China has promised millions of coronavirus vaccines to countries around the world. And ready to deliver them

A security worker is on duty wearing a face mask, surgical gown and rubber gloves. Anyone who enters this part of the warehouse is either quarantined for two weeks or wears a hazmat suit from head to toe.

In the coming months, China will send hundreds of millions of doses of coronavirus vaccine to countries that have conducted experiments with its leading candidates in the final phase. Chinese leaders have also promised that access to successful vaccinations will be a priority on a growing list of developing countries.

Vaccines “Beijing can also use as a foreign policy tool to promote soft power and international influence,” said Yanzhong Huang, a senior global health officer at the Washington-based Foreign Relations Council.

In the past pandemic, China has made efforts to donate masks and other supplies to countries severely affected by the virus, reports of poor quality care and accusations that Beijing has launched a disinformation campaign to change the narrative of the coronavirus.

Beijing Vaccination Diplomacy, Huang he said he could give it another chance.

“Vaccine diplomacy”

In China, there are currently four coronavirus candidates from four companies that have achieved Phase 3 clinical trials, the final and most important step in testing before seeking official approval.

After the coronavirus was largely eradicated within its borders, Chinese pharmaceutical manufacturers had to look abroad for places to test the effectiveness of their vaccines. Together, Phase 3 trials were introduced in at least 16 countries.

In return, many host countries have been promised early access to successful vaccinations – and in some cases local know-how is being produced.

Beijing-based Sinovac Biotech, a Nasdaq-listed pharmaceutical company, has signed shipments of 46 million doses of Covid-19 vaccine to Brazil and 50 million doses to Turkey. It also delivers 40 million doses of vaccine – the vaccine concentrate before being divided into small vials To Indonesia for local production.
CanSino Biologics, which developed a coronavirus vaccine with one of the Chinese army’s research units, is delivering 35 million doses of the vaccine to Mexico, one of the five countries hosting the experiments.
The unit of China National Biotec Group (CNBG), the state pharmaceutical giant, China National Pharmaceutical Group (Sinopharm), is less open about its dealings. The company’s two vaccine candidates are undergoing phase trials in 3 countries in 10 countries, mainly in the Middle East and South America. Sheikh Mohammed bin Rashid Al Maktoum, ruler of Dubai in the United Arab Emirates volunteered must be vaccinated during the studies and the vaccination has been authorized for emergency use. Emirati, in partnership with Sinopharm, hopes to produce between 75 and 100 million doses next year.
Liu Jingzhen, president of Sinopharm, said last month that dozens of countries had asked to buy the company’s vaccine. It did not name the countries and did not detail the amount of doses they suggested, but said the CNBG could produce more than a billion doses in 2021.

“China not only has the political will (for its vaccination diplomacy), but also a strong ability to do so,” Huang said.

Since China largely contained the virus, there is no urgent need to vaccinate its 1.4 billion people. “It gives me that leverage … to do business with countries in need of vaccinations,” he said.

“Health Silk Road”

China’s global vaccination campaign contrasts sharply with the Trump government’s “America’s First” approach, which focuses on vaccinating its own citizens elsewhere.

“So far, we have not heard the United States say or suggest that one percent of their vaccine be set aside to support poor countries. So this puts China in an even better position to use the vaccine to achieve its foreign policy goal,” Huang said.

China joined a global initiative supported by the World Health Organization in October to ensure the rapid and equitable distribution of Covid-19 vaccines in both rich and poor countries.

The project, known as COVAX, aims to deter governments from accumulating coronavirus vaccines and instead focus on vaccinating high-risk groups in all countries. But the United States avoided in part because President Donald Trump did not want to work with the WHO, leaving a global public health leadership vacuum for China.

From the beginning, Chinese leaders have repeatedly stressed that China’s vaccines are for sharing, especially with the developing world.

Chinese President Xi Qing-ping speaks to the World Health Assembly via a video link on a giant screen in Beijing, next to a street, on May 18th.
In May, Chinese President Xi Qing-ping told the WHO Annual General Assembly that he called China’s “coronavirus vaccine” a global public good, calling the country’s “contribution to ensuring the availability and affordability of vaccines in developing countries.”

In a video conference with African leaders in June, Xi promised that “once the development and deployment of the Covid-19 vaccine in China is completed, African countries will be among the first to benefit.”

In August, Chinese Prime Minister Li Keqiang said that Beijing would also give priority to Cambodia, Myanmar, Laos, Thailand and Vietnam. Other countries to which Chinese officials have promised privileged access are Afghanistan and Malaysia.

Many of these countries are also participating in the Beijing Belt and Road Initiative, a multi-billion dollar infrastructure and trade program that lost some of its steam during the pandemic. Recently, Chinese officials have accelerated negotiations on the “Health Silk Road.” At the May WHO meeting, Xi promised to donate $ 2 billion over two years to help countries in the pandemic. Beijing has also offered a $ 1 billion loan to Latin America and the Caribbean for access to coronavirus vaccines.
China is doubling its global efforts to vaccinate against coronavirus
But there are signs that Chinese vaccination diplomacy will not always be smooth. In Brazil, Sinovac’s vaccination, CoronaVac, has been embroiled in political strife by President Jair Bolsonaro – known for his famous anti-China stance – and Sao Paulo Governor Joao Doria, who is expected to run against Bolsonaro in the United States. country’s next 2022 presidential election. In Bangladesh, Sinovac’s trial stalled due to a funding dispute.
International public health experts have also questioned China’s emergency use program, which vaccinated nearly one million Chinese people with experimental vaccines before their safety was fully demonstrated in clinical trials.

Then there is the issue of efficiency. Last month, Pfizer and Moderna announced that early results showed that their vaccines were more than 90% effective, while the other candidate, jointly produced by the University of Oxford and AstraZeneca, had an average efficiency of 70%. To date, none of the Chinese vaccine candidates have reported preliminary efficacy results, although company executives have repeatedly stressed their safety, insisting that no serious adverse effects were observed in vaccinated volunteers.

Cold storage

Compared to Pfizer and Moderna, Chinese vaccines have a decisive advantage – most of them do not require a freezing point for storage, making transport and distribution much easier, especially in developing countries where there is no cold storage capacity.

Kate O’Brien, director of the WHO’s Department of Immunization and Vaccination, likens the development of vaccines to building a base camp in Everest. “But getting to the top is actually about giving up vaccinations,” he said at a news conference last month.

Both Pfizer and Moderna vaccines use pieces of genetic material called messenger RNA (mRNA) to stimulate the body to produce synthetic pieces of the coronavirus and stimulate the immune response – a new technology not used in current vaccines.

But mRNA is sensitive to degradation at room temperature. Moderna should be stored at -20 degrees Celsius (-4 degrees Fahrenheit) or refrigerated for up to 30 days, while Pfizer should be stored ultra-cold at -75 ° C (-103 ° C). ˚F) and should be used within five days if refrigerated at elevated temperatures.
Here is an overview of how different coronavirus vaccines work
Sinopharm and Sinovac, meanwhile, take an old-fashioned approach that has long been shown to be effective in other vaccines, such as polio and influenza. Their coronavirus vaccines use inactivated whole virus to stimulate the body to develop immunity and should only be stored in a normal refrigerator at 2 ° C to 8 ° C. The CanSino vaccine, which uses a common cold virus called adenovirus 5 to deliver genetic fragments of the coronavirus into the body, can also be kept at 2-8 ° C.

Nevertheless, the required temperatures must be maintained during transport, from leaving the production site to airport storage and finally to global distribution.

Cainiao, the logistics arm of Alibaba’s Chinese e-commerce giant, will help distribute Chinese vaccines as they launch. He says his air-conditioned, end-to-end infrastructure is there and ready.

The company has partnered with Shenzhen Baoan International Airport, which recently received a pharmaceutical logistics certificate from the International Aviation Association. A cold chain warehouse was built in 2019 for frozen food and goods. Earlier this year, it was converted to store coronavirus test kits – and now vaccines. The airport said on its website that Shenzhen “intends to make Covid-19 vaccine a global transport base”.
Cainiao, in cooperation with Ethiopian Airlines, distributes Chinese-made coronavirus vaccines abroad.

Cainiao also works with Ethiopian Airlines, which sends Chinese vaccines to the Middle East and then to Africa. Since the epidemic, the airline has delivered more than 3,000 tons of medical care from Shenzhen to Europe, Africa, the Middle East and South America.

But Cainiao CEO Wan Lin said he wants to take additional routes to achieve greater global reach.

“Of course, we’re still not quite sure of the exact need, but we’re definitely developing our ability to prepare for that,” Wan said.

CNN’s Emma Reynolds contributed to this story.