Hospitals across China have almost everything needed for a mass vaccination campaign: millions of doses. Refrigerators to store them. Health professionals trained to manage them.
Everything except proof that any of your vaccines work.
Unlike their Western competitors, Chinese companies have not released data from advanced clinical trials that would show whether their vaccines are effective, and regulators in China have not officially approved them.
This did not stop local governments across the country, which started an ambitious vaccination campaign. The goal is to inoculate 50 million people – approximately 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 appeared a year ago, is going to great lengths – and scientifically unorthodox – distances to prevent a resurgence of the outbreak. Although Beijing has not officially announced the target of the vaccine, the government has signaled that the implementation will be managed in the same way as the outbreak, through a top-down approach that can mobilize thousands of workers to produce, dispatch and administer the vaccines. Local authorities were informed that the campaign was a “political mission”.
The campaign will focus on what China calls “priority groups”, including doctors, hotel staff, border inspection personnel, food storage and transport workers, as well as travelers. Irene Zhang, a 24-year-old student, was vaccinated on December 22 in the city of Hangzhou, before going to Britain next month for graduate school.
“Since my situation is very urgent and all the students around me who are going abroad have accepted it, I think it is relatively reliable,” said Zhang.
Even before this current campaign, more than a million people lined up to be vaccinated, baffling scientists who warned that taking unproven vaccines poses potential health risks. Their efforts now, which are broader, are being implemented in a similar ad hoc manner.
In southern Guangdong Province, 180,000 people – mostly food workers storage and transport, quarantine and border inspection – were inoculated on 22 December. In eastern Zhejiang province, 281,800 people were vaccinated. In Wuhan, where the outbreak was first detected, the government said it had designated 48 vaccination clinics for its emergency program, which started on Thursday.
China, which is testing five vaccines in Phase 3 tests, has not provided any information from the latter phase to show the effectiveness of these vaccines. In contrast, the United States and Britain started vaccines after reviewing and approving this test data.
Instead, Chinese officials issued broad statements with little detail, assuring the public that vaccines are safe and effective. Three of the vaccines have been approved for emergency use only. Last month, Liu Jingzhen, president of Sinopharm, a state-owned vaccine manufacturer that has two vaccines in final-stage tests, said that none of the nearly one million people vaccinated so far had adverse reactions and that “only a few had mild symptoms”.
Data and approval should arrive within weeks. Although there have been promising signs, they do come with warnings.
The United Arab Emirates and Bahrain said this month that a Sinopharm vaccine was effective, although they gave few details on how the conclusions were drawn. Turkey said a vaccine made by Sinovac, a private vaccine manufacturer based in Beijing, has an effectiveness rate of 91.25 percent, a finding based on preliminary results from a small clinical trial. Officials in Brazil said the Sinovac vaccine has an efficacy rate of more than 50 percent, but has postponed the release of detailed data.
The scale and speed of the vaccination campaign are the result of a public health infrastructure centralized in an authoritarian system. During the crisis, China showed how it can mobilize thousands of workers to reach millions of people; tested 11 million people in Wuhan in 10 days.
Chinese vaccine manufacturers have been working to increase their production, both for their own country’s needs and for global exports. The Chinese government has pledged to produce 610 million doses by the end of the year and expects to make more than one billion doses next year.
“When they say 50 million, they will probably do that,” said Jennifer Huang Bouey, senior policy researcher at RAND Corporation and an epidemiologist. “The question is how much it would cost and what the effect is.”
The total effort took months of preparation. Since June, hospitals in Guangdong Province have started building vaccination clinics, equipping them with refrigerators and installing refrigerated storage systems.
Sinopharm conducted exercises this month. In the test, workers loaded the boxes with vaccines and ice packs, while the company employee monitored the vaccine temperature in real time during shipping.
China has some advantages in its launch. Unlike the Pfizer vaccine, those from Sinopharm and Sinovac are based on traditional methods that use inactivated or weakened forms of the virus, facilitating storage and distribution.
But the pitfalls are many, as the experience of the United States shows. Inside In the United States, just over two million people received the Covid-19 vaccine, well below the target of 20 million that the government had set for this month. Hospitals had to prepare the frozen injections and find staff for the clinics.
As China prepares, local authorities have been surveying the number of people in “priority groups”. They had to “make sure there were no omissions,” according to a document from the Xinchang County government in Zhejiang province.
Just two months ago, it looked like demand could outpace supply. The eastern city of Yiwu offered 500 doses, which were used in a few hours.
Ms. Zhang, the student, said she initially hesitated to get a vaccine because everyone around her told her to “wait and see”. Still, she tried to apply in Yiwu, but was unable to secure a spot.
Then, on December 21, Zhang heard that Hangzhou was going to start its own vaccination campaign. She took a high-speed train that night and signed a rental contract with her friend in the city, as local authorities required proof of residence. The next day, she paid $ 35 and received Sinovac’s injection.
At the hospital, four or five people were waiting to receive the vaccine, according to Zhang. The process took one hour, which included registration, obtaining the injection and waiting 30 minutes to check if there were any adverse reactions.
“Everything was very calm and organized,” she said. Before she left, the doctor warned her: Don’t take a shower. Don’t stay up late. Do not eat foods that can irritate your stomach.
The government stressed that the vaccination campaign is voluntary and people will have to pay for vaccines. Yanzhong Huang, a senior global health researcher at the Council on Foreign Relations and a health expert in China, noted that the two-dose regimen could cost around $ 70, being out of reach of the rural poor.
China may also have trouble persuading people to get the vaccine. Scientists warn that a lack of transparency may raise fears about adopting a new vaccine, especially in an industry that has a history of quality scandals.
Tao Lina, a vaccine specialist and a former immunologist at the Shanghai Center for Disease Control and Prevention, said he knew of several health professionals who refused vaccines. “In the minds of doctors, they think that any medication that has not passed Phase 3 tests is unreliable,” said Tao.
Tao, who received a vaccine against Sinopharm on Monday, said he felt confident that the vaccines were safe and effective, echoing the authorities’ comments that there were no reports of serious adverse reactions. But he added that companies could do better in their messages.
“If you say it is safe, you must show all kinds of evidence to show that it is safe,” he said.
Hminem Zhang, a 27-year-old salesman for an internet company, said he wanted to get a vaccine because he traveled on business and feared a vaccine leak if there was a resurgence of the virus. But he worries about Chinese-made ones because “few people have received them,” he said.
“I want to wait another month or two for some official data to be released,” said Zhang, who lives in the southwestern province of Chongqing. “And then, if there is no news about any side effects, I will have an injection.”
Liu Yi, Amber Wang and Elsie Chen contributed to the research.