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Cure or Harm Relationship between international relations and medicine

Mingyu Zhou

Friends Central School – International Relations 2018-2019

Why did I want to do this project?

For me, I grew up really interested in medicine and public health (partly because my mother works for the Red Cross Society). And as I studied International Relations this year, I noticed that Medicine and International Relations aren’t always talked about together, so I wanted to do some research on it.

I did most of the project back in my hometown in Haimen, China during the winter break. I mainly focused on my topic and research on mainland China. Firstly, because the relationship between medicine and international relations is a really big topic and I wanted to narrow it down by focusing on one specific country. Secondly, I thought it would be interesting to look at a developing country that has a huge population as China.

The first part of the project is research. In this part, I basically went online and read news articles on China’s medicine and international relations. Because I was trying to find the double arrow relationship between international relations and medicine, which is to say, how does international relations impact the trading and research development of medicine, and how does medicine impact international relations?

First, let's talk about how the trade, research and development of medicine influence international relations. Take China as an example. China has five thousand years of history of traditional medicine, but nowadays it is one of the biggest producers of medicine in the whole chain of international medicine market because of its abundant resources and cheap labor.China is the world's second-largest prescription drug market, according to a report released by pharmaceutical market research firm IMS Health. The report said that China's pharmaceutical revenue is growing fast and that the market there may double by 2013.

So how can a medicine impact changes in International Relations?

Take a look at this drug: Fentanyl. Pharmaceutical fentanyl is a synthetic opioid pain reliever, approved for treating severe pain, typically advanced cancer pain. It is 50 to 100 times more potent than morphine. It is prescribed in the form of transdermal patches or lozenges and can be diverted for misuse and abuse in the United States. The death rate of fentanyl has been increasing for the last decade in the States – it reached thirty thousand in 2017.

So how is China related to this? Because China is the world’s biggest producer and export country of fentanyl, many people find ways to smuggle pure fentanyl to the United States through the Fentanyl Pipeline here. As you can see, there are several different ways to export fentanyl illegally into the States.

China agrees to make fentanyl a controlled substance after talks with US at G20 summit. China has agreed to reclassify fentanyl as a "controlled substance," in what the White House is calling a "wonderful humanitarian gesture" after the much-anticipated talks Saturday between US President Donald Trump and Chinese President Xi Jinping in Buenos Aires, Argentina.
In a statement, China's Foreign Ministry said China has "decided to schedule the entire category of fentanyl-type substances as controlled substances, and start the process of revising relevant laws and regulations." China and the United States have "agreed to take active measures to strengthen cooperation on law enforcement and narcotics control," including the control of fentanyl-type substances, it said. The new designation for the synthetic opioid drug means people in China who sell fentanyl to the US "will be subject to China's maximum penalty under the law," according to a statement from the White House.
In the whole trade dispute between China and US last year, this is one of the few events that relatively alleviated the tension between the two countries. I think it is very interesting how this cooperation of medicine and health extended to economy and other trades.

After taking a look at the impact of medicine on international relations, let's think about the influence of international relations – relationships among countries, international policies – how can they change something for medicine?

In this part, I would use the Belt and Road Initiative as an example. So the BRI is a development strategy first proposed in 2013, and its purpose is to re-connect all the countries on the Silk Road two thousand years ago, now including around 60 countries in Asia, Europe and Africa. It’s basically about investment, promote trade and development of infrastructure – and also medicine!

BRI and Traditional Chinese Medicine

Belt and Road Initiative Gives Traditional Chinese Medicine a Boost. Traditional Chinese medicine (TCM), a 2,000-year-old Chinese national treasure, is experiencing a recent boom thanks to the Belt and Road Initiative. The BRI helps promote and advance Chinese Traditional Medicine by encouraging foreign scientists and companies to visit TCM factories and laboratories and seek opportunities. As a result, the overseas demand of traditional Chinese herbs, and TCM resources and services grow to attract more global attention.

BRI and Other Countries’ Medicine and Public Health

In 2015, a team led by a Chinese Nobel laureate in biology, Chen Qiyu pioneered a new approach to malaria treatment, artemisinin. BRI encourages the collaboration between China and africa countries on the production the trade of artemisinin. Many Chinese companies seize the opportunity of BRI to donate anti malaria medicine to African countries and expand their markets. As a result, thousands of lives can be saved from the hand of malaria in Africa.

However... Is BRI all about benefits and advantages?

From a public health point of view, countries with weaker health systems may not be able to cope with the health effects of such vast infrastructure projects, an influx of trade, and increased cross border movement, unless health protection and promotion is adequately embedded in the initiative’s agenda. There are also risks around the spread of infectious diseases in countries with lower vaccination rates, freer supply of products like tobacco and unhealthy food, and environmental and road safety concerns. Moreover, the rapid development of new infrastructures, without sufficient consideration of the effect on health, may escalate already existing health gaps.

Things I gained from the interviews

I interviewed to experts in the field of medicine and international relations separately. Mrs.Qiu is the department chair of Department of Public Health and the Red Cross Society of Haimen, while Mr.Ge is a sociologist of Nanjing University. They offered me valuable perspectives of the questions that I felt confused during the research.

Here are some highlights from the interview:

Mrs.Qiu:

刚刚说到这个国际关系的问题啊,我觉得(这个就是)医药啊,这个包括研发啊,购销啊这些东西,其实在(这个就是)国与国之间,包括在这个经济发展的过程当中,其实我觉得应该是类似于其他的那种就是那种普通的商品一样的,也作为一种特殊的商品存在的,然后它也可以作为一种,正常的经济关系之中很重要的一部分。

I just mentioned the topic of international relations. I think the area of medicine includes research and development, purchase and sale. In fact, I think it is similar to the other common kinds of goods that is traded among countries in the process of economic development. Medicine exists as a special commodity, and it can also be a very important part of normal economic relations.

医药,(其实可以)某种意义上应该是等同于其他类型的商品,包括医疗技术和药品,它其实也是商品的一种存在形式,但是呢,它又要区别于其他商品,(就像你刚刚提到的,)它毕竟是关系到人的生命的,一个特殊的商品。然后其实就我自己目前的了解来看的话,就是国家层面啊,包括监管层面啊,在对待药品,或者医疗技术,或者医疗器械,然后和一些普通商品的态度和政策还是非常不一样的。比如说,像一些国外已经投入市场的一些新药,然后在我们国内它还要,引进到国内来。像比如说原料,这个药品生产的技术,它在国内还是要经过一个漫长的(这个叫)临床试验期。为什么要设这个临床试验期呢?就我自己理解来讲的话,就是说,一个,它是为了保护本土的(这个)生产研发技术。因为大家都知道,你国外的技术和中国的技术来讲的话,有很多的层面上还是确实还是(这是客观存在的现实)确实比我们提前发展了很多年。那如果我说,是没有保留的,不考虑国内市场的发展,毫无保留的引进进来的话,肯定会影响到国内的研发技术的。因为它只要拿来就好了嘛,就不用再研发了。所以呢这个是一个临床试验,它给国内的生产企业,包括一些技术的发展,它有一个缓冲的空间。另外一个,就是,(我不知道我的想法是不是成熟),就是说,因为国家层面也要考虑到一个国家安全的问题,因为生物制药技术,包括一些医疗技术,它应该来讲也是一个,就某种意义上它是一个控制这个就是基因啊,我们亚洲人种的这样一个就是手段吧,说的极端一点的话就是。我把国内这块的市场全部开放了以后,那就很容易在这一块上收到国外这个技术的牵制。那就是压制。就是说我们从另外一种意义上来讲我们要保护基因的纯洁度。就是这两个方面。就想国外争议很大的这个转基因技术啊。 防人之心不可无。保护自己的一个手段。

Medicine, in a sense, including medical technology and medicine, should be equivalent to other types of goods. But it must be distinguished from other goods, (as you mentioned, it is, after all, related to human life). In fact, my own understanding of the situation is that, at the national level, including the regulatory standards, the treatment of drugs, medical technology, or medical devices, and then the attitudes and policies of some common commodities of different countries are very different. For some new drugs that have already been put on the market abroad, we have to introduce them in China after regulation and investigation of, for example, raw materials, the technology of drug production, etc. It (most new medicines) have to go through a long clinical trial period in China. Why should we set this clinical trial period? As far as I understand it, that is, one, it is to protect the local production, research and development of technology. As everyone knows that, in terms of foreign technology and Chinese technology, Chinese medicine technology is still behind the ones the developing countries have developed (this is an objective reality). Their technology has indeed developed many years ahead of us. If there is no clinical trial period regardless of the situation of the domestic market, if the introduction is unreserved, it will definitely affect the domestic development of medicine. So a clinical trial gives domestic manufacturing companies, including some technological developments, a buffering space. The other one is, the national level also needs to consider a national security issue. Because biopharmaceutical technology, including some medical technologies, in a sense, is a control of the public health and gene pool. This is the means of our Asian race. The extreme thing is that. After I opened all the domestic market, it is easy for foreign technology to contain the domestic development and research of the drug. These are the two aspects. I want to think of this GM technology that is very controversial abroad. The heart of the defense is indispensable. A means of protecting yourself.

那么说到药品呢,其实我们改革开放以后就是实际上受到国外先进科学技术的影响,对国内医药技术的水平和老百姓能够享受到的这个好的生物医药的产品来讲的话,还是得益了非常多的。就拿最近两年我们老百姓比较关注的这个HPV疫苗来讲的话,就是说,其实就从二阶到四阶的疫苗,现在为止,我们的疾控中心疫苗管理供不应求的这个状态来讲,其实老百姓是非常需要【这些疫苗的】。

And when it comes to medicines, in fact, after our reform and opening up, we have been influenced by foreign advanced science and technology. If we are able to enjoy the quality of domestic medical technology and the good biomedical products, we benefit a lot. Many. Take the HPV vaccine that our people started to pay more attention to in the past two years, that is to say, from the second-level to the fourth-level vaccine. Now, in the state where our vaccine (HPV) supply in the Department of Disease Surveillance and Management is in short supply, the vaccine is needed by an increasing amount people.

社会开放=》生活质量提升=》希望享受到更加先进的医疗技术

18大 国家要结合老百姓日益增长的物质精神文化生活水品的追求,它能够及时的引进,让老百姓享受到这个好的疫苗,然后及时的来进行免疫接种,那就是说在改革开放,开国家开放的过程中,带来的一种实惠吧,我觉得这也是全人类的一种进步吧。

The society opens up => the life quality of citizens improves => people wish to enjoy more advanced medicine technology

The 18th National Congress of the Communist Party of China has pointed out that the country should take care of the pursuit of citizens towards material, spiritual, and cultural life that is growing through the years. The country should introduce more vaccine and medicine on time so the citizens can use it. The development of medicine is a big advantage brought by the opening up of the country. I think it is also a progress of the whole human race.

Mr.Ge

那么它就上升到国家安全。它既然跟国际政治关系联系在一起,它就会涉及到国家安全。所以这个国际政治关系和生物医药的发展,它看上去是风马牛不相及的,但其实它里面万物都是相同的,它都是(很)交织在一起的。

Medicine is related with national security. Since it is connected with international political relations, it would be involved with national security. So, international relations and the development of medicine – they seem to be unrelated as wing, horse and cow are, but the dynamic is connected and intertwined.

一带一路的发展,当时我们国家提出是携手共赢,做大,就整个亚洲部分,乃至于亚洲边上的欧盟啊,以及一些辐射国家,其实(它就是)往这一圈要做大。然后它的做大,从本质上来说,它广义上来说,它不是光经济范畴问题。它其实包括的,文化,经济,理念,等等一系列的东西互补。

The purpose of The Belt and Road Initiative is for China and some Middle East countries and some European countries to cooperate and gain advantage together. And this “advantage” not only includes the conversations of economy, but also culture, ideology and a lot of other things.

我们中华民族是有个五千年的优秀传统的,文化底蕴的,古老国家。它的医药也有很多,包括(那个)苗药,壮药,然后中医,都有一些不同的作用。它【在一带一路中】也起到了一个文化交流大使的作用。

China is an ancient country with five thousand years of excellent traditions and cultural base. It has many traditional medicines, including Miao Medicine, Zhuang Medicine and other traditional Chinese herbal medicine and they have different functions. Traditional Chinese Medicine plays the role of a diplomat in the cultural exchange process of The Belt and Road Initiative.

My Reflections

From this project, I learnt that things that seem to be unrelated can have huge impacts on each other – for example, medicine and international relations. People's desire for a healthier and happier life can influence the development of the society and the decisions of a country, while the policies of a country can impact on the development and trade of medicine.
One thing I learnt from my experience of the interview is that: pay attention to the biases of the experts. Interestingly, from my observation, both of my experts seem to be realists, and that influences their opinion on the events and the topic I was asking about. I really learnt a lot from this 20% Time Project.

Link to my Pecha Kucha

https://docs.google.com/presentation/d/e/2PACX-1vSs5jfIwoykvKwPX3_MUMPqgVMHrsSvB_hZihySrBDWieRpHxw-ZexNGxFXahJ_UkXSf0AnDjNoQGOW/pub?start=false&loop=false&delayms=20000

Resources:

https://en.wikipedia.org/wiki/Pharmaceutical_industry_in_China

https://www.ft.com/content/38991820-8fc7-11e8-b639-7680cedcc421

https://www.cnn.com/2018/12/01/politics/fentanyl-us-china-g20-talks/index.html

https://www.cfr.org/report/chinas-healthcare-sector-and-us-china-health-cooperation

http://www.africanews.com/2018/08/19/chinaafrica-health-cooperation-enhances-medicine/

https://blogs.bmj.com/bmj/2018/11/29/global-health-disruptors-the-belt-and-road-initiative/

https://globalhealth.georgetown.edu/posts/towards-a-health-silk-road-china-s-belt-and-road-initiative-and-its-impact-on-international-development-assistance-for-health

http://www.bjreview.com/Business/201808/t20180827_800139206.html

https://www.healthaffairs.org/do/10.1377/hblog20180327.739726/full/

https://www.cdc.gov/drugoverdose/opioids/fentanyl.html

Credits:

Created with images by Simone van der Koelen - "Birth control pills" • Jay - "untitled image" • 天琦 王 - "故宫漫步" • Hush Naidoo - "Pills to make you better" • naidokdin - "door handle chinese" • chuttersnap - "untitled image" • rawpixel - "untitled image" • rawpixel - "untitled image" • Yu Kato - "untitled image" • Capri23auto - "conclusion of the contract handshake trade" • sti300p - "chinese herbal medicine culinary herbs ingredients" • Seth Doyle - "untitled image" • qimono - "bacteria medical biology" • Larm Rmah - "Rapeseed flowers" • stevepb - "capsule pill health" • gate74 - "tea variety drink" • Pexels - "architecture indoors perspective" • Vladislav Klapin - "from festival" • RyanMcGuire - "thank you neon lights neon"

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