TAIPEI, Taiwan -- The plane laden with vaccines had just rolled to a stop at Santiago’s airport in late January, and Chile’s president, Sebastián Piñera, was beaming. “Today,” he said, “is a day of joy, emotion and hope.”
The source of that hope: China – a country that Chile and dozens of other nations are depending on to help rescue them from the COVID-19 pandemic.
China’s vaccine diplomacy campaign has been a surprising success: It has pledged roughly half a billion doses of its vaccines to more than 45 countries, according to a country-by-country tally by The Associated Press. With just four of China’s many vaccine makers claiming they are able to produce at least 2.6 billion doses this year, a large part of the world’s population will end up inoculated not with the fancy Western vaccines boasting headline-grabbing efficacy rates, but with China’s humble, traditionally made shots.
Amid a dearth of public data on China’s vaccines, hesitations over their efficacy and safety are still pervasive in the countries depending on them, along with concerns about what China might want in return for deliveries. Nonetheless, inoculations with Chinese vaccines already have begun in more than 25 countries, and the Chinese shots have been delivered to another 11, according to the AP tally, based on independent reporting in those countries along with government and company announcements.
It’s a potential face-saving coup for China, which has been determined to transform itself from an object of mistrust over its initial mishandling of the COVID-19 outbreak to a savior. Like India and Russia, China is trying to build goodwill, and has pledged roughly 10 times more vaccines abroad than it has distributed at home.
“We’re seeing certainly real-time vaccine diplomacy start to play out, with China in the lead in terms of being able to manufacture vaccines within China and make them available to others,” said Krishna Udayakumar, founding director of the Duke Global Health Innovation Center at Duke University. “Some of them donated, some of them sold, and some of them sold with debt financing associated with it.”
China has said it is supplying “vaccine aid” to 53 countries and exports to 27, but it rejected a request by the AP for the list. Beijing has also denied vaccine diplomacy, and a Ministry of Foreign Affairs spokesperson said China considered the vaccine a “global public good.” Chinese experts reject any connection between the export of its vaccines and the revamping of its image.
“I don’t see any linkage there,” said Wang Huiyao, president of the Centre for China and Globalization, a Beijing think tank. “China should do more to help other countries, because it’s doing well.”
China has targeted the low- and middle-income countries largely left behind as rich nations scooped up most of the pricey vaccines produced by the likes of Pfizer and Moderna. And despite a few delays of its own in Brazil and Turkey, China has largely capitalized on slower-than-hoped-for deliveries by U.S. and European vaccine makers.
Like many other countries, Chile received far fewer doses of the Pfizer vaccine than first promised. In the month after its vaccination program began in late December, only around 150,000 of the 10 million Pfizer doses the South American country ordered arrived.
It wasn’t until Chinese company Sinovac Biotech Ltd. swooped in with 4 million doses in late January that Chile began inoculating its population of 19 million with impressive speed. The country now has the fifth highest vaccination rate per capita in the world, according to Oxford University.
Chilean Vilma Ortiz got her Sinovac shot at a school in Santiago’s Nunoa neighborhood, along with about 60 other people. Although she considers herself “kind of a skeptical person,” she said she researched the Chinese vaccines on the Internet and was satisfied.
“I have a lot of faith and confidence in the vaccine,” she said.
In Jakarta, the sports stadium was abuzz as masked healthcare workers filed in to receive their Sinovac shot. Wandering the rows of vaccination stations was Indonesian President Joko Widodo, the first person in the Southeast Asian country to get the Chinese shot, 140 million doses of which he has ordered for his people.
Among those at the stadium was Susi Monica, an intern doctor receiving her second dose. Despite questions over its efficacy, getting the shot was worth it to her, particularly because she didn’t have any adverse reactions to the first dose.
Besides, she said, “Do I have another choice right now?”
The choices are limited for Indonesia and many other low- and middle-income countries clobbered by COVID. Vaccine deployment globally has been dominated by wealthier countries, which have snapped up 5.8 billion of the 8.2 billion doses purchased worldwide, according to Duke University.
China’s vaccines, which can be stored in standard refrigerators, are attractive to countries like Indonesia, a sweltering nation that straddles the equator and could struggle to accommodate the ultracold storage needs of vaccines like Pfizer’s.
The bulk of Chinese shots are from Sinovac and Sinopharm, which both rely on a traditional technology called an inactivated virus vaccine, based on cultivating batches of the virus and then killing it. Some countries view it as safer than the newer, less-proven technology used by some Western competitors that targets the coronavirus’ spike protein, despite publicly available safety data for the Pfizer, Moderna and AstraZeneca vaccines and none for China’s.
“The choice was made for this vaccine because it is developed on a traditional and safe inactivated platform,” said Teymur Musayev, an official with the Ministry of Health in Azerbaijan, which has ordered 4 million Sinovac doses.
In Europe, China is providing the vaccine to countries such as Serbia and Hungary -- a significant geopolitical victory in Central Europe and the Balkans, where the West, China and Russia are competing for political and economic influence. This stretch of Europe has offered fertile ground for China to strengthen bilateral ties with Serbia and Hungary’s populist leaders, who often criticize the EU.
Serbia became the first country in Europe to start inoculating its population with China’s vaccines in January. The country has so far purchased 1.5 million doses of Sinopharm’s vaccine, which makes up the majority of the country’s supply, and smaller amounts of Russia’s Sputnik V and Pfizer’s vaccines.
Donning heavy coats against the winter chill, masked-up Serbians have been waiting in long lines for their turn to get the vaccine.
“They have been vaccinating their own people for (a) long period, I assume they have more experience,” Natasa Stermenski, a Belgrade resident, said of her choice to get the Chinese shot at a vaccination center in February.
Neighboring Hungary, impatient over delays in the European Union, soon became the first country in the EU to approve the same Chinese vaccine. On Sunday, Hungarian Prime Minister Viktor Orban got the Sinopharm shot, after recently saying he trusted the Chinese vaccine the most.
Many leaders have publicly supported the Chinese shots to allay concerns. Early on, “people had all these microchip theories in their heads, genetic modification, sterilization, running around on social media platforms,” said Sanjeev Pugazhendi, a medical officer in the Indian Ocean island nation of the Seychelles, whose president recently received a Sinopharm shot on camera. “But the moment we started giving out the vaccines to leaders, religious leaders and health workers, that started to subside.”
Beijing’s vaccine diplomacy efforts are good for both China and the developing world, experts say.
“Because of the competition for influence, the poor countries can get earlier access for vaccines,” said Yun Jiang, managing editor of the China Story Blog at the Australian National University. “Of course, that’s assuming that all the vaccines are safe and delivered in the right way.”
China’s vaccine diplomacy will only be as good as the vaccines it is offering, and it still faces hurdles.
Ahmed Hamdan Zayed, a nurse in Egypt, was reluctant to receive a vaccine, especially a Chinese one. The frontline health worker would be among the first in the country to get Sinopharm’s shot as part of a mass vaccination campaign. Over 9 million Sinopharm shots have been given outside China.
“We had concerns about vaccines in general,” the 27-year-old father of two said in a phone interview from the Abu Khalifa hospital in the northeastern part of the country. “The Chinese vaccine, in particular, there was insufficient data available compared to other vaccines.”
But Zayed ultimately decided to get the shot after conducting more research. A doctor at his hospital called colleagues in the United Arab Emirates, which had approved the same shot, and they met with Egyptian health officials.
Sinopharm, which said its vaccine was 79% effective based on interim data from clinical trials, did not respond to requests for an interview. Sinopharm’s chairman has said they have not had a single severe adverse event in response to their vaccine.
Chinese vaccine companies have been “slow and spotty” in releasing their trial data, compared to companies like Pfizer and Moderna, said Yanzhong Huang, a global health expert at the U.S. think tank Council for Foreign Relations. None of China’s three vaccine candidates used globally have publicly released their late-stage clinical trial data. CanSino, another Chinese company with a one-shot vaccine that it says is 65% effective, declined to be interviewed.
China’s pharmaceutical business practices also have raised concerns. In 2018, it emerged that one of China’s biggest vaccine companies falsified data to sell its rabies vaccines. That same year, news broke that a Sinopharm subsidiary, which is behind one of the COVID-19 vaccines now, had made substandard diphtheria vaccines used in mandatory immunizations.
With Chinese vaccines, “for a lot of people, the first thing you think about is ‘Made in China,’ and that doesn’t give you much assurance,” said Joy Zhang, a professor at the University of Kent in the UK who studies the ethics of emerging science.
Russia and India have faced similar skepticism, partly because people have less trust in products made outside the Western world, said Sayedur Rahman, head of the pharmacology department at Bangabandhu Sheikh Mujib Medical University in Bangladesh.
“China, India, Russia, Cuba, whenever they develop a vaccine or conduct research, their data is questioned, and people say their process is not transparent,” he said.
A December YouGov poll of 19,000 people in 17 countries and regions on how they felt about different vaccines found that China’s received the second-lowest score, tied with India’s. In the Philippines, which has ordered 25 million Sinovac doses, less than 20% of those surveyed by a research group expressed confidence in China’s vaccines.
Those concerns have been exacerbated by confusion around the efficacy of Sinovac’s shot. In Turkey, where Sinovac conducted part of its efficacy trials, officials have said the vaccine was 91% effective. However, in Brazil, officials revised the efficacy rate in late-stage clinical trials from 78% to just over 50% after including mild infections.
A senior Chinese official said Brazil’s numbers were lower because its volunteers were healthcare workers who faced a higher risk of infection. But other medical experts have said exposure would not affect a vaccine’s effectiveness.
Sinovac’s trials were conducted separately in Turkey and Brazil, and the differences in efficacy rates arise from differences in the populations, a spokesman for the company said in a previous interview with the AP. The company declined to be interviewed for this article. An expert panel in Hong Kong assessed the efficacy of the vaccine at about 51%, and the city approved its use in mid-February.
Globally, public health officials have said any vaccine that is at least 50% effective is useful. International scientists are anxious to see results from final-stage testing published in a peer-reviewed science journal for all three Chinese companies.
It’s also unclear how the Chinese shots work against new strains of the virus that are emerging, especially a variant first identified in South Africa. For example, Sinopharm has pledged 800,000 shots to South Africa’s neighbor, Zimbabwe.
There are concerns among receiving countries that China’s vaccine diplomacy may come at a cost, which China has denied. In the Philippines, where Beijing is donating 600,000 vaccines, a senior diplomat said China’s Foreign Minister, Wang Yi, gave a subtle message to tone down public criticism of growing Chinese assertiveness in the disputed South China Sea.
The senior diplomat said Wang did not ask for anything in exchange for vaccines, but it was clear he wanted “friendly exchanges in public, like control your megaphone diplomacy a little.” The diplomat spoke on condition of anonymity to discuss the issue publicly.
Philippine President Rodrigo Duterte publicly said in a news conference on Sunday that China did not ask for anything, as the donations were flown in.
Meanwhile, opposition legislators in Turkey are accusing Ankara’s leaders of secretly selling out Uyghurs to China in exchange for vaccines after a recent shipment delay. The legislators and the Uyghur diaspora community fear Beijing is trying to win passage of an extradition treaty that could see more Uyghurs deported to China.
Despite all the worries, the pandemic’s urgency has largely superseded hesitations over China’s vaccines.
“Vaccines, particularly those made in the West, are reserved for rich countries,” said one Egyptian official, who spoke on condition of anonymity to discuss the matter. “We had to guarantee a vaccine. Any vaccine.”
Gelineau reported from Sydney.
Associated Press researcher Chen Si in Shanghai, and AP reporters Patricia Luna in Santiago, Chile; Sam Magdy in Cairo; Jim Gomez in Manila, Philippines; Niniek Karmini in Jakarta, Indonesia; Aida Sultanova in London; Justin Spike in Budapest, Hungary; Dusan Stojanovic in Belgrade, Serbia; Cara Anna in Nairobi, Kenya; Allen G. Breed in Raleigh, North Carolina; and Diane Jeantet in Rio de Janeiro contributed to this report.