China has everything it needs to vaccinate millions, except as proof that the vaccines work

Hospitals across China have almost everything needed for a mass vaccination: Millions of doses. Refrigerators to store it. Healthcare workers trained to administer them.

Everything, that is, except proof that any of their vaccines work.

Unlike their Western competitors, the Chinese companies did not release data from late-stage clinical trials that would indicate whether their vaccines were effective, and regulators in China did not officially approve it.

This has not deterred local governments across the country, which have embarked on an ambitious vaccination campaign. The goal is to vaccinate 50 million people – roughly the population of Colombia – by mid-February, before the lunar New Year holiday, when hundreds of millions of people are expected to travel.

China, where the virus first surfaced a year ago, is going to do a lot – and scientifically unorthodox – work to prevent the outbreak again. Although Beijing has not officially announced the vaccine target, the government has indicated that implementation will be managed in the same way as the outbreak, through a top-down approach that could mobilize thousands of workers to produce the shots, to transmit and administer. Local officials were told the ride was a ‘political mission’.

The campaign will focus on what China calls ‘key priority groups’, including doctors, hotel workers, border inspection staff, food depots and transport workers, as well as travelers. Irene Zhang, a 24-year-old student, received a vaccine in the city of Hangzhou on December 22 before going to Britain for postgraduate school next month.

“Because my situation is quite urgent and all the students around me are going abroad, I feel it is relatively reliable,” she said. Zhang said.

Even before this current campaign, more than one million people stood in line to be vaccinated, confusing scientists who warned that taking unproven vaccines posed potential health risks. Their efforts, which are broader, are implemented in a similar ad hoc manner.

In the south of Guangdong province, 180,000 people – mostly workers involved in food storage and transport, quarantine facilities and border inspection – were vaccinated from 22 December. In the eastern province of Zhejiang, 281,800 people were vaccinated. In Wuhan, where the outbreak was first noticed, the government said it had designated 48 vaccination clinics for its emergency program, which began on Thursday.

China, which is testing five vaccines in Phase 3 trials, has not provided any information from this last phase to demonstrate the efficacy of these vaccines. In contrast, the United States and Britain began vaccinations after reviewing and approving such trial data.

Instead, Chinese officials have issued broad statements with little detail to assure the public that the vaccines are safe and effective. Three of the vaccines have been approved for emergency use only. Last month, Liu Jingzhen, the chairman of Sinopharm, a state-run vaccine that has two vaccines in late-stage trials, said none of the approximately one million people vaccinated so far had any adverse reactions and that ‘only a few mild symptoms’ had occurred. .

The data and approval is expected to come within weeks. Although there were promising signs, it gave reservations.

The United Arab Emirates and Bahrain said this month that a vaccine made by Sinopharm is effective, although they offer little detail on how the conclusions were reached. Turkey said a vaccine made by Sinovac, a private vaccine manufacturer in Beijing, has an efficacy rate of 91.25 percent, a finding based on preliminary results from a small clinical trial. Officials in Brazil said the Sinovac vaccine had an efficacy rate of more than 50 percent, but delayed the postponement of detailed data.

The extent and speed of vaccination is the result of a centralized public health infrastructure in an authoritarian system. During the crisis, China showed how it can mobilize thousands of workers to reach millions of people; it tested 11 million people in Wuhan in ten days.

Chinese vaccine manufacturers have worked to increase their production, both for the country’s own needs and global exports. The Chinese government has promised to produce 610 million doses by the end of the year and expects to make more than one billion doses next year.

“If they say 50 million, they’ll probably do it,” said Jennifer Huang Bouey, a senior policy researcher at the RAND Corporation and an epidemiologist. “The question is how much would it cost and what is the effect.”

The overall effort required months of preparation. Since June, hospitals in Guangdong Province have started vaccinating clinics, equipped with refrigerators and installed cooling systems.

Sinopharm did exercises this month. During the trial run, workers loaded boxes with the vaccines and ice packs, while the industry official monitored the vaccines’ temperature in real time during shipment.

China has some advantages in its deployment. Unlike the Pfizer vaccine, those manufactured by Sinopharm and Sinovac are based on traditional methods that use inactivated or attenuated forms of the virus, making it easier to store and spread.

But the pitfalls abound, as the American experience shows. In in the United States, just over two million people received a Covid-19 vaccine, far less than the 20 million target set by the government for this month. Hospitals had to prepare the frozen shots and find staff to man the clinics.

As China manages to do so, local officials have investigated the number of people in the ‘key priority groups’. They had to “ensure that there are no omissions”, according to a government document from Xinchang Province in Zhejiang Province.

Just two months ago, it appeared that demand could exceed supply. The eastern city of Yiwu offered 500 doses that were used within hours.

Me. Zhang, the student, said she was initially reluctant to get a vaccine because everyone around her told her to wait and see. Still, she tried to sign up in Yiwu but failed to find a place.

Then, on December 21, Ms Zhang heard that Hangzhou was going to start its own vaccination process. She took an express train that evening and signed a lease with her friend in the city, as the local authorities required proof of residence. The next day she paid $ 35 and got the shot from Sinovac.

According to me. Zhang waited four or five people in the hospital to get the vaccine. The process took one hour, which included registration, recording and waiting for 30 minutes to see if there were any adverse reactions.

“Everything was very calm and orderly,” she said. Before she left, the doctor warned her: Do not shower. Do not stay awake. Do not eat foods that can irritate your stomach.

The government emphasized that the vaccination was voluntary and that people should pay for the vaccinations. Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations and a health expert in China, noted that the two-dose regimen could cost about $ 70, which could put it out of reach for rural poor.

China may also have trouble persuading people to take the vaccine. Scientists warn that the lack of transparency could cause fears about the intake of a new vaccine, especially in an industry that has a history of quality scandals.

Tao Lina, a vaccine expert and former immunologist at the Shanghai Center for Disease Control and Prevention, said he knew of several health workers who turned down the shots. “In the minds of doctors, they feel that any medicine that has not passed phase 3 tests is unreliable,” he said. Tao said.

Mr. Tao, who received a Synopharm vaccine on Monday, said he was confident the vaccines were safe and effective, and officials commented that there were no serious and adverse reactions. But he added that the businesses could do better in their messages.

“If you say it’s safe, you have to show all kinds of evidence that it’s safe,” he said.

Hminem Zhang, a 27-year-old sales employee in an internet business, said he wanted to get a vaccine because he traveled to work and feared he would run on the shots if the virus revived. But he is worried about the Chinese manufacturers because “not many people have received it”, he said.

“I want to wait another month or two for official data to appear,” he said. Zhang, who is based in the southwestern municipality of Chongqing, said. “And if there is no news of any side effects, I’ll get a chance.”

Liu Yi, Amber Wang and Elsie Chen contributed research.