A huge scandal involving hundreds of thousands of defective vaccines given to Chinese children rocked the world of Chinese medicine in July, leading to multiple arrests.

Chinese President Xi Jinping called the vaccine scandal “vile and shocking” and ordered a “thorough investigation” by both the Chinese Food and Drug Administration and anti-corruption agencies.

Vaccine maker Changsheng Biotechnology was accused of selling over 250,000 doses of diphtheria, pertussis, and tetanus vaccines that failed to meet safety standards. Changsheng was further accused of fabricating production and testing records for a human rabies vaccine that was found to be defective.

Terrified parents in Shandong province, where most of the suspect vaccines were shipped, have been told it will take time to determine exactly which children were given injections from the dubious batches or what effects they might experience.

Chinese authorities quickly made at least 15 arrests in the case, including four top Changsheng Biotechnology objectives and its chairwoman Gao Junfang, formerly known as the “vaccine queen.”

The damage to public confidence was already done because Changsheng was one of the largest vaccine suppliers in China, and the new scandal was only the latest in a string of medical and pharmaceutical embarrassments for the Chinese government. The government’s response validated fears of widespread malfeasance in the pharmaceutical industry by virtually paralyzing drug companies and causing their stocks to tumble.

The outraged response on Chinese social media had the feel of a final straw deposited on the back of a deeply frustrated camel. Perhaps most disturbingly for the aggressive authoritarian government in Beijing, the public response indicated a collapse of trust in public officials and loss of faith in Chinese products ranging from medicine to food and baby milk.

The Wall Street Journal noted that medical malpractice in China is accompanied by endemic corruption, which seems to sprout everywhere in China despite the government’s constant no-holds-barred war against it. Changsheng Biotechnology has a lot of deep political and business connections:

The company, based in China’s northeast industrial heartland of Jilin, faced censure this week after disclosing that the province’s local drug authority found that its vaccines to protect against diphtheria, pertussis and tetanus didn’t meet safety standards.

The doses were sold mostly to the government of eastern Shandong province. This month the company sponsored a conference in Shandong on flu prevention attended by more than 400 government officials, according to a local-government announcement.

The company spent 582 million yuan on marketing in 2017, including product promotion and sponsoring meetings, according to its annual report.

Corruption has long plagued China’s medical system, including the cash-filled red envelopes patients give doctors for better care to payments by drug companies to secure sales.

Changsheng’s case brought up memories of a 2016 scandal involving improper storage of vaccines. The main suspect in that case had earlier been convicted of illegally selling vaccines. President Xi Jinping and Premier Li Keqiang vowed this week to better police China’s vaccine supply, echoing similar vows by Mr. Li two years ago.

In a bit of news that will no doubt displease the proud ruling elite of Beijing, the WSJ reported that “birth tourism” to the United States is suddenly a hot item, with Chinese parents shelling out $500 for tour packages that include inoculation of their children by American doctors.

Xi was out of the country when the scandal blew up, but Chinese state-run media made a big deal about his personal involvement in the case. The Global Times reported on Tuesday that Xi has ordered a “thorough investigation” followed by the “serious punishment of those found responsible.”

The people’s health should always be a top priority and the bottom line of safety should be resolutely guarded, Xi said.

He described the illegal production of vaccines by Changchun Changsheng Life Sciences Limited (Changchun Changsheng) as hideous and appalling.

Relevant departments and local authorities should pay close attention and immediately probe the case to find the truth, Xi said, adding that the investigation should be thorough, the punishment severe, the accountability held seriously, and the case’s progress should be publicized on time to address public concern.

Xi stressed that it is a bounden responsibility for Party committees and governments at all levels to ensure drug safety. A firm determination should be mustered to improve the country’s vaccine management system, and utmost efforts should be made to protect the people’s interests and social security and stability, he said.

The New York Times noted that despite Xi’s effort to appear shocked, appalled, and personally dedicated to making medicine safe again, the Chinese public appears deeply skeptical. A devastating meme floating through the Chinese internet quotes Premiere Li Keqiang’s vow on Sunday to “resolutely crack down on all illegal and criminal acts that endanger the safety of people’s lives” alongside his nearly identical promise to clean up the medical industry after a previous vaccine scandal in 2016.

Based on the criticism in social media and man-on-the-street news reports, the Chinese public doubts the government’s ability to conduct an open and transparent investigation, fears the worst culprits will remain politically protected, and suspects the measures necessary to bring Chinese pharmaceuticals up to American standards would increase their price beyond what Beijing is willing to pay.

Human Rights Watch echoed those criticisms on Monday by portraying the vaccine crisis as a symptom of China’s authoritarianism and calling for top-down reforms of the system:

First, release from incarceration all the lawyers who assisted victims in previous vaccine scandals. From 2006 to 2009, lawyer Tang Jingling represented a group of parents whose children were left permanently disabled after being given problematic meningococcal vaccines. This would require quashing the five-year sentence Tang is currently serving on baseless charges of  “inciting subversion.” Similarly, lawyer Yu Wensheng has languished in a detention center on spurious “subversion” charges. Yu had represented a man who was detained for seeking redress for his daughter, who became seriously ill after being given spoiled vaccine.

Second, stop harassing, detaining, and prosecuting families of victims of faulty vaccines. In July 2015, after being given vaccines at the local government-run epidemic prevention center in Henan province, Wang Nuoyi was diagnosed with a brain injury and other illnesses. In pursuit of justice, her family wrote letters to the government. The authorities responded by detaining Wang’s father for four months in 2017 as well as at least six other members of his family, and prosecuting Wang’s grandmother for “provoking trouble,” which resulted in a two-year prison sentence.

Third, stop punishing journalists for exposing vaccine scandals. In 2010, prominent investigative journalist Wang Keqin was removed from his post at the China Economic Times after the newspaper published his story about mishandled vaccines that led to the deaths of four children in Shanxi province. Amid the current scandal, while netizens are free to condemn the drug company, news articles and social media posts that showed the Chinese government in a critical light continue to be censored.

The vaccine crisis could present a business opportunity for foreign pharmaceutical companies as well as an opportunity for political reform. China currently imports less than three percent of its vaccines, but not only is the future of number-two vaccine maker Changsheng Biotechnology in serious doubt, all of the other Chinese pharmaceutical manufacturers and distributors saw stock tumbles on Monday that were as large as China’s strict market controls allow.