A staff member displays samples of a Covid-19 inactivated vaccine at Sinovac Biotech in Beijing. Photo: Xinhua/Facebook/Zhang Yuwei

Clouds are gathering over Indonesia’s Covid-19 inoculation rollout plan after Brazilian scientists reported this week that the efficacy of China’s CoronaVac vaccine was just barely over 50%.

The readout was well below the 78% mark the same Brazilian researchers asserted last week and considerably lower than trials on the Sinovac-produced vaccine conducted in other countries.

Indonesia, which has the highest number of Covid-19 cases in Southeast Asia at 850,000, has already ordered 125.5 million CoronaVac doses. Its president, Joko Widodo, received a shot of the same vaccine on Wednesday morning in a symbolic start to Indonesia’s national vaccination program.

Two days earlier, Indonesia’s food and drug agency became the first regulator in the world to approve use of the Sinovac vaccine, after its own local trials found 65.3% efficacy, above the World Health Organization’s 50% threshold for advised use.

The World Health Organization (WHO) is reportedly currently debating whether to approve the vaccine for global use. China has at least four Covid vaccines under development, including Sinovac’s CoronaVac.

Yet Brazil’s revelation that Sinovac’s vaccine was only 50.4% effective in its trials raises concerns for other Southeast Asian states, including Thailand and the Philippines, both of which have already ordered the vaccine and are contending with acute Covid outbreaks.

Last week, Beijing-based Sinovac announced a 78% efficacy rate during its trials, an eyepopping gap with Brazil’s much lower estimate. But Beijing’s so-called “vaccine diplomacy” drive in neighboring Southeast Asia is now very much in doubt.

A health worker delivers containers of Covid-19 vaccines produced by China’s Sinovac from a cold room in Bandung on January 13, 2021, as the sprawling archipelago of nearly 270 million kicks off a mass inoculation drive Photo by Timur Matahari/AFP

Thailand’s Ministry of Public Health, for one, has reportedly requested further information from China about the vaccine before initiating its use. Bangkok has ordered 2 million doses from Sinovac, with the first batch of 200,000 set to arrive next month.

Indonesians are now asking hard questions of Widodo’s plan to use the vaccine. 

“Why doesn’t Indonesia wait for a better vaccine? My impression is that this is rushed and forced,” Sulfikar Amir, an Indonesian associate professor of disaster sociology at Nanyang Technological University in Singapore, was quoted saying in media reports. 

Malaysia’s Science, Technology and Innovation Minister Khairy Jamaluddin has since demurred on his country’s apparently ongoing negotiations to purchase Sinovac vaccines following news of the Brazil study.

“If we are not satisfied with the safety and efficacy, we will not go through with the procurement,” the minister wrote on social media. The previous day, the Malaysian pharmaceutical group Pharmaniaga signed a deal with Sinovac to purchase 14 million CoronaVac vaccines, which require two doses per person.

Days earlier, Manila made an order for 25 million doses from Sinovac, with 50,000 are set to arrive in the Philippines in February. Philippine President Rodrigo Duterte, a staunch China ally, had earlier discredited Western vaccine makers for unscrupulous price-gouging.

His financially beleaguered government is seeking multilateral loans to purchase sufficient vaccines for the Philippines’ mostly poor 100 million-plus population.

In December, Cambodian Prime Minister Hun Sen took the outlier decision to only purchase WHO-approved vaccines, which to date doesn’t include any produced by Chinese firms. 

Cambodian Prime Minister Hun Sen wears a face mask at Phnom Penh International Airport, May 11, 2020. Photo: Tang Chhin Sothy

This led to much clucking that the authoritarian leader was snubbing his government’s closest ally and economic patron, which Hun Sen quickly discounted as false.

Yet the Economist Intelligence Unit doesn’t expect Cambodia to be able to vaccinate more than 60% of its population until at least mid-2022, a function of Hun Sen’s comparative wait and see approach.

Yet Cambodia’s comparative patience could mean it ends up last in line for vaccines, notably at a time other Southeast Asian nations announced their intentions to purchase millions of vials of Chinese-made vaccines. 

Predictably, the Chinese government and its state-straitened media have talked down the latest efficacy results. That’s expected since Beijing has made vaccine diplomacy a key pillar of its pandemic era soft power push, especially in Southeast Asia where governments are less able to purchase more costly Western vaccines. 

Vaccines produced by Moderna and Pfizer-BioNTech, the latter a German-US partnership, have been shown to have efficacy rates of about 95%, but are more expensive and require transport and storage in costly freezers. 

The world is now waiting to see if new trial data, including crucially from the WHO, raises or diminishes the efficacy rates of Sinovac’s vaccine.

On the one hand, as Chinese media point out, even a 50% efficacy is better than nothing. Moreover, the trial data from Brazil doesn’t suggest the vaccines are unsafe, only less efficient than more costly alternatives. 

Health worker and volunteer Paulo Roberto Oliveira receives a Covid-19 vaccine produced by Chinese company Sinovac Biotech at the Sao Lucas Hospital, in Porto Alegre, southern Brazil on August 08, 2020. Brazil has become a testing ground for vaccines. Photo: AFP/Silvio Avila

On the other hand, the revelations of lower efficacy will inevitably complicate inoculation programs as public doubts mount, as already seen spreading on Southeast Asian social media about the reliability of Chinese vaccines.

The chatter will gain deeper resonance if wider-ranging clinical results on Coronavac’s efficacy are interpreted, rightly or wrongly, as proof that the Chinese-made vaccines are unsafe or were hastily produced by cutting clinical corners.  

Regional governments will need to dance around this issue with great care. While cheaper and more readily available than Western-produced vaccines, buying from China will bring potential wider benefits for Southeast Asian governments.

Beijing has already made clear that it will look kindly on purchasers of its products. 

Myanmar’s State Counsellor Aung San Suu Kyi (R) meeting with China’s Foreign Minister Wang Yi (L) at the Presidential Palace in Naypyidaw, January 11, 2021. Photo: Thar Byaw/AFP

China’s Foreign Minister Wang Yi started a four-nation tour of Southeast Asia this week, his second since October, eager to communicate China’s message to the region ahead of Joe Biden’s inauguration on January 20. 

Speaking in Myanmar on January 11, Wang pledged to donate vaccines to Aung San Suu Kyi’s government, which has increasingly allied with Beijing in recent years while being pilloried by the West. 

The diplomat, who in October let it be known at least in Thailand he had received jabs of Chinese vaccines, will not be required to enter mandatory quarantine in visited countries, namely Indonesia, Brunei, Myanmar and the Philippines.   

Shawn W. Crispin contributed reporting from Bangkok