Hospitals across China have almost everything that is needed for mass vaccination: millions of doses. Refrigerators to store them. Health care workers trained to manage them.
Anything but evidence that one of their vaccines is working.
Unlike their Western competitors, the Chinese companies have not released late-stage clinical trial data showing whether their vaccines are effective, and regulatory agencies in China have not officially approved them.
This hasn’t stopped local governments across the country from launching an ambitious vaccination campaign. The aim is to vaccinate 50 million people – roughly the population of Colombia – before the New Year holidays by mid-February, when hundreds of millions of people are expected to travel.
China, where the virus first emerged a year ago, will be making great – and scientifically unorthodox – efforts to prevent the outbreak from recurring. Although Beijing has not officially announced the vaccination target, the government has signaled that the rollout will be similar to the outbreak, through a top-down approach that can mobilize thousands of workers to produce the shots, too send and manage. Local officials were told that the trip was a “political mission”.
The campaign will focus on what China calls ‘key priority groups’ including doctors, hotel workers, border control personnel, Food warehouse and transport workers and travelers. Irene Zhang, a 24-year-old college student, received a vaccine in Hangzhou on December 22nd before going to graduate school in the UK next month.
“Because my situation is pretty urgent and all the students around me going abroad have accepted it, I think it is relatively reliable,” said Ms. Zhang.
Even before this current campaign, more than a million people had lined up for vaccinations, confusing scientists who warned that taking undetected vaccines poses potential health risks. Their efforts, which are now larger in scope, are similarly implemented on an ad hoc basis.
The southern province of Guangdong has 180,000 people – mostly workers who are involved with food Storage and transportation, quarantine facilities and border controls – had been vaccinated by December 22nd. 281,800 people had been vaccinated in eastern Zhejiang Province. In Wuhan, where the outbreak was first discovered, the government said it had designated 48 vaccination clinics for its emergency program that began Thursday.
China, which is testing five vaccines in phase 3 studies, has not provided any information from this final phase to prove the effectiveness of these vaccines. In contrast, the United States and Great Britain began vaccination after reviewing and approving such experimental data.
Instead, Chinese officials have made extensive statements with few details to reassure the public that the vaccines are safe and effective. Three of the vaccines are only approved for emergency use. Last month, Liu Jingzhen, the chairman of Sinopharm, a state-owned vaccine maker that has two vaccines in late studies, said none of the roughly 1 million people vaccinated so far had side effects and that “few had mild symptoms.”
The dates and approval are expected to be available within weeks. While there have been promising signs, there are limitations.
The UAE and Bahrain said this month that a vaccine made by Sinopharm was effective, although they provided few details on how the conclusions were drawn. Turkey said a vaccine from Sinovac, a private vaccine maker based in Beijing, had an efficacy rate of 91.25 percent, a result based on preliminary results from a small clinical study. Officials in Brazil said the Sinovac vaccine had an efficacy rate of over 50 percent but had postponed the publication of detailed data.
The extent and speed of the vaccination campaign are 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 10 days in Wuhan.
Updated
Apr. 29, 2020, 6:59 p.m. ET
Chinese vaccine manufacturers have worked to increase production, both for the country’s own needs and for global exports. The Chinese government has promised to produce 610 million cans by the end of the year and expects to produce more than a billion cans in the next year.
“If they say 50 million, they probably will,” said Jennifer Huang Bouey, a senior policy researcher at RAND Corporation and an epidemiologist. “The question is how much it would cost and what effect that would have.”
The whole effort took months of preparation. Since June, hospitals in Guangdong Province have started building vaccination clinics, equipping them with refrigerators and installing cold storage systems.
Sinopharm was doing exercises this month. During the test run, workers loaded boxes of the vaccines and ice packs, while the company official tracked the temperature of the vaccines in real time as they were shipped.
China has some advantages in introducing it. Unlike the Pfizer vaccine, the vaccines made by Sinopharm and Sinovac are based on traditional methods that use inactivated or weakened forms of the virus, making them easier to store and distribute.
But the pitfalls are numerous, as the US experience has shown. in the In the United States, just over two million people have received Covid-19 vaccine, well below the government’s 20 million target for this month. Hospitals had to prepare the frozen shots and find staff to occupy the clinics.
While China was preparing, local officials asked the number of people in the “key priority groups”. According to a government document from Xinchang County in Zhejiang Province, they had to “make sure there were no omissions.”
As recently as two months ago, it seemed that demand might exceed supply. The eastern city of Yiwu had offered 500 cans that were used within a few hours.
Ms. Zhang, the student, said She had initially hesitated about getting vaccinated because everyone around her told her to “wait and see”. Nevertheless, she tried to register in Yiwu, but could not secure a place.
Then on December 21st, Ms. Zhang heard that Hangzhou was launching its own vaccination campaign. She took a bullet train that evening and signed a lease with her friend in town because local authorities required proof of residence. The next day, she paid $ 35 and was shot by Sinovac.
According to Ms. Zhang, four or five people were waiting for the vaccine in the hospital. The process took an hour. This included registering, getting the shot, and waiting 30 minutes to see if any side effects occurred.
“Everything was very calm and tidy,” she said. Before she left, the doctor warned her: don’t shower. Don’t stay up late. Do not eat foods that may irritate your stomach.
The government has emphasized that the vaccination campaign is voluntary and that people have to pay for the vaccinations. Yanzhong Huang, a senior fellow on global health at the Council on Foreign Relations and a health care expert in China, noted that the two-dose regime could cost about $ 70, making it inaccessible to the rural poor.
China may also have trouble convincing people to take the vaccine. Scientists warn that the lack of transparency could spark fears about taking a new vaccine, especially in an industry with 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 several health care workers who turned down the shots. “In the minds of doctors, they believe that any drug that fails Phase 3 trials is unreliable,” Tao said.
Mr. Tao, who received a Sinopharm vaccine Monday, said he was confident the vaccines were safe and effective, reiterating officials’ comments that there had been no reports of serious side effects. But he added that companies could do better with their news.
“If you say it’s safe, you should come up with all kinds of evidence to show it’s safe,” he said.
Hminem Zhang, a 27-year-old sales rep at an internet company, said he wanted to get vaccinated because he had traveled to work and feared that the virus could reappear if the virus recurs. But he is concerned about the ones made in China because “not many people received them,” he said.
“I would like to wait a month or two for some official data to be released,” said Mr. Zhang, who is from Chongqing, southwestern town. “And then if there’s no news about side effects, I’ll get a chance.”
Liu Yi, Amber Wang, and Elsie Chen contributed to the research.
