Why vaccines donated by China would be less effective 4:03
(CNN)
- In Mongolia, hospitals are overwhelmed.
In the tiny Seychelles archipelago, more than 100 new cases of covid-19 are registered every day.
And in Chile, nationwide lockdown was lifted this week, but the country still reports thousands of cases a day.
What links these countries is that each of them has fully vaccinated more than 50% of its population, largely with coronavirus vaccines made in China, raising questions about the efficacy of the vaccines.
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If Chinese vaccines don't work, it's a big problem, and not just from a health perspective.
Beijing has staked its reputation on providing vaccines to other countries.
While western nations accumulated supplies for their own populations, China shipped vaccines abroad;
In June, the Foreign Ministry announced that the country had delivered more than 350 million doses of COVID-19 vaccine to more than 80 countries.
That mission highlighted insufficient Western efforts at a time when tensions were rising between China and many of the major democracies.
A healthcare worker in China prepares to administer a dose of the Sinopharm vaccine.
Questions about the efficacy of China's Sinopharm and Sinovac vaccines now jeopardize that diplomatic influence victory for Beijing, though Chinese Foreign Ministry spokesman Wang Wenbin has dismissed such criticism as "bias-motivated defamation. ».
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Experts say that while these Chinese vaccines may not be as effective as some, they are not failures.
No vaccine provides 100% protection against covid-19, so new cases are expected.
The crucial metric to measure success, they say, is preventing deaths and hospitalizations, not aiming for zero COVID-19 infections.
Why do vaccinated people get sick?
China has two vaccines authorized by the World Health Organization (WHO), for emergency use;
Sinopharm and Sinovac.
Both use inactivated viruses to elicit an immune response in the patient, a tried and tested vaccine method.
Now that it's proven effective against coronavirus, mRNA can do much more
Pfizer and Moderna, by contrast, use a newer technology called mRNA, which teaches cells in the body how to make a part of the coronavirus spike protein that triggers an immune response.
"If we want to reduce severe cases (and) the number of deaths, Sinopharm, Sinovac can help," said Professor Jin Dong-yan, a virologist at the University of Hong Kong.
So far, trials show that Sinopharm and Sinovac are less effective against COVID-19 than their mRNA counterparts. In Brazilian trials, Sinovac was approximately 50% effective against symptomatic COVID-19 and 100% effective against severe disease, according to trial data submitted to WHO. The efficacy of Sinopharm for both symptomatic and hospitalized disease was estimated at 79%, according to WHO.
Both the Pfizer / BioNTech and Moderna vaccines are more than 90% effective against symptomatic COVID-19.
Overall efficacy studies of the Johnson & Johnson vaccine showed it to be 66% effective against moderate to severe illness, 85% effective against severe illness, and 100% effective against death.
The trials were carried out at different times and in places where different variants were circulating.
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Experts say that the COVID-19 outbreaks in places that used Chinese vaccines are in line with their expected efficacy rates.
"If we want to reduce severe cases (and) the number of deaths, Sinopharm, Sinovac can help," said Jin Dong-yan, professor of molecular virology at the University of Hong Kong.
Ben Cowling, a professor of infectious disease epidemiology at the same university, said Chinese vaccines appeared to be limiting the number of serious infections and deaths.
"I think vaccines are certainly working and they are certainly saving a lot of lives," he said.
What is happening in Chile, Mongolia and Seychelles?
Chile reports thousands of new covid-19 cases every day.
There, 55% of the population is fully vaccinated, and among that group almost 80% received Sinovac.
But according to the Ministry of Health, 73% of the cases in the intensive care unit between June 17 and 23 were not fully vaccinated.
It's a similar situation in the Seychelles, where authorities said nearly all critical and serious COVID-19 cases occurred in people who had not been fully vaccinated.
The country uses Sinopharm in adults under the age of 60, while those over the age of 60 receive Covishield, AstraZeneca's vaccine made in India, which has a 76% efficacy rate against symptomatic COVID-19 and 100% efficacy against severe or critical covid-19.
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The Seychelles Ministry of Health said in a Facebook post last month that of the 63 people who had died from COVID-19 in the country at the time, three had been vaccinated with two doses.
All three were between 51 and 80 years old.
CNN has reached out to the Health Ministry for comment.
Mongolia has fully vaccinated 53% of its population, and 80% of those people received Sinopharm, according to Enkhsaihan Lkhagvasuren, head of public health policy implementation at the Ministry of Health.
One fifth of Mongolia's COVID-19 cases have been fully vaccinated, but 96% of COVID-19 deaths occurred in people who were not vaccinated or had received a single dose, Lkhagvasuren said.
To achieve herd immunity, Lkhagvasuren said that more than 80% of the population needed to be vaccinated.
The country of 3 million still has 1.6 million people vulnerable to covid-19, he said.
And he maintained that Sinopharm had been very effective.
“We cannot differentiate between vaccines against covid-19, saying that this is bad or the other is good.
All available vaccines reduce the risk of serious disease, ”Lkhagvasuren said.
Odgerel Chuluunbat, a business owner who is fully vaccinated in Mongolia's capital Ulaanbaatar, tested positive for COVID-19 two weeks ago and recovered at home, said she believed her infection could have been much worse without the Sinopharm vaccine. .
"I do not regret having received the injection," he said.
"Without her, the situation in the country would be very bad."
With vaccine shortages around the world, many developing countries had few other options.
Mongolia was assigned more than 112,000 doses of AstraZeneca and 126,000 doses of Pfizer through COVAX, but production problems and the outbreak in India have delayed deliveries.
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Why are vaccinated people dying?
Some people who get vaccinated with Sinovac or Sinopharm are dying of COVID-19, although these novel cases are possible with any vaccine.
In Indonesia, where the Red Cross warned this week that it is "on the brink of catastrophe," at least 88 doctors died of COVID-19 between February and June 26.
At least 20 were fully vaccinated with Sinovac, according to Dr. Adib Khumaidi, the head of the risk mitigation team at the Indonesian Medical Association.
Another 35 had not been vaccinated and 33 deaths are still under investigation.
An estimated 1,600 doctors in Indonesia were infected with COVID-19 in May and June alone, although it is unclear how many of them were vaccinated.
Medical personnel carry the body of a patient who died of covid-19 at a hospital in Bekasi on July 1, 2021.
Adib said that most medical workers died because they were in a unique circumstance: They were overwhelmed with patients, meaning they had to work long hours with little rest.
"According to our research data, the death of medical workers has nothing to do with the Sinovac vaccine," Adib said.
"The most important thing is to take the covid vaccine and people must follow health protocols."
Dr. Hermawan Saputra, an epidemiologist and member of the Indonesian Association of Public Health Experts, said that more aggressive strains of COVID-19 may have reduced the effectiveness of vaccines.
Indonesian President Joko Widodo received his first dose of the Sinovac vaccine in Jakarta on January 13.
The reason vaccinated people die from COVID-19 is not linked to Chinese vaccines.
A public health report from England published in June found that of 117 people who died within 28 days of testing positive for the Delta variant in the UK, 50 had received two doses.
But such deaths are rare, in total there were 92,029 positive cases of the delta variant, of which 58% of people were not vaccinated.
The UK uses the Moderna and Pfizer / BioNTech vaccines, which are mRNA vaccines, and Oxford / AstraZeneca, which uses a different technology.
In a Guardian article, statesmen David Spiegelhalter and Anthony Masters said that some deaths were expected due to good, but not perfect, vaccines.
Virologist Jin warned that there could be underlying problems in these severe cases.
Some hospitalized vaccinated people with COVID-19 could be immunosuppressed, meaning their body cannot produce a strong immune response, he said.
Have Chinese vaccines failed?
The Pfizer and Moderna vaccines appear to be more effective than Sinovac and Sinopharm in limiting transmission, but whether the two WHO-approved Chinese vaccines have failed depends on the metrics of success.
Jin said the efficacy of Chinese vaccines might not be high enough to stop the virus from circulating in a community, thus putting herd immunity out of reach.
That increases the risk of vaccine-resistant variants emerging.
"The end of the pandemic may be delayed or we may have to deal with these flu-like illnesses for a longer period of time," Jin said.
“(Sinovac, Sinopharm vaccines) are good, but not good enough.
We want the vaccine to help end the pandemic, and if that's the case, Pfizer and Moderna are doing a much better job. "
He said the makers of the Sinopharm and Sinovac vaccines have a responsibility to improve, which could just be a matter of increasing the dose or adding a third dose.
Sinovac vaccine boxes in Surabaya as part of Indonesia's vaccination campaign.
There are also signs that China may not be entirely reliant on homegrown vaccines in the future.
China's Shanghai Fosun Pharmaceutical said in a Hong Kong Stock Exchange presentation that it would work with BioNTech to produce up to 1 billion vaccines a year.
Pfizer and Moderna may reach more countries next year after manufacturing capacity is increased.
But right now, there is simply not enough for everyone.
Still, getting a Chinese vaccine is better than nothing, said Scott Rosenstein, director of the Eurasia Group's global health program.
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"In places where that is the only option, it is still the best decision to make it," he said.
And he's concerned that criticism of Chinese vaccines may encourage people to wait until more effective vaccines are available.
"That in itself creates challenges for implementation, it means that people are vaccinated more slowly," he said.
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How does politics influence this?
While Beijing exports vaccines around the world, the Asian country has promoted Sinopharm and Sinovac injections as "Chinese vaccines," linking them to the Chinese government in a way that is not seen in the United States or the United Kingdom.
After the WHO validated Sinovac and more data on the efficacy of Sinopharm was published in June, for example, state media Xinhua published an article with the headline: "Latest evidence reaffirms the benefits of Chinese vaccines for the world." .
When vaccines are successful, that is well reflected in the Communist Party of China, even though Sinovac is a privately owned company (Sinopharm is state-owned).
But because injections from China are often compared to "Chinese vaccines," when there are doubts about efficacy, it affects them all and also hurts the party.
No vaccine company has made the trial data public, allowing questions about efficacy to continue.
"The most I can say about those data is that these vaccines seem to work well," Rosenstein said.
"You're flying partially blind here because the gold standard is a random test, and we don't have much to work with for that."
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The lack of data has fueled skepticism.
Now case reports even among vaccinated people are causing a setback.
In Mongolia, where anti-China sentiment has long existed, partly thanks to the belief that neighboring China wants to undermine its sovereignty, many are frustrated by the rate of infections.
Gandi Boldbaatar, a 22-year-old student, said she had been fully vaccinated with Sinopharm for a month but tested positive for COVID-19 last week and is now in intensive care at a government hospital.
He said that he did not believe that Mongolia's vaccination campaign was very effective.
"Still I got seriously ill," he said.
"If I am given the option to vaccinate again with Sinopharm or any other vaccine, I will decline."
Part of the answer lies in the "political accounting" of vaccines, Rosenstein said.
When China's efforts began, Western countries were accused of hoarding vaccines.
Questions about the efficacy of the Chinese vaccine arose when the United States announced its own plans to donate millions of vaccines abroad.
Workers unload a shipment of Sinopharm vaccines in Ulaanbaatar, Mongolia, in February.
"It is too early to say there is a verdict," Rosenstein said.
"The downsides (of vaccine diplomacy) may have outweighed the silver lining… I think the goals of China's vaccine diplomacy are not being met right now."
But the big picture, Rosenstein said, is not about politics, it's about health.
"It is bad for public health to have so many political maneuvers rather than bona fide discussions about how best to control this outbreak."
Julia Hollingsworth wrote and reported from Hong Kong, with information from Saruul Enkhbold in Ulaanbaatar, Amy Sood and Sophie Jeong in Hong Kong, Yong Xiong in Seoul, Angus Watson in Sydney, David Culver in Beijing, and Cristopher Ulloa in Santiago.
coronavirusCovid-19 vaccines