In July of 2018, parents of children in China received worrying news — vaccinations that were distributed and administered to children across the country were faulty. Paperwork and security checks at a major pharmaceutical company, Changsheng Biotechnology, were recently discovered to be fabricated, and thousands of vaccinations for rabies and DPT — diphtheria, pertussis, and tetanus — were revealed to be “substandard” as described by the government.

According to TIME, Changsheng Biotechnology is a major pharmaceutical powerhouse in China, responsible for manufacturing and distributing 23% of China’s total rabies vaccinations. However, in July, it was revealed that the company’s top officials were entangled in an extensive cover-up and bribery scandal involving paying off and forging multiple documents ensuring the authenticity of these vaccinations. DPT vaccines are one of the required vaccinations for entry into schools and, as such, is widely distributed. It is estimated that over 250,000 of these faulty vaccinations were sold to major cities across China. While these vaccinations are not believed to be harmful, main concerns lie in a lack of protection against these illnesses.

Following the breaking of this news, the backlash by parents and the public in China has been immediate. Parents are outraged that their children were exposed to these substandard vaccinations and are now at risk. Individuals have openly criticized the government and officials over their handling of these cases. In a country where dissent is not encouraged, the public’s uproar and protests are a big shock and indicator over the lack of faith and trust in the government that this scandal has caused.

This pharmaceutical scandal and others before it have significant ramifications for China’s public health. This recent public health crisis comes after a string of other healthcare scandals in recent years in China, most notably involving melamine-contaminated milk power, heart medicine containing a class of compounds believed to be carcinogenic, and improperly stored vaccines that led to many children falling ill.

Due to this crisis over vaccinations, many parents have had their faith shaken in China’s vaccination industry and also in the government officials who are supposed to be regulating companies and protecting the public. This could have significant consequences as many people live in tight quarters and busy cities in China where diseases spread quickly and easily.

China also has the world’s second highest rate of rabies infections, and public fear of rabies and animal bites runs high. With decreased trust in these vaccinations, parents might choose to receive their vaccinations elsewhere, like Hong Kong, or may simply forgo these critical vaccinations, according to reports by the South Morning China Post.

Furthermore, a lack of transparency and insight into the government’s handling of the problem has simply served to further anger the public, leading to protests in China. According to an editorial in the newspaper China Daily, this scandal could easily become a “public health crisis should it not be handled in a reasonable and transparent manner,” and it argues that it is also time for a “thorough overhaul of the industry.”

According to an international student from China, Elena Zhou, this latest scandal has caused people to panic and has resulted in people “not believing in vaccines” and a “reluctance to take vaccines in China.” In her opinion, in order to fix this problem in China, it is necessary for the government to be transparent instead of censoring news surrounding this scandal.

This vaccination crisis is indicative of a looming problem with China’s healthcare system. A general lack of confidence and happiness with the Chinese medical system and the government’s response to scandals such as these have caused many parents to doubt the medical system and vaccination programs, which could lead to many future public health crises if not addressed.