A banner with two flags is unfurled, a large box is lowered from a cargo hold, and cameras flash for a photo op as local politicians and a Chinese ambassador welcome a shipment of Covid-19 vaccines from China.
This moment has been repeated around the world – in the tiny South American country of Guyana receiving 20,000 doses for its nearly 800,000 people, in the Balkans’ Montenegro, Africa’s Zimbabwe, in Laos, Southeast Asia, and the list goes on.
It puts a face to China’s vaccine assistance, which together with commercial deals has reached more than 60 countries to date. It also reveals the unlikely position of China – a small player in the global vaccine market pre-pandemic – as a leader in international supply, with its companies accounting for a significant chunk of the doses being sent around the world.
Figures from official sources and media compiled by the South China Morning Post show China and its vaccine makers have now shipped around 80 million ready-made vaccine doses overseas, and another 90 million doses worth of bulk ingredient have gone out to be finished in factories in Mexico, Indonesia and Brazil, with at least a third of those already processed.
Those figures place China as the world’s top global exporter, ahead of major producers the European Union and India, according to their latest available data. Meanwhile, China has administered more than 145 million doses at home.
Together, the doses administered at home and shipped abroad stand at about a third of the nearly 700 million that Unicef estimates have been delivered worldwide to date – though it is unclear how many doses have been administered overall.
China’s outsize role in vaccinating the planet is playing out at a critical moment. Rich countries are guarding doses as they mass inoculate at home, and a World Health Organization distribution programme that leans heavily on India is mired in delays amid a spike in cases there.
With its vaccines still under review for potential inclusion in that programme, China – which contributed less than 1 per cent of vaccines procured by other countries in 2018 by WHO’s count – has struck out on its own.
That has included small-scale donations in the low hundreds of thousands to poorer nations, while its leading vaccine makers – Sinopharm, Sinovac Biotech and CanSino Biologics – send out initial shipments to fulfil commercial deals in the tens of millions.
All the while, Beijing has pushed back on criticism that its so-called vaccine diplomacy has ulterior motives. Most recently Taiwan has claimed an offer of doses to Paraguay was linked to severing ties with the island that Beijing views as a rogue province.
Chinese foreign ministry spokesman Zhao Lijian hit back during a scheduled briefing on Thursday, saying, “We have to warn the Taiwanese authorities that the vaccine is a weapon to fight the pandemic and save lives, not a tool for political manoeuvres.”
But despite the early reach of China’s vaccines just months into the global roll-out, their ultimate impact on the pandemic is not yet clear, experts say.
Jerome Kim, director general of the International Vaccine Institute in Seoul, said it was an accomplishment that Chinese companies had developed Covid-19 vaccines with such speed.
“The flip side is that right now [we don’t yet know] will WHO really approve them? Will quality vaccines be provided in the quantities and on the timelines promised? And will they really be provided as a global public good as President Xi Jinping said?” Kim added, referring to a pledge made by the Chinese president last May.
No Chinese vaccine is yet able to supply the Covax Facility, the WHO programme whose mission is to make vaccines a public good. Suppliers first need an emergency use licence from the WHO.
Six Chinese-made vaccines have been approved since 2013 for other diseases, including from Sinovac and a Sinopharm subsidiary responsible for one of its Covid-19 shots. But China’s status outside the group of elite “stringent” national regulators is likely to have slowed down the emergency licence process for its Covid-19 vaccines, experts say.
On Tuesday, the WHO said more data was required for vaccines by both companies, pushing their review to the end of April. Last month, the chair of a WHO advisory panel said the data presented did appear to meet efficacy requirements, the first such statement since their dossiers were first submitted in December and January.
In the meantime, China says dozens of countries have already authorised its vaccines for use, sidestepping the WHO quality, safety and efficacy endorsement as they seek access – despite concerns about efficacy and data transparency due to a lack of published findings.
Another source of pressure comes from home. China’s vaccine makers have made promises to send half a billion doses overseas, but the country is now ramping up its domestic vaccination drive, with an aim to immunise 40 per cent of its population – some 560 million people – by the end of June.
“There is a large gap between growing domestic and international demand and the existing vaccine manufacturing capacity – I don’t see any reason for the decision makers to be so confident that they are going to make both ends meet,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations in New York.
Some cracks may be showing – late last month Turkish President Recep Tayyip Erdogan said China had not met their agreed target of delivering 50 million doses of its Covid-19 vaccine by the end of February, according to Reuters. Reports from last month show the country has received around 16 million doses.
But in comments last month, health officials remained optimistic they could meet both demands, while forecasts reported in Chinese media for projected supply have reached as high as 4 billion doses between China’s vaccine makers by the end of 2021.
Despite deals in the tens of millions with a number of countries worldwide, so far only six nations, all involved with clinical trials, have received 3 million or more doses exported from China, according to the Post’s tally.
Many of the rest are state donations, ranging from 20,000 doses up to 1.5 million, or smaller increments of commercial fulfilment. The donations may be more “symbolic”, according to Huang, though he said that did not mean they had not made a difference in regions struggling for access.
Those struggles have become particularly acute given that Covax shipments of a vaccine – developed by British-Swedish firm AstraZeneca and manufactured by the Serum Institute of India – have been delayed for the next two months by the country’s surge in new cases. Up to 90 million doses were expected from the manufacturer in April and March, according to Covax operator Gavi, the Vaccine Alliance.
So far, Covax has shipped 38 million doses of vaccines from manufacturers AstraZeneca, Pfizer-BioNTech and Serum Institute of India. Some 64 million doses in total have been exported by India, while Europe – which has enacted Covid-19 export controls – has sent out 77 million doses from manufacturers like Pfizer and AstraZeneca since December, according to an update late last month.
The recent delays from India “create an opportunity for Chinese manufacturers to do more, deliver more, maybe in the context of Covax [if licensed by the WHO] or maybe in the context of bilateral agreements”, said John Donnelly of Vaccinology Consulting in the US.
But despite the urgency, some experts also say that the window for China to have a wide impact on global vaccine access may be limited, with more supply from Western drug makers likely in the coming months after Americans and Europeans are vaccinated.
China’s vaccines, while easier to transport than the mRNA vaccines being used widely in the US and Europe, do not match the over 90 per cent efficacy of these products. Sinopharm has self-reported 79 per cent for one of its vaccines, while the efficacy data from Turkey and Brazil for Sinovac ranges from just over 50 to 83.5 per cent.
“If we assume the larger, global pharmaceutical companies continue to keep producing at the rate they’re producing now [even after a large proportion of people are vaccinated in the US, Europe and elsewhere], there would be sufficient supply from all of the manufacturers to send to countries globally,” said Prashant Yadav, senior fellow at the Centre for Global Development in Washington.
“The value of the vaccines from the three companies based in China may largely depend on how quickly they can deliver doses.”
But Jin Dong-yan, a professor at the University of Hong Kong’s medical school, said the vaccines from China still played an important role at this stage.
“Even if those [Chinese vaccines] might not be as effective as other vaccines … for those who have no access to vaccines without them, it can still help,” said Jin, pointing to preliminary indications.
“They could protect people from severe disease and death – that is the contribution and the value of the Chinese vaccines.”