Few places around the world are giving people the choice of two competing Covid-19 vaccines, but in Hong Kong, Chinese and Western versions are on offer.
But while the less-than-impressive efficacy rate of China’s Sinovac has tempered hopes of a high take-up in the city, unfolding issues relating to the packaging of BioNTech shots may also dent confidence in a city that still lives under the specter of a fresh resurgence of the coronavirus.
The 150,000 residents in Hong Kong who heeded the government’s call and rolled up their sleeves for shots are now left distraught, wondering when and whether they can get their second dose.
On Wednesday the Asian city became the first jurisdiction to pause mass immunization using jabs supplied by the Germany-based BioNTech.
This happened less than a month after the first consignments arrived. The novel messenger ribonucleic acid (mRNA) vaccine, the most widely trialed and used in the West, continues to be administered across multiple continents.
Some Hongkongers are due to have their second shots as soon as Saturday. The question they face is how the delay will affect efficacy and ability to provoke an immune response if the drug’s quality is compromised due to the observed “deviations” in the vial seal of a batch from Germany.
About 57 cases involving hairline cracks in bottles, loose capping and liquid squirting out after opening have been reported in Hong Kong, after the city added the BioNTech product to its expanded roll-out since March 3. Vial and sealing defects may lead to contamination of the contents.
In a subsequent hiccup that irked vaccine takers, about 1,080 residents were still given the mRNA drug on Wednesday, hours after the distributor, the Shanghai-based Fosun Pharma that is a partner of BioNTech, notified the city’s government that a small number of vials could have “packaging defects.”
The batch concerned, numbered 210102 containing 585,000 doses, had been pulled back from inoculation pending Fosun’s investigation, and as a precaution, another bigger batch, 210104 with 758,000 shots, has also been held back from distributing to vaccination centers. Vials found with defects have already been disposed of.
It is not immediately clear, though, if future shipments to Hong Kong will be affected, as the city’s advance purchase deal with BioNTech and Fosun, announced in December, would cover as many as 7.5 million shots.
Fosun, sole logistical agent for the Greater China Region, has pledged to work with the producer for an exhaustive review of the manufacturing procedures as well as the whole shipment and warehousing process from the German plant to the city, according to Hong Kong’s Minister for Civil Service Patrick Nip, who coordinates the city-wide vaccination blitz.
Nip also revealed that about 11,000 doses have been defrosted on Wednesday before the suspension and these were unlikely to be used. The BioNTech vaccine must be chilled at 70 degrees Celsius below freezing and can only be kept refrigerated at 2-8 degrees for five days after the pulp is warmed and diluted for inoculation.
Assuring takers of the vaccine in question, Nip cited advisories from a government-convened expert panel that the gap between each jab could be as long as 42 days and its protection would unlikely be lessened if more days lapsed than recommended. He admitted, though, the government had no idea how long the review would take.
Dr. Ho Pak-Leung, chief of the University of Hong Kong’s Center for Infectious Diseases, told reporters that BioNTech vaccine’s effectiveness could reach 95% when two doses were given a week apart, as seen in human trial and regulatory approval data furnished by the drugmaker and Western watchdogs, and that even a single shot could trigger a meaningful immune response among 90% of takers, according to British and Israeli researchers.
Ho said the second jab, even given belatedly, was unlikely to compromise protection because it would be a booster shot to increase antibodies. His view is echoed by Dr. Ivan Hung, convener of the government-established Expert Committee on Clinical Events Assessment Following Covid-19 Immunization.
A former marketing specialist with Fosun told Asia Times on condition of anonymity that the packaging issue found in Hong Kong would be “significant” to remind other recipient countries to step up inspection but the incident could just be a standalone case as no similar problems had been reported thus far across the West amid the extensive take-up.
“It’s just the sealing and vials not the formula itself, so what is needed may just be a few tweaks to the final bottling and packaging equipment, the problem should be easy to fix,” said the former Fosun employee.
Meanwhile, Hong Kong continues to offer free jabs of Sinovac’s attenuated vaccine, and it remains to be seen if BioNTech’s packaging issue will dent the public’s willingness to sign up or will boost the take-up of the competing Chinese drug. Hong Kong’s top officials have endorsed the Sinovac one.
So far, 412,800 people in the city have received their first dose, with about 261,500 picking Sinovac as of Wednesday.
Hung, head of the government’s expert panel, revealed a tenfold jump to 793 in abnormal outcomes within the past two weeks, including hypersensitivity and facial paralysis. This was merely a month into Hong Kong’s mass injection program which was launched at the end of February.
Hung said ten people had passed away after their inoculations. Nine of them took the Sinovac drug. He said most of them had underlying comorbidities such as hypertension and cardiovascular conditions. His committee will weigh and discuss each case to determine if vaccine side effects were possibly to blame. The panel has, nonetheless, preliminarily concluded that the events reported and the vaccination did not have direct causal association.
Now the many anti-vaxxers in Hong Kong have more reasons to shun the calls to get jabs. They say Sinovac’s effectiveness rate only barely crossed the 50% threshold and more data is still lacking and that the quality of BioNTech’s batches could also be suboptimal.
So far just 5.5% of the city’s population of 7.5 million have received their first dose.