China opens trip to foreigners taking Chinese Covid-19 vaccines as geopolitical vaccine silos emerge

Hong Kong (CNN) – China makes it easier for foreigners to enter the country. But there is one condition: they must have received a China-made Covid-19 vaccine.

At least 23 Chinese embassies around the world have issued new visa policies in the past week, including in the United States and the United Kingdom – both places where Chinese vaccines are not available.

The Chinese Foreign Ministry says the move is to embark on an “orderly” international trip, and vaccinated travelers will still face the state-controlled quarantine.

But experts expressed concern about China’s decision to prioritize domestic vaccines over those approved by the World Health Organization, and with a higher efficiency rate.

They say it runs the risk of setting countries up to approve Chinese vaccinations, creating a dangerous precedent that, if adopted by other nations, could leave the world in silos on the vaccine.

It also raises practical issues – what options do people have if they live in countries that have not been approved by China-made vaccinations?

“This is very much at the sharp end of vaccine diplomacy,” said Nicholas Thomas, associate professor of health security at City University in Hong Kong. “(It is) essentially say if you want to visit us, you have to take our vaccine.”

A man receives a dose of Sinovac Covid-19 vaccine during the mass vaccination program on March 2, 2021 in Yogyakarta, Indonesia.

A man receives a dose of Sinovac Covid-19 vaccine during the mass vaccination program on March 2, 2021 in Yogyakarta, Indonesia.

Ulet Ifansasti / Getty Images

What’s behind the move?

The timing of China’s new visa rules is remarkable.

After the Quad – a partnership between the US, India, Japan and Australia – met last week, US President Joe Biden announced that together by the end of 2022 they would jointly fund at least 1 billion vaccines for the Indo-Pacific, manufactured and distributed. .
These vaccines will be developed in the US and manufactured in India, which is pursuing its own vaccine diploma in the region. Some see it as a direct contradiction to China’s own efforts to vaccinate, which was recently criticized by US Secretary of State Antony Blinken, saying Chinese vaccines come with ‘strings attached’.

China was one of a number of countries at the forefront of vaccine development and on March 15, according to the Chinese mission to China, China exported vaccinations to 28 countries. Massive public vaccination programs with Chinese vaccinations are underway in Indonesia and Turkey. In China alone, 65 million people have been vaccinated with the country’s five approved local vaccines.

But none of China’s vaccines have yet been approved by the WHO, or have released complete Phase 3 trial data, leading to a lack of clarity on how effective the vaccines really are. The available data suggest that China’s vaccinations may actually be less effective than other vaccines – Sinovac, for example, had an efficacy rate of 50.38% in late stages in Brazil, lower than the 78% announced in China, and lower than the efficiency. other vaccines such as Pfizer, which have an efficacy rate of 95%.
On January 13, 2021, health officials released the Covid-19 vaccine manufactured by Sinovac China, under police surveillance, at the Pharmacy Warehouse in Surabaya, Indonesia.

On January 13, 2021, health officials released the Covid-19 vaccine manufactured by Sinovac China, under police surveillance, at the Pharmacy Warehouse in Surabaya, Indonesia.

Ahmad Mukti / Riau Images / Barcroft Media / Getty Images

This means that China can not claim that its preference for indigenous vaccines is due to the fact that it is better than other vaccines. Instead, Thomas views the new visa rules in China as a ‘power movement’, which will push people to take one of China’s vaccinations.

Sarah Chan, a reader in bioethics at the University of Edinburgh’s College of Medicine, says if someone’s livelihood depends on travel to China for work, it could move him to take the vaccines, despite their lack of data. Scott Rosenstein, director of the global health program at Eurasia Group, said it could also put countries under pressure to authorize Chinese vaccines.

Some people have health conditions which means they are unable to take certain shots. “It’s simply not justified to let so much of what we do depend on whether we had a vaccine, let alone whether we had one specific version of the vaccine,” Chan said.

Despite China’s new visa rules encouraging travelers to take Chinese vaccines, Chinese Foreign Ministry spokesman Zhao Lijian has rejected the idea of ​​’vaccine nationalism’.

“No matter where a vaccine is made, it is a good vaccine, as long as it is safe and effective,” he told a news conference on Monday. “China stands ready to promote mutual recognition of vaccination with other countries.”

What are the long-term effects?

China’s move comes as countries around the world tackle the broader demand to introduce so-called “immunity passports” to open international travel for people with coronavirus antibodies – either because they have recovered from it or through a vaccine.

But this leads to more questions – if an immunity passport gives special rights to people who have been vaccinated, what vaccines should be counted?

One option is to follow the WHO authorization. At present, only four vaccines, including two versions of the AstraZeneca / Oxford vaccine, have been given a list of emergency uses by the WHO – and not one has been manufactured by China.

Another option is to have the 194 member states of the World Health Organization vote – the vaccines approved and recognized by most countries would set the standard, according to Thomas.

Dr. Akay Kaya, right, and a nurse, Yildiz Ayten of Bahcesaray Public Hospital, arrive in the remote village of Guneyyamac in eastern Turkey to vaccinate residents aged 65 and over with the Sinovac CoronaVac Covid-19 vaccine. on February 15, 2021.

Dr. Akay Kaya, right, and a nurse, Yildiz Ayten of Bahcesaray Public Hospital, arrive in the remote village of Guneyyamac in eastern Turkey to vaccinate residents aged 65 and over with the Sinovac CoronaVac Covid-19 vaccine. on February 15, 2021.

Bulent Kilic / AFP / Getty Images

But a uniform vaccine passport for the world is far from over. For the time being, countries will probably only recognize the vaccines they have approved for use – and there are already signs that this is leading to silos.

The The European Commission this week announced a Digital Green Certificate with a QR code to indicate if someone has been vaccinated. But member states will only waive free movement restrictions for people vaccinated with shots that have received EU marketing authorization – those who have had the Chinese shots can be left in the cold.

“It’s this challenging challenge that I think will be interesting to look at,” Rosenstein said. “It will create a certain amount of tension and will increase this existing vaccination diplomacy tension.”

Rosenstein said people even prefer to take multiple vaccines so they can travel to other regions – a move that is unlikely to have negative health consequences, but which could harm the supply of vaccines.

What is the best way forward?

Apart from the difficulties in deciding which vaccines to accept, there are other problems with immune passports – we do not know how long immunity to Covid-19 lasts, either through virus recovery or through vaccines. There are also ethical issues – while the WHO is working on a ‘smart digital certificate’ that includes vaccination information, it discourages the use of vaccine passports for travel. “There is a worldwide shortage of vaccines,” WHO director Hans Kluge said on Thursday. “It will therefore increase inequalities.”
A woman holds a phone with a mockery of China's new digital health certificate, the first known implementation of a

A woman holds a phone with a mockery of China’s new digital health certificate, the first known implementation of a “virus passport” concept, on March 9, 2021.

Nicolas Asfouri / AFP / Getty Images

Chan sees a series of problems with immunity passports, especially high-tech digital people who have problems with data privacy. She also points out that once everyone has been given a chance to be vaccinated, vaccine passports can quickly become obsolete, meaning money can be better spent elsewhere.

A better approach would be to ensure that vaccines are available as widely as possible, she said. When a large part of the world population has been vaccinated, immigration authorities can use simpler approaches, such as asking the public to report themselves if they have had any vaccine. If some people lie, the population will generally still be small because most people have been vaccinated, she added.

Thomas also hopes for a best-case scenario where countries do not follow China’s lead – instead, they treat all vaccines the same, regardless of the vaccine, as long as the vaccine has the effectiveness of the vaccine. He hopes countries can stop treating vaccines as a race, and rather see it as a global health issue.

“The viruses do not care about borders, they do not care about nationalities or races or religions or ideologies or ethnicities or anything like that; they just want to repeat and mutate,” he said.

‘And I think, unless we take a real global approach to vaccines and realize that we simply have to do the best in the world, then we’ll look at latent pools of Covid popping up again in the future and possibly like the second wave of Spanish flu, which mutates so much that it makes it worse than before. ‘

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