A SinoPharm employee at a Beijing plant examines injectors of the company’s attenuated Covid-19 vaccine. Photo: Xinhua

China claims it was “ahead of the pack” in the global race to find vaccines to stop Covid-19, with a handful of promising, homegrown candidates either wrapping up final-stage clinical trials or being administered in pilot inoculation schemes.

Yet the nation appears to be lagging behind Western powers as the vaccine competition heads into the home stretch of regulatory approval and population-size universal injections, with such programs being kickstarted across both sides of the Atlantic, piling pressure on Beijing. 

In the final week of 2020, Chinese public health watchdogs have scrabbled to cut red tape and get the green light, with some strings attached, for the sale of an attenuated vaccine from the Beijing-based China National Biotec Group, a subsidiary of the state-owned SinoPharm.

While granting its “conditional approval” on Wednesday, the National Medical Products Administration said its scrupulous evaluation found the vaccine was 79.34% effective and that protection outweighed any risks or side effects.

The watchdog added that SinoPharm should carefully follow up with the drug’s wider use for post-approval assessments.  

The National Health Commission (NHC) also assured the 1.3 billion Chinese citizens on Thursday of “free and voluntary shots,” albeit without a definitive timeframe. Details of what is set to become the largest mass vaccination program ever in mankind’s fight against a public health scourge are still lacking.

But NHC vice-director Zeng Yixin, Beijing’s point man on vaccine development and administration, told a State Council press conference on Friday morning that a “phased approach” would be adopted to first take care of at-risk groups of senior citizens and those with underlying conditions, before gradually expanding to cover the masses, provided that drugmakers could crank out enough doses, running into billions. 

SinoPharm’s attenuated vaccine, made by its subsidiary CNBG, has been approved by Chinese authorities and will be used for free inoculation programs that will ultimately cover all Chinese. Photos: Xinhua

Another assuring pledge from Zeng was that, while noting forming meaningful herd immunity would only require about 60% of the population – in China’s context, about 780 million people – to receive jabs, he said top leaders would beseech each and everyone to be vaccinated, given the “proven safety and efficacy” of these indigenous drugs.

He said free inoculations would entice more to get the protection and entrench “population-size immunity.” 

The NHC also added that the other five homemade vaccines, from three technological paths, are nearing the end of their respective third-stage trials at home and abroad.  

Earlier this month, the United Arab Emirates and Bahrain approved SinoPharm’s registration applications for sale in the two Middle Eastern countries, while Brazil and Turkey have also accredited the “high efficacy rate” of another attenuated vaccine developed by Sinovac, a listed pharmaceutical firm also based in Beijing. 

While clearing all the regulatory hurdles for more Chinese vaccines to hit the market and teasing the people with a top-down, no-one-left-behind free immunization drive, the NHC has also taken potshots at the safety of some Western drugs developed with “frontier but less verified” techniques. 

The messenger ribonucleic acid (mRNA) vaccines researched by Moderna as well as Pfizer and its German partner BioNTech, which will also be marketed in China via a Shanghai-based distributor, have been called into question by the chief of China’s National Center for Disease Control and Prevention. 

Gao Fu, director of the Chinese CDC, reportedly said mRNA vaccines were being injected into healthy people across the United Kingdom, the United States and other parts of the West for the first time and such a large-scale roll-out was not without its risks.

Gao, a virologist by training, told Xinhua right after the Chinese regulator approved SinoPharm’s product that the cutting-edge mRNA formula was meant for treating cancer patients, so applying it to produce a vaccine against a virulent respiratory disease was a “bold step.”

Gao went so far as to suggest that Chinese authorities would not hasten its review and allow the mRNA drug to be used on such a massive scale as seen across the West. 

Vials with Covid-19 vaccine stickers attached and syringes with the logo of US pharmaceutical company Pfizer and German partner BioNTech. Photo: AFP/Justin Tallis

The mRNA vaccines being progressively rolled out in the West use a copy of a natural chemical called messenger RNA to induce an immune response. They transfect molecules of synthetic RNA into immunity cells to build the viral protein that would normally be produced by a pathogen or a cancer cell.

These protein molecules stimulate an adaptive immune response to teach the body how to identify and destroy the corresponding pathogen, like the novel coronavirus. 

Traditional, attenuated vaccines from SinoPharm and Sinovac, by comparison, use diluted and detoxified viruses to trigger an immune response, and since they are developed using existing, time-tested platforms and techniques, they are believed to be safer. 

Gao, once under the full glare of the media as some Chinese aimed to pursue the National CDC for being remiss in the onset of the Covid contagion in the country a year ago, also said China was not in a race with other countries to produce vaccines, but was racing to squash the virus. 

A pharmaceutical arm of the Shanghai-based Fosun Group, one of China’s largest private conglomerates, has struck a deal with BioNTech to sell the mRNA vaccine in China in 2021. Fosun said a small-scale trial had been underway in neighboring Jiangsu province and that state drug watchdogs had agreed to skip the third-stage trial since ample data were already available from extensive overseas trials of the drug. 

It is believed that by the end of the first half of 2021, Chinese people will be able to choose from homemade attenuated vaccines, likely the ones on offer for free, and the West’s mRNA alternatives.

Residents in Hong Kong and Singapore can also choose between Chinese and Western drugs in mass inoculation schemes, as both cities have placed orders with Sinovac, Pfizer and other suppliers. 

Still, the global scramble for vaccines means tight supplies and production and distribution bottlenecks, as more countries count down to mass immunization.

Packages of vaccine roll off from a production line at a SinoPharm plant in Beijing, where employees prepare products for delivery to clients. Photos: Xinhua

Professor Wong Tze-wai, with the Chinese University of Hong Kong’s School of Public Health and Primary Care, has proposed a new approach to inoculating populations. 

Writing on her blog, Wong, an expert on infectious diseases epidemiology, noted populous nations like China, India, Indonesia etc would find it impracticable to give sufficient doses to all people within 2021, so governments should ditch fallacies about mass vaccinations and opt for what she called “ring vaccination,” focusing on known patients and their close contacts to snap infection chains. 

“Concentrated efforts and limited resources in the developing world should be directed to looking for and tracking down anyone displaying a cough, fever or other onward febrile symptoms and test them for Covid-19 … Once a patient is confirmed and contact tracing is initiated, all close contacts of that patient, asymptomatic or not, must be administered vaccines, on top of putting them in quarantine,” said the academic.

Wong said such a “ring vaccination,” coupled with priority injection for medical workers and the elderly, could maximize protection when initial vaccine production and supplies could not be ratcheted up. 

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