China’s decision to join Covax was seen as a boost to the global scheme to ensure fair access to Covid-19 vaccines for poorer countries, but membership could benefit itself as well as any nations receiving its doses.
Joining the initiative, after having initially opted out, will give China access to vaccines not previously available in its domestic market and could help its scandal-plagued vaccine industry gain the international recognition it has lacked, experts said.
Four Chinese candidates are in the final stage of human trials in the global race for a Covid-19 vaccine, while seven other Chinese candidates are in different stages of trials. Production facilities have been built in preparation, with capacity expected to reach 610 million doses by end of this year and 1 billion next year – expected to meet China’s own inoculation needs if those vaccines have been approved.
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Nonetheless, the Chinese government has agreed to buy vaccines for 15 million people through Covax, and has boosted the initiative’s resources by pledging to deliver at least 2 billion doses of China-made vaccines, if approved, by the end of next year to be available to its 172 member countries.
These doses may yet be needed to meet China’s own domestic demand as well, Tang Bei, assistant professor in the international relations and public affairs faculty at Shanghai International Studies University, said.
“Chinese vaccines look very promising, but joining Covax is like a double insurance to have access to all the vaccine candidates procured by Covax,” Tang said. Some vaccine candidates, including one developed by Germany biological company BioNTech and another by the University of Oxford and biopharma company AstraZeneca, could be available in China through Chinese partners, but others such as one being developed by US biotech start-up Moderna could not.
“China might not need those vaccines, but in the event of its production capacity not meeting demand, it can use its rights from joining Covax and purchase the vaccines,” Tang said.
Joining Covax is also an opportunity for Chinese domestic vaccine developers to increase their competitiveness and global presence, she said.
Shop window for China
“For China, joining Covax gives it a chance to demonstrate the responsibilities of a superpower and promote health diplomacy and international exchanges,” said a public health expert with experience of international vaccine procurement, whose name was withheld because he was not authorised to discuss the matter.
“It also lays the foundation for Chinese vaccines to go abroad and will undoubtedly increase their competitiveness in the international market.”
Nicole Hassoun, a professor of philosophy at Binghamton University who has been studying equitable access to Covax, said: “It seems most likely that China will have an opportunity to sign a multimillion-dollar agreement with Covax that will let Covax secure billions of vaccine doses if the Chinese vaccines prove to be safe and effective.”
Furthermore, being endorsed by internationally recognised entities such as Covax co-founders the World Health Organization (WHO), vaccine alliance Gavi and the Coalition for Epidemic Preparedness could spare Chinese vaccine manufacturers the embarrassment of being complained about for substandard exports of personal protection equipment and test kits, Tang said.
Fast track to approval?
Three Chinese vaccine candidates have already been authorised for China’s emergency use programme, but full approval is not expected until satisfactory safety and efficacy data from phase 3 trials is obtained. Approval by the Chinese drug regulator does not guarantee Covax will accept them.
Covax will consider procuring vaccines that complement its portfolio from any producers in the world that are approved by a high-standard regulatory authority or are classed as “pre-qualified” by the WHO, according to a Gavi spokesperson.
The WHO’s prequalification programme assesses the quality, safety and efficacy of drugs for United Nations agencies such as Unicef. The four non-Covid-19 Chinese vaccines that have previously been pre-qualified under the programme spent several years in preparation, but the programme has scope to fast-track vaccines for emergencies such as containing a pandemic.
That, though, “mainly depends on the quality control capabilities of the national regulatory agency and the vaccine manufacturers”, according to the public health expert with experience of procurement.
China’s regulatory body, the National Medical Products Administration, passed the WHO’s assessment in 2011 and 2014 and will receive its third evaluation in March.
But if they satisfy Covax, vaccine candidates would still need to pass the confidence test for countries to use them, with several recent Chinese vaccine scandals yet to fade from memories.
In 2016, vaccines worth 570 million yuan (US$85 million) were confiscated in the eastern province of Shandong because they had been improperly stored and transported.
Two years later, Changsheng Bio-tech, a vaccine developer in the city of Changchun in northeastern China, was found to have forged production and inspection records and changed process parameters for a human rabies vaccine, and produced substandard vaccines for diphtheria, whooping cough and tetanus (known as DPT vaccines) that had been given to 215,000 children.
In 2017, more than 400,000 substandard DPT vaccines produced by Wuhan Institute of Biological Products were sold in two Chinese provinces. In common with two of the four Chinese vaccine makers that have attained the WHO’s pre-qualified status, Wuhan Institute is a subsidiary of China National Biotec Group. Wuhan Institute also produces one of the four Chinese Covid-19 vaccines now in phase 3 human trials.
The public health expert said such scandals had harmed the industry and the country’s image, but the fact that the problems had been uncovered by the drug regulator indicated the regulator was functioning and capable.
“In the aftermath of these incidents, China adopted a stringent law on vaccines, which promotes quality control,” he said.
Zha Daojiong, a foreign relations expert at Peking University, said joint development projects with foreign partners were conductive to quality evaluation and brand recognition.
Calling it “a form of vaccine nationalism”, Zha said it was “conceivable” that governments may base their decisions about vaccine imports on factors besides quality, such as nationality or geopolitics.
“Foreign scepticism about a made-in-China product is a fact of life,”he said.
More from South China Morning Post:
- China’s public health insurance agency says it can’t afford to provide Covid-19 vaccine for free
- Coronavirus: what China’s decision to join the WHO’s vaccine scheme means
This article How joining vaccine initiative Covax could be shot in the arm for China first appeared on South China Morning Post