While states around the world are looking forward to the arrival of a coronavirus vaccine, a growing part of the Chinese population has already been vaccinated. In an interview last week for Sichuan Daily, the chairman of the Chinese pharmaceutical company Sinopharm Group said its Covid-19 vaccines have been used by nearly one million people in China.
The vaccinations took place as part of an emergency program that started in late July, although few details have been revealed by the Chinese government. What we do know is that as part of the program, the State Council of China has allowed high-risk groups, including medical workers, customs officials and transport workers, to start receiving one of the three Chinese-made vaccines ̵
So far, vaccines appear to be administered in a decentralized manner, with a handful of local governments officially announcing availability. People, however, rushed to line up for a dose, though transmission remains very low in China and the safety and efficacy of vaccines have not yet been proven.
Here’s what we know so far about China’s unconventional approach to Covid-19 vaccination, from the risks to the potential for global deployment.
What is so different about the Chinese emergency vaccine program?
The United States is also expected to launch an emergency vaccine program soon, but under different circumstances. Three large research teams published initial data on their efficacy and safety. Pfizer and BioNTech, which applied for emergency use for their vaccine last week, reported that it was 95 percent effective based on the initial results of phase 3 studies. These trials tested the vaccine on a large segment of the population (tens of thousands of study participants) for efficacy and safety. Two other vaccine manufacturers – Moderna and AstraZeneca and Oxford in the UK – have also published promising phase 3 data showing high efficacy. and there are no serious adverse events for their vaccine candidates.
On the other hand, the three vaccines approved in the Chinese emergency program have not yet reported any results from their phase 3 studies. Trials are underway in countries other than China, where transmission is still high enough, to quickly test the safety of the vaccine. A Sinovac spokesman said they were likely to report data for the initial phase 3 next month.
International audience Health experts have warned that vaccination before the evidence from phase 3 studies is available can expose vaccine recipients to unknown risks without actually protecting them from the virus if the vaccine does not prove to be effective enough.
Still, Chinese central government officials have defended the program as necessary to protect Chinese citizens, although Covid-19 cases in China remain very low. Local officials are under pressure to keep transmission to zero, so they have an incentive to allow the spread of vaccines in their regions, said Yangzhong Huang, a professor of global health at Seton Hall University.
China is also vying to be a leader in vaccine development and distribution: Chinese companies have five of the 13 vaccines in phase 3 trials. Sinopharm vaccines are now available outside China – the United Arab Emirates has also approved emergency vaccines.
“So far, all our progress, from research to clinical trials to production and emergency use, has been world-leading,” Liu Jingzheng, chairman of the Sinopharm Group, said in an interview with Sichuan Daily last week.
Because Sinopharm and Sinovac have not published phase 3 data, they are in fact behind the leading vaccine manufacturers in the United States and the United Kingdom. But these Chinese vaccines have an advantage over Pfizer and Moderna: They should not be stored at low temperatures.
This means that the spread of vaccines will not be as challenging. And the emergency program that has been introduced so far in China shows that mass deployment is now possible – on a scale of nearly 2 million doses, if the statement on the Sinopharm chair is correct. (Like the leading ones in the United States, Chinese emergency vaccines are designed to be given in two doses.)
“China has always impressed with its ability to carry out large-scale operations since the beginning of the pandemic, including the construction of new hospitals and the testing of millions of people in a matter of days. It just adds to that list of achievements, ”said Li Yang Hsu, an infectious disease expert at the National University of Singapore. said Vox.
How can 1 million people in China already be vaccinated?
In August, Zheng Zhongwei, the government official in charge of overseeing the development of vaccines in China, said: “To prevent the spread of the disease in autumn and winter, we are considering a moderate expansion of [emergency use] program. “People with high-risk occupations and high-risk demographics had to be priority recipients.
Since then, news of authorized vaccines has been available in a number of cities, but not through something resembling a coordinated campaign.
Zhejiang Province seems to be particularly open to vaccines. As of mid-October, the provincial government announced that nearly 750,000 doses of Covid-19 vaccine had been distributed in Zhejiang. The Caixin news site reported that health workers received the vaccine at a hospital in Hangzhou.
Two other cities in the province, Jiaxing and Yiwu, began offering vaccines in October. These cities are known for their export industries, and workers traveling abroad are among the main recipients of vaccines in China, according to Caixin.
However, Jiaxing officials said that any member of the public with “urgent needs” could make an appointment – not just those who were considered to be at higher risk. Vaccine recipients are also widespread in other cities: NPR’s Emily Feng said a Peking duck cook is in line for vaccination in Beijing. Chinese students going abroad have also often received the vaccines, a Sinopharm employee told the newspaper.
“It’s still a decentralized process,” Yangzhou Huang said, “so local governments and vaccine manufacturers, you know, are taking advantage of this regulatory vacuum to make the vaccine available to people in China.”
Local governments want to keep the virus completely contained to avoid the effects of higher windows and mass testing and blocking campaigns that have followed China’s small outbreaks in recent months. Meanwhile, vaccine manufacturers are making money through the emergency program, Huang said.
It has also been shown that the Chinese public is very open to Covid-19 vaccines. A study published in Nature found that 90 percent of respondents in China would receive the vaccine – the highest percentage among the country’s 19 countries. study.
Some experts question the logic behind such an early spread of mass vaccinations in a place where virus transmission is so low. “As one of the safest places for Covid-19, that doesn’t really justify the widespread use of the vaccine in the country,” Huang said.
We still don’t know how safe or effective the leading Chinese vaccines are
Even if a growing number of people in China line up, they have no guarantee that the vaccines they receive will be effective.
While we expect data from phase 3, the clearest picture of the safety and efficacy of vaccines is still from the smaller phase 1 and 2 studies. Here is a brief summary of the results published so far.
Interim results of phase 1 and 2 trials of the Sinopharm vaccine developed by the Wuhan subsidiary of Biological Products, published in JAMA showed that the vaccine elicited an immune response and recipients had low levels of side effects. A phase 1 and 2 study is the result of another Sinopharm vaccine developed by the Beijing Institute of Organic Products, published in Lancet infectious diseases last month, there were similar findings.
Last week, the results of the combined Phase 1 and 2 studies of Sinovac were also published in Lancet infectious diseases. The data show that the doses of the vaccine caused an immune response and did not cause severe reactions among the 700 people tested, but its effectiveness also seems to be lower than the others. leading candidates for vaccine.
“Although the initial data and results of the Sinovac vaccine in the early stages of the tests are good, it would be more reassuring to get the results of phase 3 before the mass vaccination,” said Li Yang Hsu of the National University of Singapore.
The risks of using these vaccines before they are proven are wide. No side effects have been reported so far, according to Sinopharm and Sinovac executives, but rare side effects may occur as more people are vaccinated.
In addition, if the effectiveness of emergency vaccines proves to be low, a second vaccine may not be possible because the previous immune response may affect the second vaccine, according to the Children’s Hospital of Philadelphia.
Will Chinese vaccines become global?
If Chinese vaccines are sufficiently protective against Covid-19, they may have an advantage over Pfizer and Moderna. Arranging cold chain logistics to keep Pfizer and Moderna vaccines at very low temperatures during distribution will be a challenge, as Vox’s Umair Irfan explained.
Inactivated viral vaccines, like the three common Chinese vaccines, should not be kept as cold and therefore do not require the same type of investment to spread. “CoronaVac can be an attractive option because it can be stored in a standard refrigerator between 2 and 8 degrees Celsius, which is typical of many existing vaccines, including influenza,” Gang Zen, a medical manager at Sinovac, told a news release. Lancet study. “The vaccine can also remain stable for storage for up to three years, which would offer some advantages for distribution in regions where access to refrigerators is challenging.”
Zheng Zhongwei, a Chinese official responsible for developing vaccines, said the country plans to have 600 million doses of the vaccine ready by the end of this year and 1 billion by the end of 2021.
But many of these vaccines are planned to be sent abroad. So far, Brazil and Turkey have signed contracts to purchase vaccines from Sinovac; 6 million doses of CoronaVac should be shipped to Brazil by January. China is also involved in Covax, a global initiative to promote the equitable provision of Covid-19 vaccines.
“The number of doses available in China will be too small to allow exports unless a political decision is made to supply vaccines abroad, despite the still existing needs for vaccines in China,” Klaus Storr, who previously said. managed the epidemic for the World Health Organization, told Nature.
In the near future, as thousands of Chinese continue to receive emergency doses of vaccines, the question is whether phase 3 studies show that Sinopharm and Sinovac vaccines are actually safe and effective.