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What we know about China’s coronavirus vaccines

A booth at a trade fair in Bejing in September 2020 displays Sinopharm's Covid-19 vaccine.
Reuters/Tingshu Wang
This might be the world's most widely used vaccine.
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Early into the pandemic, drug makers around the world began a race to deliver a safe and effective coronavirus vaccine. On March 16, 2020 the first dose of US biotech firm Moderna’s vaccine candidate was administered in the US. On the same day, just hours earlier, the first dose of a Chinese Covid-19 vaccine was given to volunteers in Wuhan.

In December that year, the UK became the first western country to authorize the widespread use of a vaccine developed by Pfizer and German firm BioNTech, after the firms shared final-stage trial data with its medicines regulator. The first jabs were given on Dec. 8, with the very first dose going to a 90-year-old woman in Coventry.

In the intervening months, several of the companies furthest ahead in the effort to provide a vaccine released preliminary data from late-stage trials of their vaccines’ efficacy and safety (none of the data is peer-reviewed yet). But until late December, Chinese vaccine makers hadn’t released any data from this final stage of clinical trials, even though some of these vaccines were already being used on hundreds of thousands of people even outside of clinical trials.

The rollout of China’s vaccines, like those out of the US and Europe, will have a major impact not only on the global efforts to stop the pandemic, but also on the international diplomatic landscape as Beijing promises developing countries priority access to its doses.

Here’s where things stand on China’s vaccines, including what we know about their safety and efficacy, and how widely they have been administered so far.

Which are the main Chinese vaccines?

Of the roughly dozen vaccines in development out of China, four shots from three companies are in the widest use so far.

Two of these have been developed by the state-run China National Pharmaceutical Group, or Sinopharm, both via its subsidiary China National Biotec Group (CNBG). One of them, known by the initials BIBP, has been developed by subsidiary Beijing Institute for Biological Products together with with China’s Center for Disease Control, while the other vaccine was developed by a Wuhan unit.

Nasdaq-listed biotech firm Sinovac developed a vaccine known as CoronaVac, while another major player CanSino Biologics worked with a Chinese military research unit to develop its shot. That development effort has been led by Chinese infectious disease expert Chen Wei, a military scientist highly regarded in China for her work on an Ebola vaccine.

The technology used by the Chinese shots is different from those deployed by Moderna and Pfizer, which use messenger RNA (mRNA), a genetic material that gives cells the instructions for mounting defenses against a virus that isn’t there. This approach is novel—it hasn’t been used in existing vaccines.

Sinopharm and Sinovac, meanwhile, are developing inactivated Covid vaccines—an approach used often in developing other vaccines—which deploys a dead version of the coronavirus to generate immunity. CanSino’s “viral-vector” vaccine, like the AstraZeneca candidate, uses a weakened version of the common cold virus to deliver genetic material to spark antibodies to Covid-19.

Like the other vaccines, most of these are delivered in two doses given over 14-28 days, but CanSino’s is a single-dose shot.

What do we know about their safety and efficacy?

The final stage of clinical trials for the vaccines largely happened outside of the country, with Chinese officials citing the control of the outbreak within China as hampering the ability to carry out these tests there as well as the desire to improve international acceptance.

Sinopharm’s vaccines were the first among the Chinese vaccines to begin widespread human trials, starting in mid-July 2020 in the United Arab Emirates.  Some 60,000 volunteers from 10 countries were inoculated with the Sinopharm vaccines as part of clinical trials, according to Liu Jingzhen (link in Chinese), Sinopharm’s chairman.

On Dec. 30, Sinopharm said in a brief statement that its BIBP vaccine, developed via subsidiary Beijing Institute for Biological Products, had an efficacy rate of 79%, but didn’t share information about study size or the demographic make-up of study participants. However, according to the World Health Organization factsheet for the BIBP vaccine, the trial was not “designed and powered” to show efficacy against severe disease in people with comorbidities, or older than 60. Sinopharm eventually published interim results for its trials of both its shots in May 2021.

Shortly after Sinopharm, Nasdaq-listed Sinovac, which is developing a vaccine called CoronaVac, also began its late-stage trials in São Paulo, Brazil, in July. Hong Kong regulators said a review of trial data showed an efficacy rate of around 62% while Brazil’s Butantan Institute, which tested the vaccine on frontline health workers, showed an an efficacy of 51% against mild disease and 100% against hospitalization. Smaller trials in Turkey and Chile showed higher rates of protection against mild disease.

By September, CanSino Biologics announced that its vaccine, co-developed with a Chinese military research unit, had entered phase 3 trials, with the aim of inoculating 40,000 volunteers. It announced in May that its vaccine, known commercially as Convidecia, had an efficacy of 65%, about on par with that of Johnson & Johnson’s one-dose shot. In April, it also began testing a vaccine that can be inhaled.

But doubts persist about China’s vaccines due to new outbreaks in places that have used them widely, though in several cases local officials have said that the new cases were driven by the unvaccinated.

Are they approved by regulators?

On Friday (Dec. 4), Wang Junzhi, the deputy head of China’s task force on vaccine development, said at a briefing that China has 600 million doses ready to administer this year, and promised a “major announcement in the coming one to two weeks.” Sinopharm subsidiary CNBG’s application to China’s Food and Drug Administration for market use was granted provisional approval on Dec. 31.

Dozens of countries have given this vaccine emergency-use approval, and so did the World Health Organization in May 2021. Its other Covid-19 vaccine secured conditional market approval in China in February 2021.

Sinovac’s vaccine got conditional market approval in China in early February, and emergency listing by the World Health Organization in June 2021. It has also secured emergency-use authorization in multiple countries.

What is China’s Covid-19 vaccination rate?

In China, as of early December, over a million people had already received injections of Sinopharm’s Covid-19 vaccines, under an emergency use program, according to the company’s chairman. But the mass rollout kicked off for real in 2021.

The inoculation program had some slow months, largely due to the perception that the risk of contracting Covid-19 in China was low. But as more aggressive variants began circulating, and places once free of Covid saw new outbreaks, China ramped up the program sharply. By June, it was administering 20 million doses a day.

As of June 19, it said it had administered 1 billion doses of Covid-19 vaccines at home.

Which other countries are using these vaccines?

China-developed vaccines made up a relatively small portion of the global pre-orders of more than 7 billion confirmed purchases for Covid-19 vaccines—most of which were for the candidates from Pfizer, Moderna, and AstraZeneca.

According to tracking by a Duke University initiative, as of December 2020, Chile had signed up for 60 million doses of Sinovac’s CoronaVac, its biggest order of any of the vaccines. Indonesia had placed 50 million orders for it and Brazil had ordered a similar number, while Turkey had placed orders for 20 million doses (which could go up to 50 million). Indonesia had also ordered 60 million doses of one of the vaccines developed by Sinopharm.

According to Chinese foreign ministry spokesman Wang Webin, as of June 2, the country has delivered 350 million vaccine doses beyond its borders, in a mix of exports and assistance.

Beijing-based Bridge Consulting, which is tracking China’s vaccine use, says some 400 million vaccines have been delivered to 99 countries as of early July. The largest share, around 214 million, has gone to Asian countries, with Indonesia counting for perhaps half of those.

This story was updated in July 2021 with newer efficacy information and distribution numbers for the vaccines.

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