China’s Covid-19 success is slowing down its vaccine rollout

China’s Covid-19 success is slowing down its vaccine rollout
Image: Reuters/Aly Song
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While China’s Covid-19 vaccines are helping a number of countries carry out mass vaccination, its own rollout of the shots seems to be proceeding relatively slowly.

China administered 53 million doses to citizens as of Feb. 28, according to Zhong Nanshan, one of China’s most prominent epidemic experts. While that doesn’t seem a low number, it only covers around 3.6% (link in Chinese) of its 1.3 billion citizens. In comparison, the US has administered more than 90 million doses, covering around 18% of its people, while the UK has given around 22 million first doses or nearly 30% of the population.

For sure, China’s massive population is a major factor in its low share of coverage, but there are other elements at play too. China’s early success in containing the virus is, ironically, one of them. Despite being the epicenter of the pandemic in early 2020, the country now reports new cases only in the single digits, and life in China has basically come back to normal with citizens free to move around and socialize with others.

“When the UK and US began their vaccination programs the level of community transmission of Covid-19 in both countries was very, very high. So vaccination was viewed as more or less a measure to bring the community outbreaks under control,” said Siddharth Sridhar, an assistant professor in the University of Hong Kong microbiology department. “The situation on the ground in China is very much different, you don’t have the same sense of urgency because there are so few cases.”

The ultimate target, regardless of the specifics of each situation, is to reach herd immunity, which is essential for life to return to it was before the pandemic. A November paper from the medical journal The Lancet estimated for a vaccine with 100% efficacy—not the case for any of the vaccines in use so far—around 60%-72% of a  country’s population would need to be inoculated for it to achieve herd immunity. For a jab with an 80% efficacy that range becomes 75%-90%.

“Every country is doing what they need to do to protect citizens in the best way possible…but China will have to be mindful that eventually, it’s very important to reach a herd immunity threshold for longer-term stability,” said Sridhar.

How China has rolled out its vaccines

China is at present only using its own Covid-19 vaccines domestically, and has approved four shots. The ones most in use are two vaccines produced by state-owned pharmaceuticals giant Sinopharm, and one from Nasdaq-listed biotech firm Sinovac, as they were the first to get the nod from local regulators. No foreign vaccines, such as the Pfizer/BioNtech shot or AstraZeneca’s, have been approved yet.

While as many as a million people were vaccinated before the end of last year under emergency-use authorization, mass vaccination began in mid-December, targeting “key groups” such as customs officers, transportation workers, people who need to travel overseas, medical workers, and government officials, among others. China’s focus is to vaccinate those aged between 18 to 59 instead of the elderly groups as it aims to vaccinate those most likely to spread the virus.

As the most advanced city in terms of vaccination, capital Beijing inoculated over 5 million people (link in Chinese) as of March 2.The vaccination is currently voluntary but Chinese media and health authorities have emphasized the importance of getting the jabs to the public, and the government has made the inoculation free of charge.

Outside of China, the Chinese shots are also being used in more than 20 countries, as part of its “vaccine diplomacy“—a bid to help repair an image tarnished by the pandemic.

Lingering doubts

In addition to a perceived lack of urgency around getting the vaccine with the virus under control for now, citizens’ doubts about the vaccines’ efficacy and safety are also leading some people to delay getting the shots. The three major Chinese vaccine makers have yet to reveal detailed or peer-reviewed data of the late-stage trials of their shots amid contradicting results of some of the jabs’ efficacy released by different countries. Health authorities with access to Sinovac’s data have reported efficacy rates ranging from 50% to 62%, while Sinopharm said its shot has a 79% efficacy rate.

Past vaccine scares in the country that have been linked to disabilities, and reports of deaths of infants in some cases of vaccination, are also contributing to hesitancy.

A survey (link in Chinese) of health workers in China’s affluent Zhejiang province found only around one-third of the professionals were willing to get Covid-19 vaccine last month because of concerns about possible side effects, and doubts about efficacy. Around 61% of the Chinese public surveyed by polling firm YouGov in December said they wanted to get the shots, lagging behind the UK and Denmark, which saw 73% and 70% of their population saying yes to the idea, respectively.

One way to boost the public’s confidence in vaccines is for major players like Sinovac to release extensive clinical trial data, offering bilingual versions and online access to the information instead of only announcing it at press conferences, said Sridhar, the microbiologist.

Bi Jingquan, the former head of China’s food and drug regulator, has also urged the companies to release more data on the vaccines. The companies didn’t reply immediately to requests for comment.

Ramping up

Gao Fu, director of China’s health authority, said last week that 70% to 80% of the Chinese population needs to be inoculated for it to have herd immunity, estimating this could be achieved by the middle or the end of 2022. That’s a key deadline for China—when Beijing will host the Winter Olympics, another occasion to showcase its soft power just as it did with the 2008 Beijing Summer Olympics.

And for its citizens to travel internationally smoothly, they will also require vaccination. To that end, China this week unveiled its vaccine “passport” on the WeChat app.

But rising demand for Chinese vaccine both at home and overseas will pose another challenge for the country, which will need to balance the needs of its own population while also making good on its promises to other countries. Right now, the vaccine materials delivered to Indonesia, Brazil, and the United Arab Emirates total about 40 million doses—not much fewer than those administered at home as of February. China has committed to delivering around 500 million vaccine doses globally, according to the Duke Global Health Innovation Center, with the biggest demand coming from Brazil, Chile, Turkey, and Indonesia.

Countries like Egypt and Morocco faced delayed shipments of the vaccine by Sinopharm last month. Sinovac’s shipments to Brazil have also been proceeding with delays. This partly because the type of inactivated virus vaccine that the Chinese drug makers are using takes longer to make and scale up than the ones developed by pharma firms Pfizer and Moderna.

However, China’s vaccine makers say they are expanding their production capacity, which was supposed to reach 600 million doses by the end of 2020. Sinovac’s chairman has said the addition of another production line last month would take annual capacity to 1 billion doses, according to The Wall Street Journal. And the four approved vaccines in China could reach a combined output amount of around 2.4 billion (link in Chinese) this year, according to Chinese brokerage Tianfeng Securities.