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China has backed itself into a corner.
About a year ago, in Spring 2020, it emerged triumphant—after months of devastation,
it became the first country to coax life back to near-normal after a widespread COVID epidemic.
Just as it emerged from lockdown, the rest of the world was entering into it, so China
started to focus its attention on not only recovering from COVID, but also from the hit
it took to its global image as a result of perceived mismanagement in the virus’ early
days.
As the US and Europe struggled from far larger, far more devastating outbreaks, China sat
on the sidelines, working on ways to be viewed not only as the country that crushed COVID
within its borders, but also led the fight against it around the world.
They wanted to be seen doing what the US and Europe couldn’t while they were focused
on their problems at home.
As hospital ships docked and intensive care units ballooned in size throughout April in
New York, planes were landing at JFK carrying thousands of desperately-needed ventilators
from China.
As hospitals around the world ran out of supplies and required healthcare workers to reuse masks
for days or weeks on end, national airlines were making special, dedicated trips to pick
up medical supplies donated by China.
As every corner in the world worked to ramp up testing to get a more accurate picture
of their problems, Chinese-made test kits were streaming through their borders.
China was at the center of the fight against the virus, but the center can be the riskiest
place to be.
As donations turned into purchases, it emerged that there was a major quality problem.
Some 90% of mask certifications from China, according to one measure, were fake; tests
that were supposed to have 80% sensitivity actually had 30%; and stories emerged globally
of Chinese officials demanding public displays of thanks in exchange for donations.
What was supposed to be a diplomacy coup rekindled an old narrative of Chinese-made as inferior.
At best, this effort did little to rewrite China’s role in the pandemic, but at worst,
it seems very possible that it actually further damaged their global image.
However, while the start and the middle of the pandemic did not entirely go China’s
way, in terms of global image, there was still the end.
China still had the chance to recover what they’d lost and, more specifically, they
had the chance to display their home-grown scientific skill and manufacturing might.
China could be the country that supplies the shots that would end the world’s misery
and put the pandemic in the history books.
They could make the world’s vaccine, but, of course, first, they needed a vaccine.
Luckily, they had a head-start.
As soon as the outbreak begun in China, a number of private companies, state-owned enterprises,
and government-run institutes started work on developing a vaccine.
By Spring, there were some strong, viable candidates, so the next step was testing.
Just as most of the western world entered their lockdowns, the first Chinese vaccine—Ad5-nCoV
by CanSino Biologics—entered a Phase I clinical trial on March 17th, 2020, with 108 adults
in Wuhan receiving the shot.
After positive data, this same vaccine became the first in the world to enter Phase II trials
on April 11th, with 508 participants.
When the results from that trial were published on July 20th, they revealed that not only
was the vaccine acceptably safe, but that it was also generating the desired immune
response—in short, it was seemingly both safe and effective.
However, the next phase of clinical testing presented a problem for CanSino.
You see, Phase I vaccine trials are about seeing if they're safe, and then phase II
trials are about seeing if they generate the desired immune response in the body.
Phase III, however, that’s about seeing if a vaccine works in the real world—to
see if it actually protects humans.
To do so, researchers divide the study participants into two equal-sized groups.
One receives the actual candidate vaccine, the other receives a placebo shot—typically
just a saline solution.
Then, the two groups are tracked to see if one is less likely to contract the virus than
the other.
The problem for CanSino, the other Chinese vaccine makers, and the country at a whole
was that, by late-summer, when the first Chinese vaccines were moving into Phase III trials,
daily COVID cases in the country had been reduced to double-digit levels in a country
of well over a billion.
Most Phase III vaccine trials have below 50,000 participants, so it would take years, if not
decades, at those case loads to get to the hundreds of infections needed in a trial to
prove a vaccine’s efficacy.
Essentially, it was impossible for Chinese companies to complete their COVID vaccines
in China exactly because the country had done so well at surprising the virus.
Therefore, they had to move abroad.
The CanSino Ad5-nCoV vaccine started Phase III trials in Russia, Pakistan, Saudi Arabia,
Mexico, Argentina, and Chile, while the other leading candidates moved to dozens of other
countries with more severe COVID epidemics.
However, with many of these, China and its pharmaceutical companies had to curry favor
with each government.
Typically, that took the form of offering priority access to the very vaccines that
they were testing, which was fine… for the moment.
As of now, five Chinese-made vaccines have been approved in the country.
In general, there has been widespread criticism of the country’s vaccine development practices—they’ve
started vaccinating the general public before their Phase III trials reached their endpoints,
they haven't been forthcoming with clinical trial data, they’ve misrepresented efficacy
ratings from trials, and more—however, despite that, there is evidence that these vaccines
are acceptably safe and effective—even if potentially less so than other approved vaccines.
On December 30th, the BBIBP-CorV vaccine manufactured by Sinopharm—a Chinese state-owned enterprise—was
approved in the country, making it one of the first COVID vaccines in the world to be
deployed in the general population.
Despite the fact that this vaccine was developed and manufactured by a company owned by the
Chinese government, and despite the fact that the country had some 1.4 billion people to
inoculate, many of the first doses of the Sinopharm vaccine were sent beyond their borders.
Chinese state-owned media reports that the company has orders for its vaccine from over
100 countries, although the details of such orders are not publicly known, leading to
some skepticism over the numbers.
We do know details for certain orders, though, and in some cases, we might know more than
China wants us to.
In general, though, China’s goal with its global vaccine distribution is essentially
to do what it failed to do with masks, ventilators, and tests in 2020—China wants to be the
country that ended other country’s epidemics.
Now, even though Western vaccines from Moderna and Pfizer have a 95% efficacy rating compared
to 50% to 83% in Chinese vaccines, those Western vaccines have order obligations taking up
their inventory until well into 2022.
However, that's not the case with certain Chinese vaccines, so some countries are making
the calculation that it's better to have less-effective vaccines sooner than the alternative.
Of course, for China, this is a major diplomacy coup—countries historically allied with
the West, such as Hungary and Mexico, are turning to China.
In their narrative, China is doing what the West cannot.
Of course they want this to continue, and even ramp up.
That’s why they’ve been sending their vaccines all around the world, for free.
Mongolia and Sri Lanka received 300,000 doses of the Sinopharm vaccine; Algeria, Sierra
Leone, and Zimbabwe—200,000; and Belarus, Equatorial Guinea, Gabon, Mozambique, Namibia,
and Bolivia—100,000.
Now, a couple hundred thousand doses isn’t going to end any of these country’s epidemics,
but it’s enough for clips of healthcare workers receiving Chinese-made and donated
vaccinations to make the evening news.
It’s also enough for each of these countries to see that these vaccines are acceptably
safe and effective, giving them little reason to not order more when China is offering them
months or years before the big Western manufacturers.
However, the fact that many of China’s vaccines are made and distributed by state-owned enterprises
has led many to wonder whether the country is choosing who gets these life-saving inoculations
based on diplomatic intentions.
It’s leading many to wonder whether who lives and who dies in this pandemic is starting
to be based on how friendly the country on a given person’s passport is to the People’s
Republic of China.
The answer to this question is not hard to find.
On the read-out of the call between Chinese State Councilor and Foreign Minister Wang
Yi and Algerian Foreign Minister Sabri Boukadoum, the Chinese official brought up Algeria’s
vote 50 years ago to switch Chinese representation at the UN from the Republic of China government,
now known as Taiwan, to the People’s Republic of China, which most now refer to as China.
In addition, the Chinese official noted Algeria’s participation in China’s Belt and Road infrastructure
development initiative, before announcing the country’s intention to donate 200,000
Sinopharm vaccine doses to Algeria.
Elsewhere, in South America, ten of its twelve countries have vaccinated their populations
with either purchased or donated Chinese vaccines.
The only two exceptions are Suriname—the lowest population country on the continent—and
Paraguay.
Now, Paraguay’s absence on the list of countries to have received Chinese vaccines is not tough
to figure out—it’s because of another list that they are on.
Paraguay is one of just 15 countries worldwide that recognizes Taiwan as an independent nation—something
that undermines China’s claims of the island.
In fact, there is zero overlap between the list of countries that recognize Taiwan and
those that have received Chinese COVID vaccines.
However, the cases of Algeria and Paraguay simply show China rewarding its allies, and
ignoring its foes.
This is not at all different from how the US, for example, has operated so far regarding
COVID vaccine donations—it’s sent them to strong allies like Mexico and Canada—although,
it’s quite possible that China is going beyond rewarding its key existing allies,
and using vaccines to try and form new ones.
Brazil and the US have gotten along rather well in recent years, especially over most
of the past four as Brazilian president Jair Bolsonaro is an open admirer of former US
president Donald Trump.
That meant that Brazil followed the US’ lead in banning the Chinese telecom giant
Huawei from playing a part in building out their 5G cell network infrastructure—purportedly
out of security concerns.
Therefore, it was a bit of a surprise when Brazilian communications minister Fábio Faria
took a trip to Beijing in February and met with Huawei executives.
According to Faria, he “took advantage of the trip to ask for vaccines, which is what
everyone is clamoring for.”
Soon after, he posted a letter on Twitter from the Chinese ambassador to Brazil which
noted the request, reading “during your visit to China, you expressed the desire to
continue to strengthen cooperation between our two countries regarding COVID-19 vaccines.
I give this matter great importance.”
A few weeks later, the Brazilian government announced the rules and structure for its
5G auction and, in a change of course, Huawei was now allowed to participate.
The company, in response to questions about this, didn’t even directly deny that a tit-for-tat
deal took place.
In a statement, they said that while they could not directly provide vaccines, they
could facilitate, “communication in an open and transparent manner in a topic involving
the two governments.”
While there’s no direct evidence of China trading vaccines for its foreign policy goals,
people are starting to pay more attention to situations like this, where countries are
opening the door for such an action, and China’s certainly not closing that door.
While its exact details might still be murky, it is clear that China is engaging in some
form of vaccine diplomacy.
This, however, presents a problem.
You see, one of the main advantages of mRNA vaccine technology—the kind used in Moderna
and Pfizer’s COVID vaccines—is that its relatively easy to manufacture.
Most other types of vaccines include an attenuated or dead version of the virus itself, or a
portion of it, but growing and then processing the virus itself is a time-consuming process
that is harder to scale.
Meanwhile, mRNA vaccines simply include the genetic instructions for the body to create
a harmless version of the Coronavirus’ spike protein which can train the immune system
to respond to it.
Done right, that means that mRNA vaccine production can be faster than that of attenuated or inactivated
virus, protein-based, or viral vector vaccines—the technologies that China's vaccines are based
on.
That means that, after a slow-to-scale manufacturing processes, priority order obligations to trial-hosting
countries, a robust program of vaccine diplomacy, and an insistence to only use Chinese-made
vaccines, that doesn’t leave a whole lot of Chinese COVID vaccines for China to use
for itself.
As of March, 2021, China has administered about 5 doses for every 100 citizens.
That’s compared to between 10 and 15 for every 100 in most EU countries, 35 for 100
in the US, and 42 for 100 in the UK.
Of course, with very few COVID cases within its borders, there is less of a pressing need
for vaccination in China, but the country’s entire foreign image goal during the pandemic
has been to be viewed as better than Europe or the US—it's to be viewed as the country
that, thanks to its remarkable economic transformation over the past decades, has caught up to Europe
or the US’ superpower status.
At present, estimates believe that China will attain widespread vaccination towards the
end of 2022—roughly the same time period as India, Iran, Egypt, Ethiopia, or Columbia.
By that time, assuming all goes to plan, most of the Western World will have been back to
normal for at least a year, as the era of border restrictions, snap lockdowns, and economic
uncertainty drags on in the People’s Republic.
That’s not the look the country wants both at home and abroad.
Now, none of this is to say that China’s vaccination practices necessarily are or are
not immoral or harmful or any other value judgement, but it is to say that the practices
are problematic for China itself.
People, both within the country’s borders are beyond, are going to wonder why doses
are going to foreign arms first, when Chinese citizens are still vulnerable; they're going
to wonder why China didn't use its newfound wealth to purchase more effective and faster-delivering
vaccines from foreign manufacturers; they're going to wonder why, when life is back to
normal in the West, the country that flouts itself as the conqueror of the Coronavirus
is still far from herd immunity.
This wonder will lead to conclusions, and without the narrative control that they so
desperately work to maintain, China’s foreign and domestic image might, once again, suffer
in what is, hopefully, COVID-19’s third and final act.
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