China's COVID-19 Vaccine Goes Global

China’s Xi Jinping has openly described his country’s coronavirus vaccine development and deployment efforts as a “global public good.” In May, the World Health Organization granted emergency approval for the COVID-19 vaccine developed by Chinese state-owned Sinopharm, a move that bolstered China’s goal of playing an active role in global inoculations. The Sinopharm vaccine is the first non-Western COVID-19 jab green lit for approval, joining vaccines from Pfizer/BioNTech, AstraZeneca/SK Bio, Serum Institute of India, Janssen, and Moderna on the WHO’s emergency use list.

“The addition of this vaccine has the potential to rapidly accelerate COVID-19 vaccine access for countries seeking to protect health workers and populations at risk,” said Dr. Mariangela Simao, WHO assistant-director general for access to health products. Meanwhile, the status of another Chinese vaccine, Sinovac, is pending, with the WHO technical advisory group awaiting additional information.

Emergency use listing from the global public health body serves as a signal to national regulators that a vaccine is both safe and effective, and is intended to pave the way for expedited approval by regulatory agencies from country to country. The green lighting of Sinopharm may also revitalize the COVAX program, launched to boost equitable access to vaccines. The COVAX scheme, designed to accelerate the development, manufacturing, distribution, and portfolio of vaccines, particularly to help middle and lower-income countries, has so far been challenged by supply problems. These supply issues have predominantly been linked to challenges in sourcing the raw materials necessary for large-scale vaccine manufacturing, as well as trade barriers (e.g. export controls).

Still, even before the WHO review of the Sinopharm and Sinovac vaccines, Chinese doses were widely used. Both of the coronavirus vaccines use inactivated viruses to prompt an immune response – a method that has long been used to create vaccines, including those that protect against polio, rabies, and hepatitis A. The Sinopharm and Sinovac vaccines have also both been in use for the general population in China since early 2021. As of mid-May, more than 390 million doses have been administered domestically in China, reaching 27.8 doses for every 100 people. According to data from China’s National Health Commission, inoculations in China have ramped up to vaccinate nearly 14 million people a day, bringing the country closer to meeting its target of vaccinating 40 percent of its population by the end of June.

As China scales up efforts at home, its coronavirus vaccines are also making their way abroad. The front-runner Chinese vaccines conducted Phase 3 trials in numerous countries and have now both been approved for use in dozens of countries. The Sinopharm vaccine carried out trials in Argentina, Bahrain, China, Egypt, Jordan, Peru, and the United Arab Emirates; Sinovac held trials in Brazil, Chile, China, Hong Kong, Indonesia, the Philippines, and Turkey. Other regulatory bodies are currently assessing the Chinese-developed Sinopharm vaccine. While the European Union’s agency reviews Chinese vaccines, as well as the Russian-developed Sputnik V, Hungary became the first EU member state to approve general use of the Sinopharm vaccine in February and has since reached one of the highest vaccination rates within the EU.

As Western-produced vaccines have been prioritized for domestic populations and the Serum Institute of India paused its vaccine deliveries amid the spike in India’s coronavirus outbreak, Chinese vaccines have started to step in to meet demand from countries in Africa, Asia, and Latin America. “China has become not just the largest exporter,” China expert and senior fellow for global health at the Council on Foreign Relations Yanzhong Huang told Fortune. “In many countries it has become the only option.”

Distribution is not the only global dimension of China’s vaccine efforts. The Chinese COVID-19 vaccines are also moving manufacturing offshore to local plants, with Sinopharm having agreements with the United Arab Emirates, Egypt, Serbia, and Bangladesh and Sinovac having licenses in Turkey, Indonesia, Brazil, Malaysia, and Egypt.

Combined, Sinopharm and Sinovac are said to be able to produce upward of 3 billion doses annually, a significant boost in capacity that would position them well for shipping doses to countries in need. (Pfizer and BioNTech also upped their capacity from 1.3 billion to 2.5 billion.) China has already exported around 240 million doses, and has pledged to provide another 500 million as part of its contributions to the global response to the pandemic.

More Chinese vaccines may quell shortages, but concerns regarding potency, efficacy, and data transparency remain. No official data has been released on Sinopharm but its efficacy at preventing symptomatic infections and hospitalizations is estimated to be 79 percent. Comparatively, Sinovac’s efficacy rates have been variable. In April, a study by the Chilean government found Sinovac’s vaccine 67 percent effective in preventing symptomatic infections. Meanwhile researchers in Brazil found Sinovac’s doses to have a 50.65 percent efficacy rate, compared to a Turkish study’s results of 91.25 percent. While these rates are lower than those found for Pfizer and Moderna, vaccine choice is a luxury resource constrained nations don’t have. In the UAE and Bahrain, authorities are offering a third booster dose of the Sinopharm vaccine for residents and citizens who received their second dose more than six months prior.

Even China’s own officials have signaled some degree of concern over vaccine efficacy. In April, during a conference presentation on Chinese COVID-19 vaccines and immunization strategies, China’s top disease control official Gao Fu said, “We will solve the issue that current vaccines don’t have very high protection rates.” Gao also suggested that mixing the vaccines may be a successful strategy to increase their effectiveness. However, Chinese media outlets and the country’s propaganda apparatus were quick to demonize international attention toward Gao’s remarks as part of a political attack to discredit Chinese vaccines. (Separately, Chinese commentary has challenged both the safety and effectiveness of Western COVID-19 vaccines developed using mRNA technology.)

Although China is likely to remain the largest source of vaccines in the world, recent moves by the United States will also diversify vaccine portfolios. Not only has the United States recently pledged to export its millions of AstraZeneca doses and ramp up production of the Pfizer, Moderna, and Johnson & Johnson vaccines, the Biden administration also backed waiving patent protections for COVID-19 vaccines, a move that if enacted would facilitate the sharing of intellectual property rights, paving the way for the production of generic vaccines around the world.

China’s vaccine diplomacy endeavors will undoubtedly help the country’s image as a more willing participant, and even leader, in public health global governance. But amid an ongoing pandemic that has shaken everything from economies to global supply chains to daily life, efforts to share protection from a fatal virus should not be seen purely through a lens of power politics.