H5N1

Sierra Leone revives Ebola funds probe

Via The East African, a reminder that post-Ebola syndrome also includes political symptoms: Sierra Leone revives Ebola funds probe. Excerpt:

The vexing issue of alleged misuse of funds meant to fight the deadly West African Ebola epidemic is back on the spotlight in Sierra Leone. 

The Anti-Corruption Commission (ACC) says it has re-opened files for an unspecified number of cases that did not get the attention they deserved.  

An official said thorough probing into the matters was necessary to ensure proper justice for the taxpayer.  

The Ebola epidemic, which erupted in early 2014 in Guinea and spread to Liberia and then Sierra Leone, claimed nearly 12,000 lives, mainly in the three neighbouring countries, among nearly 30,000 cases recorded in the region, and as far as the US and Europe. 

Hundreds of millions of US dollars were poured into the fight from both foreign and local sources.  

The Sierra Leone government itself put aside $10 million (80 billion leones) for the period. 

The mandate 

There were reports that much of the money in the three countries was diverted into personal accounts of officials in charge of the battle against the virus.  

In Sierra Leone, the issue notably attracted international attention as it became a subject of a row between parliament and ACC, over who had the mandate to investigate it. 

Eventually, the Public Accounts Committee (PAC) of the House held a public hearing, where officials named in a damning auditor’s report were drilled over their role in the misuse of the funds.  

The Auditor General's report found that a third of taxpayers’ money allocated to the fight against the virus in the first six months of the epidemic was not accounted for. 

The authors pointed out that payments were made to hospitals without proof that the monies were going to health workers.  

The report also noted that the failure to spend the funds appropriately might have slowed Sierra Leone’s response to the epidemic, thereby causing unnecessary loss of life. 

The epidemic  

About 4,000 people died in Sierra Leone alone due to the epidemic. 

About 40 individuals, including high-profile medical officials, were invited to provide documentation to show how the funds were disbursed.  

Some of the accused paid back monies they were found guilty of misappropriating. 

While parliament, at the time, said it was satisfied with the manner in which it handled the issue, very few people outside the House were impressed by its response. 

Mr Emmanuel Amara, the Coordinator of Operations at the anti-graft agency, said ACC was now going after people with outstanding payment with no answers.  

“The PAC’s work wasn’t as exhaustive as the scope of the Ebola operations required,” Mr Amara said in a radio interview.

MSF: HIV and TB treatment at risk as countries gradually lose Global Fund support

Via MSF.org: HIV and TB treatment at risk as countries gradually lose Global Fund support. Excerpt:

GENEVA — Médecins Sans Frontières (MSF) has called on the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria to make urgent changes to their policies and practices for countries transitioning away from, or gradually losing, donor support, which increase the risk of critical drug stock-outs and alarming drug quality issues in many countries. People receiving treatment for tuberculosis (TB) and HIV in transitioning countries have faced dangerous treatment interruptions and have been treated with drugs of unknown quality. The countries are also faced with paying much higher prices for drugs than they should be paying.  

Beyond the countries that are about to transition from Global Fund support, even low-income countries are being called upon by Global Fund to start paying for key medical commodities. This is often occurring in the absence of a rigorous assessment of procurement challenges and financial capacity, and often in the absence of the robust risk mitigation planning needed to safeguard people’s access to treatment.  

“The current pace of Global Fund country transitions, hastened by underfunding from donors, is creating a ticking time bomb where people’s HIV and TB treatment is jeopardised by unknown drug quality and drugs simply not being there,” said Dr Els Torreele, Executive Director of MSF’s Access Campaign. “Allowing countries to fall off a cliff without mitigating the risks for people who need treatment could reverse nearly two decades of progress against two of the world’s deadliest infectious diseases.” 

Over the last 16 years, the Global Fund’s central purchasing of HIV and TB treatment commodities has helped secure affordable prices through high-volume orders and attracting multiple competing suppliers. Crucially, the Global Fund has also been instrumental in ensuring people’s access to quality treatment by requiring all drugs purchased with its funding to have quality approval from either the WHO Prequalification of Medicines Programme or a stringent drug regulatory authority.  

The Global Drug Facility (GDF), which helps countries procure TB drugs, has documented a number of problems related to the Global Fund’s policies. In the past 18 months, 15 countries in Asia, Africa, and the Eastern Europe and Central Asia region have experienced stock-outs of TB drugs. Additionally, 29 countries in these regions, along with Latin America, have purchased TB drugs of unknown quality, and 21 countries have purchased TB drugs and tests at prices that far exceed the lowest global prices they should be paying.

As a case in point, see this report in Nature News & Comment, on the impact on TB in North Korea after the Global Fund withdrew from the country.

Papua New Guinea is rich in resources but poor in health

Via The New York Times: Papua New Guinea Is Rich in Resources but Poor in Health. Excerpt:

PORT MORESBY, Papua New Guinea — Polio was vanquished by the Pacific nation of Papua New Guinea 18 years ago. Now, as world leaders gather there for the Asia-Pacific Economic Cooperation summit meeting this week, polio has returned — on top of raging drug-resistant epidemics of tuberculosis, malaria and H.I.V., and deadly flash points of preventable diseases like whooping cough and measles.  

All over the country, there are symptoms of a profound public health emergency; young and old are getting sick and dying unnecessarily, while facilities lack basic medicines and equipment. 

Doctors and experts say the unfolding crisis is the realization of their worst fears after years of deterioration and neglect.  

“We were expecting something like this,” Dr. Anup Gurung, a public health specialist with the World Health Organization, said of the polio outbreak at a news conference in the capital, Port Moresby, in September. 

He pointed to the erosion of vaccination rates, which are down to 30 percent in some parts of the country. “It’s like someone lit a paper castle where everything is on fire,” he said. 

Officials in Papua New Guinea hope that hosting the Asia-Pacific Economic Cooperation, or APEC, meeting in Port Moresby will elevate the country’s international profile, but the health crisis has become an embarrassment for a nation with an abundance of gold, copper, silver, oil and gas. 

Public frustration with the summit spending has already led to two national strikes. The collapse of health services has been a focus of the protests. 

The return of polio is a clear indicator of the failures, with Papua New Guinea accounting for 21 of 109 cases found globally this year. 

The Papua New Guinea outbreak is vaccine-derived, which means that weakened live virus excreted by vaccinated children has mutated and escaped into the rapidly increasing unprotected population. Dr. Gurung blamed “the steady breakdown of the health system” for the country’s polio emergency.  

Local and international experts point to three interlinked causes of the country’s health crisis: the collapse of the medical supply chain; changing relations with the country’s biggest aid donor, Australia; and rampant corruption. 

Getting medicines, equipment and other supplies around Papua New Guinea has always been challenging. The country has few roads, formidable geography and a widely dispersed population, with about 80 percent living in rural and remote locations.  

That improved with assistance from Australia, but the Australian government withdrew from the arrangement in protest in 2013 after Papua New Guinea awarded the national medicine supply contract to a local company that Julie Bishop, then the Australian foreign minister, said had no accreditation and “a history of supplying substandard drugs.” 

The company, Borneo Pacific, won the contract — worth 32 million Australian dollars, or $23 million — despite its bid being millions of dollars higher than those of reputable international organizations. At the time, the Medical Society of Papua New Guinea said the deal would “lead to the deaths of many Papua New Guineans.”  

Reports from health facilities across the country indicate those fears have been borne out. (Borneo Pacific did not respond to requests for comment.)

Lessons from the Ebola front lines

Thanks to Mary Marshall for sending the link to this book review by Nahid Bhadelia in Nature: Lessons from the Ebola front lines. Excerpt:

Outbreak Culture: The Ebola Crisis and the Next Epidemic. Pardis Sabeti and Lara Salahi Harvard University Press (2018)  

When you work inside a system that you believe in, yet recognize as dysfunctional, it can be hard to offer a balanced critique. And the stakes are high when the system in question is the response to a humanitarian emergency, where public opinion determines crucial funding. Outbreak Culture, on the Ebola crisis of 2013–16, strikes this delicate balance expertly. 

The central theme of the book, by geneticist Pardis Sabeti and journalist Lara Salahi, is that common threads of dysfunction run through responses to epidemics. These emerge from the underlying architecture of societies (resulting from history, politics and culture), the competition between international organizations and (sometimes) the self-serving motivations of individuals in high-stress situations. We fracture along lines of existing weaknesses. 

Sabeti — who was part of the Ebola response effort — and Salahi show that the world is doomed to repeat the same mistakes with every new epidemic unless outbreak response shifts to a “mode that favors collaboration instead of competition, and readiness instead of reaction”. My experience leads me to concur. I was a clinical responder in Sierra Leone during the Ebola epidemic in both 2014 and 2015; I now work in Uganda, across the border from the current outbreak in the Democratic Republic of the Congo. (Full disclosure: I appear briefly in the book.)  

Outbreak Culture is based on the cumulative accounts of more than 200 people who worked on the West African response, from clinicians and researchers to public-health workers and administrators. By bringing in these voices, the work distinguishes itself from recent individual accounts. Yet it maintains a personal tone. It also incorporates the post-epidemic analyses by international organizations and governments, such as the internal and external World Health Organization reviews, and independent reports by the US National Academy of Medicine and other academic collaboratives. And it puts a human face on the challenges by telling the stories of researchers, clinicians and patients, including Sabeti and members of her lab.  

Today, every new outbreak demands the re-creation of administrative structures. Negotiations for access and operations are made in real time. Sabeti and Salahi argue that the dearth of dependable administrative structures and oversight in West Africa created a space in which competing incentives and personal ambitions wreaked havoc. They highlight the dark underbelly of on‑the-ground interactions that slow down and ultimately stymie the response itself, and which many reports have previously shied away from. 

The authors interviewed numerous people and sent out an e-mail survey; 132 people answered. This was anonymous, because otherwise most of us (I took the survey) would have baulked at answering the hard questions it featured about competition, corruption and waste. About 27% of respondents said that they had experienced illegal tactics during the epidemic. Another 37% noted that they had experienced intimidation, for instance by personally facing, witnessing, hearing about or perpetuating it.  

Sabeti and Salahi share stories of how data and samples that could have helped were hoarded by researchers and organizations, including individuals within several international public-health bodies. They give an unflinching account of how corruption at all levels siphoned resources away from communities in need. 

For example, the International Federation of Red Cross and Red Crescent Societies confirmed that almost US$6 million of its Ebola funds were misappropriated in West Africa. The authors also highlight concrete examples of how organizational politics, cultural differences and mistrust led to ineffective communication at crucial points during the epidemic. 

Despite these revelations, the book ends on a positive note. It links failures during the epidemic to specific underlying gaps in governance (for example, the ways in which aid is distributed and reported allowed for individuals to siphon off funds). It identifies core processes required for reform. These include streamlining communication systems between outbreak-response partners, and establishing a central research-governance structure composed of experts without conflicts of interest.

North Kivu: Free healthcare concerns all diseases until healing

Via Radio Moto Butembo-Beni: Health: Free healthcare concerns all diseases until healing. The purpose, of course, is to keep people coming for non-Ebola treatment, and the story says something about the state of the local healthcare system. The Google translation, lightly edited:

How can we understand free care? 

The representative of the provincial health division indicated that free care covers all diseases without exception. Dr. Hyppolite SANGALA said that throughout the patient's contact with the caregiver until the cure, the patient will not pay a penny. 

Dr. Hyppolite SANGALA reminded that no one can be excluded from this free care. He added that routine consultations such as NPC and cases of surgical operations of diseases are also supported. 

It must be said that a warning has been issued to all caregivers who might ask for money from patients in selected health facilities.

Chinese maker of faulty rabies vaccines fined billions of yuan

Via Nature News & Comment: Chinese maker of faulty rabies vaccines fined billions of yuan. Excerpt:

A Chinese pharmaceutical company caught producing faulty rabies vaccines has been fined billions of yuan by national and local agencies. 

China’s national drug regulator announced on 16 October that it will fine Changchun Changsheng Biotechnology 12 million yuan (US$1.7 million), and revoke the company’s licence to make rabies vaccines. 

The regulator determined that when the company created several batches of faulty rabies vaccine, it broke multiple laws, including: using expired products to make the vaccine; not testing the potency of vaccines according to prescribed methods; and destroying evidence to cover up its actions.  

The drug regulator of Jilin province, where the company’s headquarters are based, has issued the firm with a much greater fine: 7.21 billion yuan, which is close to double its reported assets in 2017. The local drug regulator has revoked the company’s licence to produce pharmaceuticals and has banned 14 executives and others involved in the incident from engaging in drug production in the future. It has also ordered the confiscation of illegally produced vaccines and earnings from the company, amounting to 1.89 billion yuan. 

In July, China’s drug regulator announced that a surprise inspection of the company had revealed faked production data for batches of its rabies vaccines. At the same time, the Jilin government exposed violations in the company’s production of a vaccine that protects against diphtheria, tetanus and pertussis (whooping cough). Several of the company's executives were arrested, and several top officials with the drug regulator resigned following the scandal.

Beaten, terrified and disappeared: China cracks down on faulty vaccine outcry

Via The Guardian: Beaten, terrified and disappeared: China cracks down on faulty vaccine outcry. Excerpt:

There are fears for the safety of a woman campaigning about China’s defective vaccines, with activists saying she has been missing for more than 40 days. Authorities have been clamping down on families demanding redress over hundreds of thousands of doses issued by the government.  

Following revelations in July that a state-sponsored vaccine programme had been using faulty serum, Tan Hua, 38 had been organising parents calling for compensation and changes to how health authorities manage vaccines.

It is one of the largest public health scandals to hit China since the discovery of melamine-tainted baby formula in 2008. Changsheng Biotechnology, based in China’s northern province of Jilin, was found to have sold 250,000 defective vaccines. It also fabricated inspections dating back to 2014. Another major vaccine maker, the state-owned Wuhan Institute of Biological Products, was also producing faulty inoculations for infants.

Tan, who claims she is the victim of a defective rabies vaccine in 2014 and has been protesting for years, was among a group of at least nine other protesters who were detained after attempting to protest in Beijing’s Tiananmen Square in early September at the time of a China-Africa summit in the capital. 

He Fangmei, another campaigner, who was with Tan at the time, said: “Some 10 or 20 men in plain clothes surrounded us and caught Tan Hua. I was trying to make calls to other activists for help.” He, who says her daughter became partially paralysed after receiving one of the substandard vaccines discovered this year, was sent back to her home province of Henan.  

Unlike the others who were released or whose family members have received notice of their detention, there has been no news of Tan since she was taken away on 3 September. She reportedly has epilepsy and other health problems and had been seeking compensation in Beijing for disability. “Tan Hua is the only who totally disappeared without any information,” said He.

Authorities have tried to respond swiftly to the latest vaccine scandal, firing senior officials in China’s Food and Drug Administration and detaining the chairwoman of Changsheng as well as more than a dozen other employees. President Xi Jinping promised the government would “investigate to the end” and “effectively respond to the concerns of the people”.  

Yet parents who have become vocal, calling for a vaccine law or more information about vaccine safety, have come under pressure to keep quiet. 

“Authorities simply refuse to work with citizens, even on issues where they are allied,” said Frances Eve, a campaigner with the advocacy group Chinese Human Rights Defenders. “That the [Chinese Communist] party would rather lock up a victim of a very scandal its trying to fix shows it still doesn’t know how to protect social-economic rights.”

EBOLA DRC - Evolution of the response to the Ebola outbreak in North Kivu and Ituri to Friday, October 5, 2018

The Ministry of Health has published EBOLA DRC - Evolution of the response to the Ebola outbreak in the provinces of North Kivu and Ituri to Friday, October 5, 2018. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Friday, October 5, 2018   

The epidemiological situation of the Ebola Virus Disease  dated October 4, 2018: 

• A total of 167 cases of haemorrhagic fever were reported in the region, of which 135 confirmed and 32 probable. 

• Of the 135 confirmed, 74 died and 48 are cured. 

• 13 suspected cases are under investigation. 

ª 2 new confirmed cases, including 1 in Beni and 1 in Butembo (from Beni). 

• 1 new person healed in Butembo. 

• No new deaths.

  

Remarks: 

• To avoid that the total number of cases varies (up or down) daily, the suspect cases have been placed in a separate category. Thus, suspect cases with positive laboratory tests will be added to the confirmed category, while negative ones (non-cases) will be removed from the table. 

• The category of probable cases includes all reported deaths for which it was not possible to obtain biological samples for laboratory confirmation. The investigations will determine whether these deaths are related to the epidemic or not. 

News of the response     

Epidemiological surveillance 

• Resistance in the Ndindi neighborhood in the city of Beni last August caused a first wave of confirmed cases in early September. A series of contacts refused vaccination and epidemiological monitoring. The incubation period being 21 days, we are now witnessing a second wave of confirmed cases among refractory contacts. 

• Following this evolution of the epidemic, Beni has become the new center of attention for all the efforts of the response. The visit of the Minister of Health, Dr. Oly Ilunga Kalenga, in recent days was aimed at defining a new operational strategy in the city of Beni. This new strategy aims to strengthen Beni's under-coordination, which is independent of the strategic coordination also localized in the city. The city of Beni has been divided into 18 operational zones that correspond to the 18 health areas of the city. From now on, each health area will have a specific response team to carry out activities corresponding to the different pillars of the response. A supervisor per health area will be in charge of controlling the progress of the programmed actions.  

Local Human Resources Management 

• Following various problems encountered in the management of local human resources at the 9th epidemic disease of Ebola in the Equateur province, the Ministry of Health, through its program of 'Development Project Sector Health (PDSS), has put in place new procedures to ensure greater transparency and traceability of funds for national agents and local providers who have taken risks in the field. 

• A human resources management team has been established at the national level with focal points in each operational site with the support of EUP Nord-Kivu auditors.   

• A computer tool developed with the help of the company Blue Square allows auditors to encode through their tablets the individual identification of each provider and its geographical location. After this physical and geographical verification of the service providers, the team at the national level, which has lists of service providers supported by the partners, checks that the identified persons have not been contracted by other organizations active in the response. This double verification makes it possible to make reliable the lists previously validated by the coordination and to avoid double payments. 

• The particularity of North Kivu is the high level of internet penetration and the widespread use of mobile banking by the population. The majority of local providers use mobile banking and have preferred this method of payment, which also allows a better security of the funds. 

• To date, nearly 2,000 local providers have already been identified in accessible sites and 1,432 have already been paid. Payments are in progress for the remaining providers by the different stakeholders. 

• As the graph below shows, the Government, through the PDSS, supports 61% of local providers without counting all the national experts deployed in the field since the beginning of the response.

 

Vaccination 

• Since the beginning of vaccination on August 8, 2018, 14,278  people have been vaccinated , including 4,737 in Beni, 4,269 in Mabalako, 1,632 in Mandima, 1,287 in Katwa, 1,060 in Butembo, 355 in Tchomia, 307 in Bunia, 270 in Masereka, 240 to Komanda, 121 to Oicha.

Inside Zimbabwe's efforts to tame cholera

Via The Lancet: Inside Zimbabwe's efforts to tame cholera. Excerpt:

Zimbabwe declared a state of emergency in response to the latest cholera outbreak, limiting gathering and vendor activity. Munyaradzi Makoni reports on the social implications of this move. 

Life is not yet back to normal in Zimbabwe, a month after Budiriro and Glenview townships in Harare, the capital, became the epicentre of a cholera outbreak that killed 32 people and infected 7500 others nationally. New cases have dropped to a trickle, declining from about 500 per day at the outbreak's peak to about 100 cases after 3 weeks, John Mangwiro, deputy health minister told a press conference. But the challenges remain to prevent the disease from making a comeback. 

The government declared a state of emergency to contain cholera and typhoid after 20 people died, resulting in authorities discouraging gatherings and clearing the streets of vendors. 

President Emmerson Mnangagwa vowed to help the Harare City Council with financial assistance toward fighting the epidemic, saying the funds being raised daily would help fix the burst pipes at Morton Jeffery Waterworks—the potable water supplier to the capital, the Central Business District, and the suburbs. Harare's water infrastructure is old and failing to cope with a burgeoning population of 2 million people. 

Zimbabwe received US$29 million from philanthropists and development partners out of the $64 million required to tackle the epidemic in the immediate, medium, and long term. Of the $29 million raised so far, $25·4 million is for immediate use and the remainder will go towards medium-term and long-term issues, said Finance Minister Mthuli Ncube. 

“The distribution of clean and safe water for household use in the affected parts of Harare through the municipality water supply systems remains sporadic”, Anderson Chimusoro, WHO-Zimbabwe disease prevention and control officer, told The Lancet. 

The Harare City Council rushed to repair sewage leakages that occurred in the affected areas and promised to respond urgently to any reported leaks, but the infrastucture needs to be upgraded, Chimusoro said. 

Samuel Mangoma, executive director of Vendors Initiative for Social and Economic Transformation, which has 60 000 members countrywide, said the government's state of emergency was a good idea because it mobilised resources to deal with the problem of cholera, but a lot of business has been lost when the government launched a crackdown to clear streets of Harare of vendors, he said. 

“The cholera outbreak has nothing to do with vendors”, Mangoma told The Lancet. The council should stop using vendors as scapegoats, he added. 

“The police have been giving us hell ever since there was typhoid outbreak last month, but things got worse when cholera outbreak hit Harare, even for us who do not sell cooked food and fruits”, Beula Korio, at the Kudzanai Bus Terminus in Gweru, told The Lancet. For the past 15 years, Korio has survived by selling vegetable seedlings. 

“We are now seeing huge regrets from people who voted for transformation and livelihood improvement in the recent elections. They will never celebrate having their sources of livelihood being torn apart in name of cholera”, said Rashweat Mukundu, a human rights activist and a commentator based in Harare. It results in people losing confidence in political office bearers, he said. 

Cholera shed light on the perennial health problems that need serious attention in the country, he said. 

“Vendors are now seen as the problem, but what took them into vending in the first place? At the apex is poor governance that has spawned poor service delivery, part of it brewed from corruption, that sits in public service, particularly tendering in the urban infrastructure development”, Mukundu said. “The rich who reap millions in this corruption won't die, but the poor will be on the receiving end.”

Hong Kong’s commercial landlords poised for bonanza from China’s vaccine safety woes as parents flock south for jabs

Via the South China Morning Post: Hong Kong’s commercial landlords poised for bonanza from China’s vaccine safety woes as parents flock south for jabs. Excerpt and then a comment:

Angela Young had the shock of her life when China’s drugs regulator revealed that the company which produced the two vaccine shots for her 16-month-old baby also supplied 400,520 doses of substandard DPT combination vaccines to children elsewhere in the country. 

Alarmed, the Beijing legal clerk consulted two agencies that specialised in arranging offshore health care, and came up with a plan: she would take her boy to Hong Kong in October when he is 18 months old for four vaccine shots. He will receive another three injections in April when he is two, plus the two combination DPT doses to protect the toddler against diphtheria, whooping cough and tetanus.  

The package of vaccines will cost Young HK$5,400 (US$688), not including the air fare, hotel lodgings and food for her son and mother, which will add up to 20,000 yuan (US$3,000) in total. For the first-time mother, that amount is well worth it.  

“Nothing even comes close to my biggest concern, which is the effectiveness of vaccines in China,” she said during an interview in Beijing. 

Young is not alone. Families throughout China have been incensed since April by a scandal involving several of the biggest producers of vaccines and drugs that have been found to be substandard. 

The loss of confidence in China’s health care could turn out to be a bonanza for Hong Kong, where 76 per cent of the 58.5 million visitors to Hong Kong last year hailed from north of the border. according to the city’s tourism data. 

Most came to shop for products and services that are either unavailable, or which cost multiple times more, on the mainland. Vaccines are the latest additions to that shopping list, on top of infant formula, residential property, insurance and wealth management products. 

The economic benefits to Hong Kong from the influx of these health care tourists could be long term, even if the Chinese regulator were to get a grip on the country’s vaccine safety soon. China’s dairy industry was decimated by a scandal involving melamine-laced infant powder that sickened 300,000 babies and killed six. 

A decade on, there is still a thriving cottage industry of buyers who raid supermarkets in Australia, New Zealand and Hong Kong for milk powder to bring back to China for eager parents. The practice was so rampant that it led to shortages that forced Hong Kong Customs to maintain a two-can purchase limit on every visitor, to this day. 

Hong Kong children need at least 17 different doses of vaccines from their birth to 12 years old, according to the city’s Childhood Immunisation Programme recommended by the Department of Health. That is not counting seven optional vaccines covering influenza and cervical cancer. 

The injections are free for the city’s residents, courtesy of a public health system. For non-residents, the total bill for the entire menu of 17 doses adds up to HK$17,350. In private hospitals, the number of doses differ and the prices differ, depending on the options on offer.  

The longer term benefits spill over from the medical profession. Landlords of commercial property could benefit from a boom in paediatrics, as more clinics open to serve the rising demand, said Colliers International Hong Kong’s research director, Daniel Shih. 

“Central, Tsim Sha Tsui (TST), Mong Kok and Causeway Bay have the highest concentrations of medical clinics and beauty centres in Hong Kong,” said Shih. “Landlords in these districts have converted more office floors into medical floors in recent years.”

While I'm happy for Hong Kong's landlords, I'm worried about the many millions of angry Chinese parents who can't afford multiple trips to Hong Kong. The Chinese healthcare system might even have to cease outsourcing vaccine production to the private sector and make it a state-owned industry under ferocious supervision.