Is there a Covid-19 vaccine in China? It could vaccinate almost a million people.

While the countries anxiously awaiting the arrival of coronavirus vaccination around the world, an increasing proportion of the Chinese population has already been vaccinated. In an interview last week with Sichuan Daily, president of the Chinese pharmaceutical company The Sinopharm Group said nearly one million people in China used Covid-19 vaccines.

The vaccinations were given as part of an emergency use program that began at the end of July, although the Chinese government has revealed little detail about it. What we do know is that as part of the program, the Chinese State Council has authorized high-risk groups, including health workers, customs officials and transport workers, to start receiving one of three Chinese-made vaccines – two from Sinopharm and one from Sinovac. But some Chinese cities also offer vaccines to members of the population.

So far, vaccines appear to have been administered in a decentralized manner and some local governments have officially announced availability. People rushed in line despite queuing for a dose transmission in China remains very low and the safety and efficacy of vaccines have not yet been demonstrated.

Here’s what we’ve known about China’s hitherto unconventional approach to Covid-19 vaccination, from the risks to the possibility of 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 groups have published initial data on their efficacy and safety. Pfizer and BioNTech, which submitted an emergency license for their vaccine last week, reported to be 95 percent effective based on initial results from Phase 3 studies. These trials test the vaccine in a large part of the population (tens of thousands of people in the study) for their effectiveness and safety. Two other vaccine manufacturers – Moderna, AstraZeneca and Oxford in the UK – have also released promising Phase 3 data showing high efficacy. and their candidate vaccines do not have serious side effects.

However, the three vaccines approved in the Chinese Emergency Use Program have not yet reported the results of their Phase 3 trials. Studies are underway in countries other than China, where transmission is still high enough to quickly test vaccine protection. The Sinovac official said Phase 3 initial data is likely to be announced next month.

International publicity health experts have warned that vaccination, even before the evidence comes from phase 3 studies, could expose vaccine recipients to unknown risks without actually protecting them from the virus if the vaccine does not prove to be effective enough.

Yet Chinese central government officials defended the program when necessary to protect Chinese citizens, despite the fact that Covid-19 cases in China remain very low. Local officials are under pressure to keep transmission to zero, so they will be encouraged to allow vaccines to be distributed in their regions, said Yanzhong Huang, a global health professor at Seton Hall University.

China is also a leader in the development and distribution of vaccines: Chinese companies have five out of 13 vaccines in Phase 3 trials. Sinopharm vaccines are already being installed outside China – the United Arab Emirates has also approved the vaccines for emergency use.

“So far, from research through clinical trials to manufacturing and emergency use, all our progress has led the world,” said Liu Jingzhen, president of Sinopharm Group, in an interview with Sichuan Daily last week.

As Sinopharm and Sinovac did not report Phase 3 data, they are, in fact, behind the leading vaccine manufacturers in the US and UK. But these Chinese vaccines have an advantage over Pfizer and Moderna: They don’t need to be stored at low temperatures.

This means that the distribution of vaccines will not be so challenging. And the emergency program introduced so far in China shows that mass deployment is already possible – in the order of nearly 2 million doses, if the statement from Sinopharm’s chair is accurate. (Like American frontrunners, Chinese emergency vaccines are given in two doses.)

“China has always been impressed with its ability to carry out large-scale operations since the outbreak began, including building new hospitals and testing millions of people in a matter of days. This only completes the list of results. – Li Yang Hsu, Infectious Disease, National University of Singapore, said the Vox.

How to vaccinate China already 1 million people?

In August, Zheng Zhongwei, a government official in charge of overseeing China’s vaccine development, said: “To prevent the disease from spreading in the fall and winter, we are considering [emergency use] “People living in high – risk occupations and high – risk demographic groups were primarily targeted at beneficiaries.

Since then, news has come that licensed vaccines will become available in many cities, but not in a similar way to a coordinated campaign.

Zhejiang Province seems particularly open to vaccinations. As of mid-October, the provincial government reported that nearly 750,000 doses of Covid-19 vaccine had been thrown out in Zhejiang. The Caixin news site reported that health workers received a vaccine at a hospital in Hangzhou.

Two other cities in the province, Jiaxing and Yiwu, began offering vaccinations in October. These cities are famous for their export goods, and workers traveling overseas in China are among the main recipients of vaccines, according to China.

However, Jiaxing officials said any member of the “emergency” could register for a meeting – not just those who are considered a higher risk. Vaccine recipients were also widespread in other cities: NPR staff member Emily Feng reported that a Peking duck chef was queuing up for vaccination in Beijing. Chinese students traveling abroad also often received vaccinations, a Sinopharm official told the paper.

“It’s still a decentralized process,” Yanzhong Huang said. “So local governments and vaccine manufacturers are taking advantage of this regulatory vacuum to make the vaccine available to the Chinese people.”

Local governments want to maintain full containment of the virus to avoid the consequences of higher-level surveys and mass testing campaigns and closures that have followed China’s small outbreaks in recent months. Meanwhile, vaccine manufacturers are making money through the emergency use program, Huang said.

It has been shown that the Chinese public is also very open to Covid-19 vaccinations. According to a survey published in Nature, 90 percent of respondents in China accept the vaccine – the highest rate among 19 countries study.

Some experts question the logic of such early introduction of mass vaccines in a place where the virus spreads so low. “As one of the safest places for Covid-19, it 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 are standing in China to get admitted, there is no guarantee that the vaccines they are taking will be effective.

While awaiting Phase 3 data, the lightest picture of the safety and efficacy of vaccines was provided by smaller Phase 1 and Phase 2 studies. Here is a quick overview of the results published so far.

Interim results of Phase 1 and 2 trials of the Sinopharm vaccine, developed by a subsidiary of the Wuhan Institute of Biological Products. JAMA showed that the vaccine elicited an immune response and the recipients had low side effects. A study developed by the Beijing Institute of Biological Products from Phases 1 and 2 of another Sinopharm vaccine and The Lancet is an infectious disease had similar results last month.

The results of the combined Phase 1 and 2 trials of Sinovac were also published last week The Lancet is an infectious disease. The data show that the doses of the vaccine elicited an immune response and did not cause severe reactions in the 700 people studied, but its effectiveness appears to be lower than in other patients. leading vaccine candidates.

“While the initial data and results of the Sinovac vaccine in the early-stage studies are good, it would be more reassuring to have the results of the phase 3 studies before the mass vaccination,” said Li Yang Hsu of the National University of Singapore.

There is a wide risk that these vaccines will be used before they are proven. According to Sinopharm and Sinovac, no side effects have been reported so far, but rare side effects may occur as more people vaccinate.

Also, if the effectiveness of emergency vaccinations is low, it may not be possible to take the second vaccine because the previous immune response may interfere with the second vaccine, the Philadelphia Children’s Hospital says.

Aerial view of a burial site reserved for victims of the Covid-19 epidemic at the Nossa Senhora Aparecida Cemetery in Manaus, Amazon Forest, Brazil, on November 21, 2020. So far, Brazil and Turkey have signed an agreement to buy vaccines in Sinovac.
Michael Dantas / AFP with Getty Images

Will Chinese vaccines become global?

If it turns out that Chinese vaccines adequately protect 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 throughout the distribution is a challenge, as explained by Vox Umair Irfan.

Inactivated virus vaccines, like the three distributed Chinese vaccines, do not need to be kept so cold, so the same investment is not required for dissemination. “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 the flu,” said Gang Zeng, chief medical officer at Sinovac. Javelin study. “The vaccine can remain stable for up to three years in storage, which would have some benefits in distributing to regions where access to refrigeration is a challenge.”

Zheng Zhongwei, the Chinese official responsible for developing vaccines, said the country plans to produce 600 million doses of the vaccine by the end of this year and 1 billion by the end of 2021.

But many of these vaccines go abroad. To date, Brazil and Turkey have entered into an agreement to purchase vaccines from Sinovac; It is planned that 6 million doses of CoronaVac will be shipped to Brazil by January. China is also participating in Covax, a global initiative to promote an equitable supply of Covid-19 vaccines.

“The number of doses available in China will be far too low to allow exports unless a political decision is made to transport vaccines overseas, despite the fact that there is still a need for vaccines in China,” said Klaus Stohr, who previously launched an epidemiological response to the World Health Organization. Organization, said Nature.

In the near future, while thousands of Chinese people continue to receive emergency vaccine doses, the question arises as to whether Phase 3 studies will show that Sinopharm and Sinovac vaccines are indeed safe and effective.