Gibson, t. First of all, thank you for being with me again. Its great to see you again. First of all, tell us about your medical background. Im not a physician, but i happened to spend three years researching and figuring out where our medicines are made. Its a real shocker. How dependent we are on china for so many of our generic drugs. You are a Senior Adviser at the Hastings Center. Tell us about what the Hastings Center is and the research you do there. The Hastings Center is a bioethics think tank. We do lots of work on ethical issues and certainly availability of good medicines is one of those. Tell us about your assessment of the extent lets talk about coronavirus first. Sure. Everybody is talking about coronavirus. Tell us about your assessment of the extent of coronavirus right now. Well, i dont want to scare people. We do have an issue with coronavirus cases popping up around the country. We have to be careful, do all the things we should do, wash our hands, not go out if were sick. Lets hope that it passes quicker than we all quick and we can get back to normal life again. The subject of your book is about the fact that china makes a lot of the medicines. Mostly the ingredients to make them. They got a global chokehold. We have a pandemic and now with china making a lot of the ingredients for our medicines first of all, are we seeing a downtick in the number of the a. Medicied m amount of medicine coming out of china to the United States or is it too early to tell . Look at it this way. Production is shut down in china, particularly in areas where the coronavirus has hit really badly. Like in wuhan, thats a hub for making a lot of the chemicals for antibiotics. That is a problem. You have a lot of transportation routes being blocked. This is serious business. We predicted this in china rx, that in the event of a Natural Disaster or Global Health emergency, if the doors were shut on china exports, we could be having problems anding are are basic medicines, these are the ones that 90 of our medicines are generic. This is what makes hospitals run. On wednesday, dr. Fauci was asked about concerns over drug shortages in the United States and chinas role in manufacturing many of the drugs. I am concerned about the fact that as we have had the conversation previously about this, the number of drugs that are made, active ingredients made, i would add we will get back to that in a minute. What type of ingredients for drugs do we depend on from china right now . Are we seeing those ingredients vanish . What were seeing is that china really has a dominant Global Market share on antibiotic components. These are antibiotics that treat Infectious Disease called by bacteria. They wouldnt help the coronavirus because these are bacterial infections and antibiotics work on those. The fda did announce short anl anlshortage of a medicine because of coronavirus. Im told it could be an antibiotic. We are seeing the effects of it right now. We have had drug shortages for 20 years. Add coronavirus. The need is greater to assure we have medicine. I can best clie hina is withhol because they need these medicines for their own people sfpeople. We have a question from one of our viewers. Why are we dependent on china for making our for making the ingredients for our pharmaceuticals . Why cant we make our own . Labor cost, availability of resources . Thats a great question. We started becoming dependent on china for the core chemicals in the 90s. It ramped up in the early 2000s when the u. S. Opened up free trade with china. Tariffs came down. Thats when we lost our last penicillin plant. We cant make bpenicillin anymore. Mo we cant take vitamins anymore. Who knew our trade laws would have such an impact . Thats where we are now. Yes, we can make them here. China has cheated on trade. They fix prices. They control supply. These are all illegal trade practices and plus, the Chinese Government is subsidizing. How can we we can make the medicines here. Thats what i have been working on the last couple of months. Because of the earlier show i was on with you, a number of people reached out to me who are really smart, brilliant people and who know how to make medicines. They want to start small companies. We can make this. We can do this. We can do it. You know what . With new technology, advanced Manufacturing Technology, we can actually make them cheaper here in the United States. Labor costs are a lot lower. We have been making medicines for the the same way for 100 years. The way we make potato chips is far more advanced than how we make our medicines. We have to bring this advanced Manufacturing Technology to making medicine here in the United States, those medicines that are really important for our Health Security and National Security. How long would it take to ramp up the production of the ingredients for these medicines in the United States as opposed to just depending on the ingredients coming from other countries . Another quick question for you. Why china . Why not why is china the hub and not india, not england, not nigeria . Why china . Because china has that was they set a goal that were going to become the pharmacy to the world. They have a whole industrial policy, a whole plan for how to do that. To their credit, they are executing it beautifully. They have ramped up quickly. If you are a country of more than a billion people, you need to have medicines. They are accelerating very quickly to become that global pharmacy to the world. To the point that even india this is really interesting. Even india, the biggest generic maker in the world, india depends on china for the core components. When china shuts down as we have seen with coronavirus, it affects everybody, not just us. Let me remind our viewers that they can take part of in this conversation. We will open up regular lines for you this morning. That means democrats, your number is 2027488000. Republicans your number is 2027488001. Independents, you can call in at 2027488002. We will open a line for medical professionals. I want to hear what you are seeing out there in pharmacies, in hospitals, in doctors offices. Are you not being able to find medicines right now . We want to hear from you specifically. Medical professionals, your number is 2027488003. You can also text us your questions and comments at that same number, 2027488003. We are reading on seesocial med and twitter. Now, you have said this line specifically earlier. I remember this line from our last show. You said that it is no ones job in the federal government to know who controls our drug supply. Is that still we had this conversation six, eight months ago. Is that still true . Well, the fda is working as fast as it can to figure out where these core chemicals are coming from, where they are made and do we have any alternative sites. This should have been done years ago. We have not been well prepared. Now were trying to play catchup. What i hope is that we can make medicines here in the United States so we dont have to even worry about this next time we have a coronavirus or whatever the next thing will be. We can fix this. There will be hearings next week in congress i hope that we can talk about the kinds of solutions that we can implement today. If there was money, we could implement solutions to bring back medicine making for those really essential medicines needed to care for people. Here is a really Interesting Data point. Lets take people who are hospitalized with coronavirus. Thats, fortunately, a small percentage. They have to be cared for. You need sedatives, you need pressers, you need antibiotics in case they get a secondary infection, bacteria infection. I asked people who make medicine, men and women in the manufacturing plants. I said, how dependent are we what percentage of those ingredients to make those medicines to care for people in the hospital, how much come from china . We went around the room. Everybody said, 90 . 90 . So 90 of the ingredients to make the essential medicines to treat people with coronavirus, not to cure them, but to care for them, we depended on china. We have a strategic decision to make as a country. Continue down the same panel th dependence, which will worsen, or we can bring some of the manufacturing back home and we can actually do it cheaper. We can sell medicines chiefer than we do now. With advanced Manufacturing Technology. Fer than we do now. With advanced Manufacturing Technology. Fer than we do now. With advanced Manufacturing Technology. Eafer than we do now. With advanced Manufacturing Technology. Pfer than we do now. With advanced Manufacturing Technology. Er than we do now. With advanced Manufacturing Technology. Lets go back to see what dr. Fauci said about this. Here is what he said. I am concerned about the fact that as we have had the conversation previously about this, the number of either drugs that are made, active ingredients, medical devices made in places like china. I dont know, do we know what that supply chain is with the companies . We did a letter this morning to the top 20 or so Prescription Drug companies and are asking this question. Do we keep track of this to know how many drugs are made in places like china and where we could be for potential shortages in a case like this . I believe the fda does. The fact you are concerned is one that we have been talking about as part of pandemic preparedness for years. When we put together the plan back in 2005, we said one of the real problems is supply chain. I was somewhat, i would say, impressed shocked that Something Like 90 of the fundamental ingredients that go into many of the drugs, not the actual drug itself, comes from china. That is a real problem. I dont have any answer to you. Its not anything that we do. Its something that impacts us. One fog july. Should we be tracking active ingredients in medical devices as well this is. I would imagine, yes. Finally its out there now about how dependent we are. Were trying to scramble in the moment. I hope this is the moment when we decide we have to bring some of this medicine making back home so were not dependent on any country. Any country that has a Public Health emergency or Natural Disaster, they will keep their medicines at home. Whether its in europe or canada. We have to realize that and make sure we can take care of our own people here in the United States. Lets go to our phone lines and let our viewers join in on this conversation. Lets start with jody calling from michigan on the democratic line. Good morning. Caller good morning. My question was, what is needed to get the funding for the pharmaceutical companies to get started . Is it legislation need . Is it an executive order . The second part of that is, what would be the time frame . Are our Pharmacy Companies geared up on a manufacturer end to provide these ingredients that are needed for us . I mean, is this a Silver Lining that now we are aware of this . Of all the awful things that have come out of this, is this something now that might promote the United States to become the center and to have a positive impact out of this devastation that has caused for many families . I think the caller, you are so right about this being a Silver Lining. We have an opportunity now to know where we are vulnerable. Its no secret anymore. What its going to take is some funding for rebuilding some of our manufacturing base. Its collapsed over the past 25 years. Plants have shut down. Jobs have moved to china and other countries. So we have to rebuild some of those plants and those ones that still are standing, we have to refurbish them. If we can use advanced Manufacturing Technology, it takes a smaller physical space, its a smaller environmental footprint. We can make them much more efficiently. It will take some funds just on the infrastructure side. And then i think the real innovation is going to come from the smaller companies. One of the interesting things to think about is, who are the western generic drugmakers now . Mylan was the largest u. S. Based drugmaker making generics. They basically merged with pfizer. So they are moving out of this. They were and are based in morgantown, west virginia. We have two european companies. Sandos and tevos. We are seeing they have been discontinuing products in recent months because they cant compete with china, because their companies are being subsidized by the kline hechine government. The Big Pharma Companies arent interested in making them because theres not that much margin in it. They can make greater margin in the more innovative products, brandnew name ductproducts. There are companies that are innovative, that dont have any legacy ways of looking at this and say, lets bring new technology to bear. Make our medicines here. How soon can we get going . Companies i have talked to, they could start within days to begin to make the active ingredients here and then to make all those active ingredients totally in the United States shortly thereafter. It will take some money. Good people that want to do it right. It cant be tax credits that are out there and hope something happens. We need to be very targeted and specific that whatever we fund, companies actually have to produce product, make drugs here in the United States to help us immediate our national Health Security needs. I want to read to you from a story that came out of cbs earlier this week. The fda on thursday said that for the First Time Since the outbreak, a drugmaker reported a coronavirusrelated shortage for an undisclosed drug because it cant access enough raw components which are made in china. The fda did not name the drug, the condition it treats or the manufacturer. The shortage is due to an issue with manufacturing of an active pharmaceutical ingredient used in the drug, the agency said in a news release, while noting there are available substitutes for u. S. Consumers. Do we know what drug this was . Do we know what manufacturing, what ingredient this was . Do we know anything more than that statement . The fda didnt name the drug. I think that could be for good reasons. We dont want any hoarding to go on by hospitals that they buy up all the supply. What we should be doing is whatever supply exists, its distributed to those patients who really need it. We dont want to cause panic around a particular product. I can understand why the fda did it. The reality is that we have a lot of medicines right now that, irrespective of coronavirus, that are in short are being rationed. The official term is allocating. Its under allocation. The reality is, we are rationing essential medicines, including antibiotics in the United States. Let me tell you a quick sorry from the field. I was visiting a hospital this past week. I met an ems worker, someone who works on ambulances to bring people who are sick to the hospital. I said, tell me what you are seeing. She said, we dont even have epinephrin, a really important medicine to revive people. You dont have epinephrin . What do you do . She said, we try to drive faster to the hospital. Thats not an answer. The American People should not be satisfied with that at all. That is properly not because of coronavirus. That was probably going on even before all this. It was probably going on even before all this. So this coronavirus is highlighting not just how dependent we are on china but how weve allowed these shortages to happen for 20 years. Weve had at least a hundred plus drugs in shortage before coronavirus. How do we tolerate that . The fda doesnt tell us the real reason. We should know exactly why a certain drug is in shortage, who is making it and the real reason. All that is obfuscated. We need honesty and transparency from the federal government on why we are not seeing these medicines. What are we doing about it . There is one entity that has started to work, done a great job in dealing with job shortages called civica rx, a nonprofit formed by 1, 300 hospitals. Mayo clinic was one of the leaders. They say this is crazy to have drug shortages. How do they fix a shortage . They do what everybody else would do if you had a shortage say of tomatoes and couldnt make pizza or a shortage of mozzarella cheese. They went out and identified trust worthy manufacturers in trust worthy countries. They paid a fair price, not a race to the bottom price, and give them longterm contacts so they can invest in their manufacturing. And total transparency on country of origin and cost. Lo and behold, within a year of startup they were delivering a really important biotic needed for people with serious infections. These are medicines of last resort. Within a year of start they could deliver it and 18 other drugs just within a year and they have 20 more lined up. Shortages are not inevitable but have been allowed to persist and it is just unacceptable. Back to our phone lines lets talk to chris who is calling from silver spring, maryland on the republican line. Chris, good morning. Caller hi. Good morning. Its politically popular to attack pharmaceutical companies and a preoccupation with reorganizing our Health Care Service which has created some havoc. Im curious. Do you think lets say the chinese lobbied to keep our american production in disruption . Im curious about that. The other question i have is do you think universities can help in the production of the needed pharmaceuticals and other things . Ill hang up and take your answer. Thank you. Well, thank you for those two questions. Certainly china is, when it becomes, as it is becoming the pharmacy to the world sees this as a tool of great leverage. Economically, politically. If youre if you are sitting in the white house and you get a call from a Chinese Government official saying, well, u. S. Government, we want you to do x, y, z, and if you dont we could withhold supply of medicine, that certainly is an example of the kind of Leverage China could use. And, in fact, china has threatened the u. S. Government in the past in a different situation with drug shortages if the u. S. Government didnt do what it wanted. So china is using its control of the Global Supply of ingredients for medicines for geopolitical purposes without doubt. Insofar as universities, wed have to find universities that have unique capabilities in chemistry and pharmaceutical engineering. The talent, the people who can actually put it together. And then have the experience in actually manufacturing product. It takes a lot of different skill sets to bring to bear. In writing china rx and researching it i developed a healthy respect for what it takes to make high quality medicines that are right, every pill, every vial, every patient, every time. So some of them with the right combination of skills, they can be part of the solution. Host lets talk to ron calling from beverly, new jersey on the democratic line. Ron, good morning. Caller good morning. I worked for a company in cherry hill, new jersey. They were the largest injectable Pharmaceutical Company in the world and they were bought by merck and bankrupted. One of the big problems is greed. If you make generics there is somebody selling it for more and they will buy you up and put you out of business. Thats all i want to say. I watched it in my lifetime. Thank you. I think what the caller is saying is a very clear reality of what happens in our Medicine Market and if were going to bring manufacturing back home, we have to treat it as a Strategic Asset, not ascent i es that can be bought and sold for financial purposes. We wouldnt do this with oil, we wouldnt do it with food supplies. We need to treat our medicines as something really valuable, essential to the survivability of our country. Thats why if we if there is ever any federal support, which i hope there is, to rebuild some of our infrastructure, that there actually be contracts so that manufacturers will know what is expected of them. And also provisions that, you know, five years from now if china or somebody else wants to come in and buy it for a billion dollars you cant sell it. This is a National Security asset for our nation. We need to make medicines for our military, for the men and women in uniform. And for seniors and for all of us. So we need to treat it in a way thats immune from a lot of the market ups and downs that have really contributed to our infrastructure base being decimated. One of our social media followers wants to challenge you a little bit on something youve said. Sure. They want to know, if it is so profitable to make drugs here with new technology why isnt big pharma doing it . Here is why big pharma isnt doing it. If they have a brand name drug, most of the funding that goes into that is for the r d. And for them its not it hasnt been worth it to invest in this advanced Manufacturing Technology. And its also habit. So theyve been really slow to the game here. But where there is urgency around generic drugs, again, talking about generic drugs, the lower cost products that are off patent. They dont have that much margin in them as the brand name products do. And generics are 90 of what it is we take. So there isnt that much margin. Thats why we need new entrants into the market place who have great capability but just need a leg up so they can get in and start making medicines for all of us. One thing i keep hearing when i hear you talk about medicines as a Strategic Asset is government. Yeah. Government control maybe of medicine. Is that something that we should have . Is that to the should the government get involved in controlling these necessary medicines . I think the governments role is to know who controls our drug supply, to be prepared for events like were seeing now with coronavirus, and have the resources to take the action steps necessary. So heres what government could and should do. If we can make the core ingredients in our medicines here in the United States, which we can do with incredible chemistry and technology, make them here from soup to nuts, and then we stockpile those and we have stockpiles, finished drugs, these stockpiles will last longer. Then if we have a coronavirus outbreak or whatever the next issue that comes up, all we have to do is have finished facilities right next door, get them up and running, and within a month you can start producing product. So we dont have any shortages. That is the type of planning and preparation that we need. And i hope this time around that theres Government Support to do exactly that. We should never be caught off guard like we are now. Were getting smarter but now we just have to invest in that infrastructure and production facilities so were ready to go. Lets go back to our phone lines and talk to valerie calling from lake alfred, florida on the independent line. Valerie, good morning. Caller hello, sir. My name is valerie. I live in lake alfred. I want to know how our government could get us in this predicament right now. That we have to depend on china for our medicine. I mean, this is america. We are a great country. Why should we ever have to depend on them no more than we now dont have to depend on, like iran for oil. We are selfdependent for the oil. But we need to be selfindependent and stop and think about it i mean, china, we do a lot of trading. I understand that. But if china china has wanted to be the greatest, and theyre not. Theyre trying to be. And what are they actually putting in our medicines that could demean us into lulling down so that they could take over one day . Well, the caller is on point with why are we doing this . If you talk to the average person on the street, if you and i go out on constitution avenue and just Start Talking about this, people will be saying, how could this be . They are right. That is the common sense of the American People that needs to come to washington and say we need to fix this and fix this fast. With regard to china and quality, what im concerned about is that the fda correctly recalled their inspectors from china because they dont want them to get sick from coronavirus. That means there is nobody over there inspecting the manufacturing facilities that are making medicines that are producing food for the United States. And i think its going to be a really long time before the fda gets over there. And bear in mind, something i learned recently, is that those who do inspections in china, these are really highly technical people. They go in these plants and they look to see if the way theyre being made meets the u. S. Standards, which are the Gold Standard highest in the world. To do that work you volunteer. So i cant say youre the fda you have to go to china next week and inspect that plant. They can say, sorry. I just dont want to do that. So people have to volunteer. Who is going to want to volunteer to do that for say the rest of the year . And even in the future . And ive also heard from very thoughtful people, think of it. Youre an inspector over there and this is a plant producing huge volume of product for the United States. And youre going to be the inspector that says, sorry. This product doesnt meet standards so were going to the fda will end up blocking it. The company cant sell it to the United States because of quality problems. Do you think the Chinese Government will want to give you a visa next time you want to come back to do an inspection . You certainly wont be very well received. What were seeing is globalalization is a new form of deregulation. I think the last time we spoke there was Blood Pressure medicine. Remember that . The Blood Pressure medicines and the active ingredient was made in china and it had carcinogens in it. 200 times the acceptable limit. Per pill. And the Chinese Company knew it had a problem. It knew its medicines destined for the United States and the rest of the world didnt meet standards. But they sold it anyway. This cavalier attitude is just not going to work for the foreseeable future. What im saying now, where im thinking as we learn more about this is i think were seeing the beginning of the end of the fdas ability to be effective in china. Lets go to james who is calling from newington, connecticut on the republican line. James, good morning. Caller thank you very much. Again, i want to say to the author, you are preaching to the choir. My question to you, also, in this would be, do you feel that the environmental by products, in other words, producing fentanyl, obviously a drug that can help but a drug that can kill or i think it is heparin is the one i often hear is produced in india. Do you think we have to really look at the environmental regulations not by lowering them but allowing companies if they were to open in the United States to not be subject to litigation provided they meet a higher, even higher government standard . Because i think a part of the reason why we dont actually have these companies here anymore is it is so easy to sue them for massive amounts of money and then that risk prevents companies from wanting to invest i guess at even a small pharmaceutical plant is going to be at least 10 million just to get a small one off the ground. Ill listen to your comments on the air. Thank you. Thats a really great question. One of the reasons that china is cheaper is not just because Emergency Preparedness response and recovery will come to order. The subcommittee is meeting today to receive testimony on Community Perspectives on coronavirus, preparedness and response. Without objection the chair may declare the subcommittee in recess at any point. Without objection, members not sitting on the subcommittee will be permitted to participate in