China appears to be giving more priority to vaccine diplomacy than its domestic inoculation programme, with Chinese pharmaceutical makers now exporting more Covid-19 doses than have been administered in the country.
Figures compiled by the South China Morning Post show China shipped at least 46 million ready-made vaccines or their active ingredients around the world, as of Monday – with hundreds of millions more doses to come.
In contrast, the country’s health authority said 40.52 million vaccine doses had been administered in China, as of February 9. The number was second only to the US, where more than 50 million jabs have been injected.
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China’s large population base means only about three vaccine doses per 100 people have been administered, compared to more than 15 doses per 100 in the US, according to Bloomberg’s vaccine tracker. Israel tops the charts, with almost 70 doses per 100 people, while Britain has delivered almost 22 doses per 100 people.
Analysts say the figures reflect the challenge faced by Beijing – which has pledged to make Chinese-made vaccines a global public good – in balancing its foreign policy goals and reaching herd immunity in China, which would allow life to return to normal.
Huang Yanzhong, a global health expert at US think tank the Council on Foreign Relations, said China’s success in largely controlling the Covid-19 outbreak within its borders had reduced its need for vaccinations until recently.
“[China was] not initially paying too much attention to this, which was partly due to the limited vaccine production capacity in the country and the perceived low risk of infection. In a way it was a false sense of security,” Huang said.
“On the other hand, China could use [its vaccines] to become the global leader in ensuring equitable access to vaccines, bridging the gap between the developed and developing world. Certainly, this would help improve China’s image and project soft power in those countries.”
Some of the global shipments include doses sent in the form of active ingredients, allowing other countries with agreements to manufacture them, which could also ease production capacity in China.
Zimbabwe received a donation of 200,000 doses from China on Monday, the first Covid-19 vaccines to arrive in the country, with a further 600,000 doses expected to arrive in early March. It is unclear how much cash-strapped Harare will pay for the second batch.
Hungary is expected to receive half a million doses of China’s Sinopharm vaccine in coming days, and has also signed a deal with the Chinese pharmaceutical company for enough of its product to treat 2.5 million people.
Prime Minister Viktor Orban said China’s vaccines would push the eastern European country ahead of others in the European Union, according to an Associated Press report.
And, according to a summary released last Thursday by the Chinese foreign ministry, Algeria’s foreign minister Sabri Boukadoum said in a phone call that his country was grateful for China’s vaccine help, and was also willing to work with China to promote its Belt and Road Initiative.
In addition, China has pledged 10 million doses of its home-grown vaccines to Covax Facility, the World Health Organization-led initiative for equitable vaccine access.
Richard Hatchett, head of the Coalition for Epidemic Preparedness Innovations (CEPI) – one of the Covax Facility partner organisations – earlier this month said Chinese-developed vaccines “absolutely” had the potential to play a role in global vaccine access via the programme.
“We welcome the government’s talk about vaccines as a global public good and their desire to provide to the global supply,” he said. “If those vaccines go through the [regulatory] steps that have been set for everyone, we hope they can contribute to the global solution.”
A WHO regulatory evaluation of Sinopharm and Sinovac vaccines is expected to be completed by March at the earliest, according to the UN body.
For a country known for mass mobilisations – including testing millions for Covid-19 in a matter of days – China missed its target, announced in early January, to vaccinate 50 million people before the Lunar New Year.
Challenges to its domestic inoculation programme include vaccine hesitancy, limited supply and the lower effectiveness of the Chinese-made vaccines.
At a press conference last month, Sun Xiaodong, deputy director of the Shanghai Municipal Centre for Disease Control and Prevention, said a survey of 1.77 million of the city’s residents had found about half did not want to take a Covid-19 vaccine.
So far in Shanghai, vaccination quotas have been allocated mainly to government agencies, public institutions and state-owned companies, whose employees were advised to get inoculated.
Harris Huang, a software engineer at state-owned car manufacturer SAIC Motor in Shanghai, joined dozens of colleagues last month in getting the jab after the company called on staff to support the programme. “The company asked us to come here to receive the vaccine, so I came. Some people refused, but more agreed, as far as I know,” he said.
“I think China should help other countries with vaccination, because the entire world is one big village. We won’t live well if others suffer,” Huang added.
In Beijing, vaccine bookings have begun in residential communities, according to Sally Liang, who lives in Haidian district. Liang, 39, and her husband had also been offered jabs by their employers, which they declined, she said.
“The coronavirus is still changing. I don’t think vaccination will definitely protect me. Besides, there are still not enough human trials on the vaccines and the long-term effect is unclear.”
The lower efficacy rate of Chinese-made vaccines – 50.4 per cent for Sinovac and 79 per cent for Sinopharm, compared to more than 90 per cent for Pfizer and AstraZeneca vaccines – could also slow China’s reaching of herd immunity, according to public health experts.
China’s vaccination programme has so far focused on high-risk working populations, leaving the elderly vulnerable to infection in any future outbreaks, according to a commentary by University of Hong Kong public health experts published in the Chinese Centre for Disease Control’s weekly bulletin.
“However, if vaccination coverage does not reach high levels, or if the vaccines prevent disease development but not infections, and specifically do not limit transmission, a more concerning scenario may play out where public health and social-distancing measures need to be maintained for much longer to protect health care systems against surges in cases,” they said.
According to Huang from the Council of Foreign Relations, if China falls behind Western countries in achieving herd immunity, it would lead to an unwelcome scenario for Beijing, with life returning to normal and international travel resuming between some countries.
“China may still need to close its borders, that certainly would not improve China’s international image,” Huang said. “This would also mean China could no longer claim a superior disease control model.”
Additional reporting by Eduardo Baptista
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