In the early days of the COVID-19 vaccine rollout, Chinese vaccines saved countless lives. They began inoculation programs across Asia, Latin America and the Middle East, while richer countries hoarded scarce Pfizer-BioNTech and Moderna COVID-19 vaccines made with mRNA technology.
However, many governments that once relied on COVID-19 vaccines from Sinovac Biotech or Sinopharm Group are instead turning to options from the US and Europe, as concerns mount about Chinese vaccines’ efficacy against the Delta variant of SARS-CoV-2 and the Western stranglehold on mRNA supplies loosens.
That preference might be showing up in China’s customs data, where exports of human vaccines dropped 21 percent in August to US$1.96 billion from US$2.48 billion in July, after rising steadily since December last year.
“Basically people took what they could get” when COVID-19 vaccines first became available, said City University of Hong Kong associate professor Nicholas Thomas, who has edited several books on foreign policy and public health.
“But as this has gone on, general populations — rather than just medical practitioners — have become more educated about the differences,” he said. “They have realized that not all vaccines are equal in terms of protection.”
This shift played out during Thailand’s deadly outbreak earlier this year. As cases surged and Southeast Asia emerged as the new epicenter of the COVID-19 pandemic, the nation desperately tried to purchase vaccines. Only one supplier came through in time: China’s Sinovac.
The vaccines allowed the country with a population of 70 million people to begin its inoculation campaign earlier than hoped, but Thailand soon confronted a challenge faced by lawmakers across the developing world.
The efficacy of China’s inactivated vaccines ranges from about 50 percent to 80 percent in clinical trials, but they are less potent than mRNA vaccines and questions are mounting about their effectiveness against the highly transmissible Delta variant.
As a result, the Thai government became the first in the world to offer an AstraZeneca COVID-19 vaccine to people who had received one or even two doses of the Sinovac vaccine. While it is not an mRNA, Thai studies showed that the viral vector vaccine is potent as a booster to the Chinese shot, and that the Pfizer-BioNTech vaccine was found to be even more effective.
However, many Thais soon expressed a strong preference for Western vaccines — even protesting to demand them — and the country’s opposition began lambasting the government for its reliance on China. Thailand halted orders of Sinovac and began buying more Western vaccines.
“I’m not anti-Sinovac,” said Chaowat Sittisak, a 29-year-old teacher in northern Thailand who got a first dose of Sinovac, but ordered the Moderna vaccine as his second dose from a private hospital. “If the world only had one vaccine and it was Sinovac, I would get it, but we have so many other choices and I want whatever is best.”
Many governments that once relied on Chinese vaccines are instead ordering or seeking donations of mRNA vaccines. The swing away from China is likely to accelerate as US President Joe Biden promises to donate 1.1 billion mRNA vaccines, Europe pledges hundreds of millions of vaccines and India prepares to once again export AstraZeneca vaccines, after curtailing shipments following its deadly second wave.
In addition to availability and efficacy, freedom of movement might be motivating the shift: Recipients of Chinese vaccines cannot travel to some locations, such as Singapore.
VACCINE EXPORTS
Sinovac said in a statement that its CoronaVac COVID-19 vaccine has been effective at preventing hospitalization, intensive care admissions and deaths throughout the pandemic.
A Sinovac spokesperson said that some countries first rolled out the Sinovac vaccine to older people, who were more likely to be hospitalized with COVID-19, while younger populations later received different vaccines — “and this should be factored in the evaluation of CoronaVac’s effectiveness.”
Many countries, including Thailand, have “purchased vaccines from multiple suppliers to maximize the number of doses available for their population,” the company said.
As things stand, the list of places shifting away from Chinese vaccines — or augmenting them with Western boosters — includes Singapore, Turkey and the United Arab Emirates.
In Hong Kong, which has long offered residents a choice between Pfizer-BioNTech and Sinovac, health officials are testing whether the Chinese vaccine would perform better when paired with a Western booster.
Even in Pakistan, an all-weather ally of Beijing that has used Chinese vaccines for 84 percent of its vaccination drive, some are going out of their way to find Western vaccines: Muhammad Kashif, a 41-year-old motorcycle delivery rider in Karachi, felt lucky to find a rare dose of the Moderna vaccine at a crowded inoculation center where later arrivals were forced to get Sinovac.
“I thought that this is American. They must have made it after a lot of high-level research,” Kashif said. “I feel delighted I was able to get it. I feel it’s much safer.”
While the Sinovac vaccine allowed Thailand to start its rollout earlier than planned, the 6 million doses arriving this month are to be the last shipment. Next year, at least three-quarters of the government’s orders are to come from AstraZeneca and Pfizer-BioNTech.
Moves like Thailand’s represent a blow to China’s vaccine diplomacy ambitions. Nevertheless, governments face a tricky balance between wanting to protect the public and maintaining good relations with China.
The Thai Ministry of Public Health has been careful to say that while it has no plans to order more Sinovac, it is not suggesting that the vaccine is not effective.
Chinese firms have exported about 884 million doses of domestic vaccines via mostly bilateral deals with places such as Brazil and Indonesia.
This week, Chile started giving Sinovac vaccines to children as young as six years old, a strong endorsement of a vaccine that has formed the backbone of their rollout.
Many parts of the world remain drastically short of vaccines. For example, some African nations have barely started their inoculation drives after struggling to procure vaccines.
Ivory Coast, Burkina Faso and Kenya are all rolling out Chinese vaccines, and Beijing is a key supplier to the WHO-backed COVAX facility aimed at getting vaccines to the developing world.
Chinese President Xi Jinping (習近平) has pledged to export 2 billion doses this year, matching commitments by G7 nations.
Various studies conducted around the world have shown Chinese vaccines to be effective at preventing serious illness and death, yet China’s pharmaceutical firms — which were initially less forthcoming than Western companies in releasing clinical trial data — have not released similarly conclusive studies that inactivated vaccines are effective against the Delta variant.
Over the coming year, policymakers might continue to turn away from the older technology of the inactivated Chinese vaccines, said University of Hong Kong epidemiology and biostatistics professor Benjamin Cowling, who published a study in the Lancet showing that the Pfizer-BioNTech vaccine generated 10 times more antibodies than the Sinovac vaccine.
“If you’ve got some vaccines that are more effective than others and the cost is roughly the same, you’re going to get a better bang for the buck if you choose the more effective vaccines,” Cowling said. “But I still think that the supplies are limited, so it may not be as easy as saying: ‘We just want to order the Moderna vaccine,’ or whatever.”
‘BETTER ALTERNATIVES’
In Thailand, the opposition Move Forward party is calling on the government to reveal the percentage of people who have only received the Sinovac vaccine.
“The government already knows that studies and research show inactivated virus vaccines are less effective against virus mutations that mRNA-based vaccines,” said Wiroj Lakkhanaadisorn, an opposition lawmaker and a key critic of the government’s vaccine policies. “We should know the vaccination rate that excludes all two-dose Sinovac shots, because the immunity may not be enough anymore. Any regions that are ready can then reopen.”
The Thai Ministry of Public Health did not respond to a request for comment.
Chaowat said that he felt pressured to get the Sinovac vaccine because of his job, but hoped to get Moderna in a month or two.
“The government is turning away from Sinovac because they have to push through with their reopening plan and they want to reduce vaccine hesitancy among people who don’t want Sinovac,” he said. “They’re turning to better alternatives.”
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