Chinese Vaccines Go Global; Does Influence Follow?

In a whiplash sequence of events, Brazilian regulators suspended and then resumed trials of a Chinese-developed coronavirus vaccine after the sudden death of a trial participant, later discovered to be a suicide. Vaccines crafted by Sinovac Biotech, Sinopharm, and CanSino Biologics are seen as promising, albeit still unproven, tools to combat the coronavirus. But the deployment of Chinese vaccines, both domestically and abroad, is rife with controversy.

In Brazil, Sinovac’s CoronaVac phase III testing has become embroiled in a dispute between President Bolsonaro and his political rivals. Sui-Lee Wee and Ernesto Londoño reported for the New York Times:

Last month Mr. Bolsonaro reacted angrily when he learned the health ministry intended to buy 46 million doses of the vaccine.

“I ordered that it be canceled,” he said. “It appears no country in the world is interested in that Chinese vaccine.”

Mr. Doria’s party, the Brazilian Social Democracy Party, said in a statement that the race to develop a vaccine “is not a political contest and cannot be treated like one.”

[…] The suspended Brazilian trial is a reminder of the formidable challenges facing Chinese vaccine companies when they go abroad. Few of the companies have experience operating overseas, much less navigating potential political minefields. All of them had to test their vaccines in places with active outbreaks because the virus had largely been stamped out in China. [Source]

China has joined COVAX (COVID-19 Vaccine Global Access), a coalition of nations seeking to deliver two billion doses of vaccines to the world’s neediest people, as well as front-line health care workers.

As the pandemic has been nearly eliminated within China, vaccine makers have gone abroad in search of places to run trials. In early November, the Prime Minister of the U.A.E. joined over 30,000 Emiratis, Egyptians, Bahrainis and Jordanians by participating in phase III of Sinopharm’s vaccine trials. Turkey, Indonesia, Bangladesh, and Chile are participating in Sinovac’s rival vaccine trials. China’s vaccine makers are focused on developing inactivated vaccines, which use viral particles that “then lose disease producing capacity.” These vaccines elicit “strong” auto-immune responses, yet it is unproven whether they protect against the coronavirus.

Some countries have rejected Chinese vaccines over concerns about potential side effects. In August, Papua New Guinea turned back a flight of Chinese miners who had been given the vaccine before their departure. In Indonesia, there are concerns about the potential political consequences of reliance on a Chinese vaccine. At Nikkei Asia, CK Tan and Erwida Maulia reported on Southeast Asian leaders’ balance of wariness with efforts protect citizens from the coronavirus:

For Indonesia, which has been ravaged by the virus, vaccines are seen as the only way out. The Bandung clinical trial, with 1,600 volunteers, started in August and is scheduled to run until May. But the government can barely wait that long. Jakarta has had to build a new cemetery for COVID deaths, while President Joko Widodo had urged vaccines to be procured and distributed as early as this year before only recently relenting to health experts’ warnings against rushing an experimental vaccine.

[…]But given the lack of alternatives, China’s vaccines are increasingly seen in Southeast Asia not just as salvation, but also as once-in-a-generation geopolitical leverage that China may well be tempted to take advantage of. Many countries awaiting vaccine doses, like Indonesia, the Philippines and Malaysia, are anxious to avoid antagonizing Beijing. And this is something the latter is keenly aware of.

[…] [Aleksius Jemadu, professor of international politics at Indonesia’s Pelita Harapan University,] said China’s vaccine diplomacy might be softening Indonesia’s stance in regards to the overlapping claims north of Natuna. “Indonesia would not want to sacrifice its partnerships with China by commenting about the South China Sea” he said. “Indonesia would be more cautious when issuing statements on the South China Sea, and also when taking actions. It would not want to corner China with its statements,” Jemadu said. [Source]

Domestically, China is engaged in a double vaccine drive, encouraging (sometimes allegedly forcing) residents to get both a flu shot and a coronavirus vaccine. China traditionally has a low flu vaccination rate, on average only 2% as compared to 50% in the United States. Due to concerns about a “twindemic,” some cities, like Beijing, have launched a flu shot campaign to preempt an outbreak, which may spark an influenza vaccine shortage.

Despite the virtual elimination of the virus in China, many Chinese with no plans to travel abroad are taking vaccines before they have finished phase III trials. Jiaxing, a city in Zhejiang province, administered 743,000 doses of the flu and coronavirus vaccines to local residents, although administrators did not specify the exact split between the two. Over the summer, PetroChina, a state-owned oil and gas conglomerate, offered the coronavirus vaccine to employees set to work abroad on an emergency use basis. Although most of the vaccine offers seem to be voluntary, the Los Angeles Times reported that some workers at state-owned firms were forced to get vaccinated in secret. Alice Su of the LA Times quoted Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, who said, “It’s unethical, and it’s dangerous.” Some observers were perplexed by the rush to administer an unproven vaccine. Yanzhong Huang told NPR that the vaccine drive is “more driven by commercial interests than by the public health needs,” as once the vaccine is given final approval, companies will lose control over its pricing. At The New Yorker, Peter Hessler investigated the thinking of those who had taken the vaccine early:

In the meantime, many Chinese citizens haven’t waited for full approval before getting injected. The state press has reported that hundreds of thousands have already been vaccinated by C.N.B.G., under an emergency-use approval granted by the government. The volunteers include many government officials and pharmaceutical executives who received the two-stage vaccination. “I know a few government officials personally, and they told me that they took the vaccine,” Yiwu He said. “It’s middle-level officials—vice-ministers, mayors, vice-mayors.” He estimated that more than a hundred Communist Party cadres roughly at the level of juzhang, or director, have been vaccinated, along with many executives at C.N.B.G. and its parent company, Sinopharm, which is the largest pharmaceutical firm in China. “Every senior executive in Sinopharm and C.N.B.G. has been vaccinated,” He said, “including the C.E.O. of Sinopharm, the chairman of the board, every vice-president—everyone.”

For people in the United States and Europe, the idea of so many Chinese being vaccinated prior to full approval is shocking. “In the West, it would be considered anti-science,” He told me. “But in China it’s viewed very positively.” He described it as a way for officials and executives to show confidence, and he said that, having worked with C.N.B.G. in the past, he has been offered the vaccine himself. [Source]

Widespread faith in China’s coronavirus vaccine contrasts sharply with the national mood in 2018, when a viral WeChat essay exposed a major Chinese vaccine manufacturer for producing ineffective diphtheria, tetanus, and whooping cough vaccines and then administering them to hundreds of thousands of children. The news shocked parents, sparking protests outside the National Health Commission. The government tried to tamp down anger by censoring the essay and ordering newspapers to censor coverage by keeping content “on back [less prominent] pages,” while deleting “comments attacking the system.” Vaccine scandals are not new. Faulty vaccines killed four children in Shanxi in the mid-’00s. A scandal about improperly stored vaccines roiled the country in 2016. In a 2019 article for the Asia Pacific Foundation of Canada, Yoel Koernich, a specialist in China’s health reform, explained the systemic issues in China’s vaccine procurement regime that cause recurring scandals:

Government-funded vaccines go through centralized procurement in which provincial governments, through a competitive bidding process, select a limited number of manufacturers to mass produce vaccines. In this procurement stream, a committee of experts decides the winner of the bidding process. But in making these decisions, the committees often focus on the price that the bidders offer rather than on the quality of their products. Not surprisingly, manufacturers who offer the lowest prices often prevail in the bidding process. As a result of this intensely competitive process, manufacturers are incentivized to save costs in vaccine production and storage.

While low prices are maintained for publicly-available, government-funded vaccines, the government permits the market-based vaccines to be sold for comparatively higher prices. Because of the relatively high profit margins for market-based vaccines, an intense competition among manufacturers ensues. Prior to 2016, the government institutions that directly purchased market-based vaccines from drug companies – County Centers for Disease Control (CDCs) and Community Health Centers – sought to buy vaccines from the bidder offering the lowest prices. Again, this caused manufacturers and suppliers to lower prices at the expense of vaccine quality. It also propelled them to offer bribes to personnel working in the County Centers for Disease Control (CDCs) and Community Health Centers. [Source]


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