic advisor to President Trump, argued against a trade war with China by invoking a Department of Commerce study that found that 97 percent of all antibiotics in the United States came from China. “If you’re the Chinese and you want to really just destroy us, just stop sending us antibiotics,” he said.

Cohn’s words highlight a security concern associated with pharmaceuticals from China. As Rosemary Gibson noted in her testimony, centralization of the global supply chain of medicines in a single country makes it vulnerable to interruption, “whether by mistake or design.” If we are dependent on China for thousands of ingredients and raw materials to make our medicine, China could use this dependence as a weapon against us. While the Department of Defense only purchases a small quantity of finished pharmaceuticals from China, about 80 percent of the active pharmaceutical ingredients (APIs) used to make drugs in the United States are said to come from China and other countries like India. For example, the chemical starting material used to make doxycycline, the recommended treatment for anthrax exposure, comes from China. When an influential Chinese economist earlier this year suggested that Beijing curb its exports of raw materials for vitamins and antibiotics as a countermeasure in the trade war with the United States, the worries surrounding our API dependence to China seemed to be vindicated. Concern about a disruption in the supply chain could explain why the tariffs on Chinese products proposed by the United States Trade Representative in May 2019, worth approximately $300 billion, excludes “pharmaceuticals, certain pharmaceutical inputs, and select medical goods.”

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While the potential exposure to raw material supply disruptions drives part of our fear, concern about the safety and efficacy of Chinese-made pharmaceuticals is another component. In the summer of 2018, one of China’s largest domestic vaccine makers sold at least 250,000 substandard doses of vaccine for diphtheria, tetanus, and whooping cough. It was the latest in a slew of scandals caused by poor quality drug products made in China over the last decade. In 2008, the contamination of a raw ingredient imported from China and used to make heparin, a blood-thinning drug, was associated with at least eighty-one deaths the United States. According to an investigative journalist, fraud and manipulation of quality data is still endemic in Chinese pharmaceutical firms.

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In order to address the growing security and safety concerns about Chinese-made pharmaceuticals, some suggest that the United States switch to India as an alternative API supplier. However, doing so would be no different from rearranging the deck chairs on the Titanic. It is true that many Indian pharmaceutical firms are leading API manufacturers but India depends on China for sourcing nearly three quarters of APIs in generic drug formulations. The disruption in the supply chain notwithstanding, switching to India for the supply of APIs would only make the drugs sold in the United States more expensive: APIs and chemical intermediates from China are 35 to 40 percent cheaper than Indian ones. Moreover, India has its own drug safety problems as well. In 2013, a generic drug maker in India pled guilty to drug safety charges, which included shipping batches of adulterated drugs, having incomplete testing records, and inadequate programs to assess drug quality. According to a former executive of the company, this was only a fraction of the safety issues the Food and Drug Administration (FDA) could identify in overseas plants.

Moreover, we could have overestimated our dependence on Chinese-made pharmaceutical products. As of 2018, China claimed 13.4 percent of all import lines– defined as distinct regulated products within a shipment through customs–among countries that export drugs and biologics to the United States. Of these import lines for drugs and biologics, about 83 percent were finished drugs, and only 7.5 percent were APIs. We certainly underestimate the share of APIs from China given that Chinese-made APIs can come to the United States as part of the finished drug products from other countries like India. However, the lack of a reliable API registry makes it difficult to estimate the true market share of Chinese-made APIs.

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In addition, when highlighting our dependence on Chinese-made pharmaceuticals, we could overlook the other side of the coin: China needs finished drugs made in the United States. China is facing a crisis of non-communicable diseases, including cancer, cardiovascular diseases, and diabetes. It is estimated that between 2002 and 2016, new cancer cases in China increased by more than 55 percent, from 2.19 million to 3.8 million. A majority of Chinese cancer patients, however, lack access to the most effective drugs. Partly because of this, cancer survival rate in China is less than half of the United States. Under the performance-based legitimacy in contemporary China, the government must justify its rule by continuously delivering public goods and services, like better healthcare, to meet people’s wants. In an increasingly state-dominated political system, the link between performance and legitimacy becomes so tight that failure to deliver such goods could endanger the system itself. In the meantime, with the rapid improvement of material living standards, Chinese people are increasingly valuing things beyond basic earnings, such as good health. As President Xi Jinping stated in the 19th Party Congress, the “principal contradiction” in the society is “the contradiction between unbalanced and inadequate development and the people’s ever-growing needs for a better life.” In fact, in 2018, the government cut the import value-added tax on cancer drugs from 17 percent to 3 percent and reduced import tariffs on all common drugs and cancer drugs to zero. Essentially, regime legitimacy requires the state to deliver the most effective drugs, which are often patented and provided exclusively by multinational pharmaceutical companies. In May 2019, China unveiled a list of imported U.S. medical products to impose punitive tariffs upon. The list includes commonly used drugs such as insulin, ibuprofen, as well as medical devices such as ultrasonic diagnostic apparatuses and endoscopes, which Chinese firms can manufacture themselves. Nevertheless, the list did not include anti-cancer drugs and other patented ones.

The same legitimacy concern also led the Chinese government to introduce incentives to improve the quality of its pharmaceutical products. In 2016, China’s FDA introduced the Generic Consistency Evaluation (GCE), which required generic drugs approved for production prior to 2008 to pass the GCE in order to gain “equivalence” to branded drugs in terms of safety and efficacy. Failure to pass the GCE in a timely manner will lead to the revocation of registration licenses or ineligibility for government tendering. Since generic drugs approved before 2008 are prone to low quality problems, a significant number of drugs that have failed to pass GCE are expected to exit the public market. The measure will help weed out over half of the nation’s 2,900 or so small, and often low-quality, domestic drug makers. Since early this year, nearly 20 pharmaceutical firms have either exited the industry or been reorganized.

So what does all this mean for a response from the United States? Before making any major decisions on this issue, it is important to collect as much information as possible for a full assessment of the risks we face. We should also nurture the development of alternative sources and capabilities to make critically essential drugs in the United States. At present, instead of looking at the issue from a national security perspective, the best approach is to work with China to ensure the safety and efficacy of their pharmaceutical products. As I argued in my testimony to the U.S.-China Commission, this involves expanding the FDA’s inspection activities in China, helping to beef up the regulatory capacities of China’s National Medical Products Administration in the drug development and review process, and making sure Chinese firms consistently follow the appropriate process for safeguarding quality in production. Lastly, the U.S.-China Social and Cultural Dialogue, the only high-level forum to discuss U.S.-China cooperation after 2017, should be reopened as an institutional venue to discuss these issues.Creative Commons: Some rights reserved.

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Afghanistan Endgame, Part One: Is Sirajuddin Haqqani Ready for Peace?

In peace talks with the Afghan Taliban, the United States should not fail to address the evolution of the Haqqani-al-Qaeda nexus.

Blog Post by Guest Blogger for Asia Unbound, Author

August 14, 2019

Students at the site of a suspected U.S. drone strike in Khyber Pakhtunkhwa, Pakistan, in 2013.  The strike killed a senior member of the Haqqani network.
Students at the site of a suspected U.S. drone strike in Khyber Pakhtunkhwa, Pakistan, in 2013. The strike killed a senior member of the Haqqani network. Stringer Pakistan/Reuters

This is a guest post by Melissa Skorka. She served as a strategic adviser to the commander of International Security Assistance Force in Afghanistan from 2011-14 and is a doctoral candidate at Oxford University’s Changing Character of War Centre.

This post is the first in a two-part series on terrorism in Afghanistan. The second is here.

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As the Donald J. Trump administration aims to end a “‘slowly deteriorating stalemate,’ with ‘no military victory’ possible,” President Trump has supported withdrawing thousands of U.S. troops from Afghanistan in exchange for peace with the Afghan Taliban. According to some accounts, the reduction of U.S. forces seems imminent, irrespective of the peace negotiation.

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Notwithstanding whether Washington pulls out U.S. combat forces, Trump said he would leave “a very strong intelligence” presence in Afghanistan, which he calls the “Harvard of terrorists.” If this strategy is to achieve its security goals, it should account for a fundamental concern that has not received sufficient attention: how modern terrorist organizations usurp U.S. foreign policy in order to survive and even prosper by adapting to Western counterterrorism measures in insidious and often underestimated ways.

The Haqqani network, a terror network with close ties to the Taliban, al-Qaeda, and Pakistan’s Inter-Services Intelligence (ISI), has evolved over the last half-century and now exerts unprecedented influence in the Afghan insurgency, according to the UN ISIL (Da’esh), Al-Qaida and Taliban Monitoring Team. In fact, as the UN Team stated in an interview for this blog:

There is no evidence that the Taliban have broken or will in future break their intrinsic relationship with the Haqqani Network and Al-Qaida. Recent reporting would suggest that these connections are actually stronger than at any time in the past 18 years. Calculations over withdrawal from Afghanistan should take account of the risk of undermining prospects for a durable peace by empowering and emboldening these groups.

The Haqqani network has increasingly become a potent force, one whose relationship with state and non-state patrons will determine what sort of country Afghanistan becomes, perhaps even more than the plans of the government in Kabul and the Taliban. The success of the Trump administration’s peace strategy will depend on whether it can eliminate, co-opt, or separate the Haqqani network from al-Qaeda and the ISI, two organizations that for decades have relied on terror proxies to advance strategic interests in the Afghanistan-Pakistan region. 

Despite advanced counterterrorism measures, the Haqqani network’s resilience and growth demonstrate that it is experienced at subverting U.S. policy, and that it will likely continue to do so in the next phase of conflict. The terrorists’ subversion strategy is reflected by their political evolution. Since 9/11, the Haqqani network has grown from a relatively small, tribal-based jihadi network into one of the most influential terrorist organizations in South Asia. This power consolidation is reflected in the prominent role of the syndicate’s leader, Sirajuddin Haqqani, who is widely understood to be operating as the Afghan Taliban’s second-in-command since 2015, leading all military operations for the overall insurgency.

Among its operations, the Haqqani network masterminded attacks on the U.S. Embassy and NATO headquarters in Kabul in 2011, on the U.S. consulate in Herat Province in 2013, and allegedly on a U.S. base in Khost Province in 2009, which killed seven CIA operatives. The group detained U.S. Army Sergeant Bowe BergdahlNew York Times reporter David Rohde, and U.S. aid worker Warren Weinstein, who died in the custody of the terrorists, U.S. officials say.

Unlike the majority of Afghanistan-based terrorist groups, the Haqqani network has succeeded in cultivating a posture of “international jihad” for nearly the last half-century, in part because it has forged relationships with a diverse set of politically or ideologically like-minded supporters. These include senior al-Qaeda members and foreign fighter volunteers from around the world, factions of the Pakistani Taliban, and wealthy private donors from the Arab States of the Persian Gulf.

Counterterrorism specialists Vahid Brown and Don Rassler demonstrate that “the Haqqani network has been more important to the development and sustainment of al‐Qa’ida and the global jihad than any other single actor or group.”

Today, the Haqqani network now includes nearly every Deobandi jihadi faction operating in the settled areas of Pakistan–factions that would cease to exist if not for Sirajuddin Haqqani’s provision of protection and patronage, U.S. officials say. Washington should now consider fresh data about the Haqqani network’s expanding influence in lands far beyond South Asia. General John R. Allen, the former commander of the United States-led coalition in Afghanistan, and the U.S. special envoy spearheading the fight in Iraq and Syria against the self-proclaimed Islamic State, observed that the United States has been concerned about the Haqqani network’s expansion beyond South Asia: “Although many Jihadi groups are sending their rank and file to places like Syria, few of these groups have the close relations with al Qaeda, media savvy, military capability, and technical expertise for suicide attacks like the Haqqani network.”

The idea that terrorists “evolve” is not novel, but today’s scale and pace of adaptation are altogether new, and, some counterterrorism experts believe, are too often underappreciated. Modern terrorists adapt to new opportunities and threats by using the internet to build increasingly powerful global networks to command forces and radicalize new adherents, by weaponizing abundantly available advanced technology such as commercial drones, and by rapidly exploiting global political and societal changes. 

U.S. policymakers need to consider not just the direction of the trend, but also its strength and speed. As Retired Lieutenant General Michael Nagata, former Strategy Director of the U.S. National Counterterrorism Center, notes:

The rise of the Islamic State (ISIS) was a revelation. In only five years, ISIS’s global network is today larger than al Qaeda’s despite decades of effort, and all terrorist groups are mimicking ISIS’ innovations. In South Asia, where we face a nexus of al Qaeda, Taliban, Haqqani, and ISIS, our search for a negotiated settlement must confront the question of whether we can ‘out-innovate’ the adversary. It is unwise to assume that our traditional approaches will suffice… these adversaries adapt too quickly.

Washington has relied on Islamabad to resolve post-9/11 security threats, especially with regard to al-Qaeda and the Haqqani network. Pakistan has exploited this Western policy by supporting Islamist proxies under the “nuclear umbrella” to buttress the state’s own narrow strategic agenda. As the Trump administration and U.S. officials now regularly observe, Pakistan is harboring one of the highest concentrations of U.S.-designated Foreign Terrorist Organizations in the world. American officials quietly place blame for Islamabad offering sanctuary for violent extremists in the region squarely on the ISI’s shoulders. The ISI continues, as it has for many years, to view the Haqqani network as particularly valuable to Pakistan’s strategic interests in anticipation of a post-NATO Afghanistan. The Haqqani network’s cohesion and reach have helped the ISI angle toward its long sought-after “strategic depth,” a euphemism for a compliant regime in Kabul to avoid Pakistan’s encirclement by India.

Publicly, the Haqqani network keeps its relationship with state and non-state sponsors of terror opaque. But empirical evidence is clear: the Haqqani network has shown no sign it is willing to end its decades-long support of al-Qaeda or provision of haven for terrorist groups with global ambitions. Over nearly four decades, the Haqqani network has created a fountainhead of jihad by facilitating al-Qaeda and adapting to the various changes that have swept the region.  Holding peace talks with the Taliban is futile if the United States is not also committed to disaggregating and defeating the ascendant Haqqani network and its partners.Creative Commons: Some rights reserved.

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