China’s COVID-19 vaccine drive is falling behind the U.S. and Europe

China quelled the coronavirus by deploying its authoritarian system to get things done: from building hospitals in days, to blitz-testing entire cities and basically sealing off its vast border.

So when it came time to roll out its homegrown COVID-19 vaccines, the world expected an inoculation effort of similar speed and ferocity, with the potential to again cast Western governments in a poor light.

But seven weeks into China’s campaign, the picture is surprisingly underwhelming. The more than 31.2 million doses administered since its official start date of Dec. 15 put it second only to the U.S., with its nearly 35 million shots. Yet for a population of 1.4 billion, China has delivered a little more than two doses for every 100 people, compared to three in the European Union, 10 in the U.S. and nearly 60 in Israel, according to Bloomberg’s vaccine tracker.

The effort is also appearing to fall short of an internal target of vaccinating 50 million people by the Chinese New Year holiday that starts Feb. 11, raising questions over whether the world’s second-biggest economy could remain shuttered as the rest of the planet — emboldened by herd immunity — starts to open up.

“We expected them to pull it off as long as the government is willing to enforce it through the top-down mobilization that we know it has done in the past,” said Huang Yanzhong, director of the Center for Global Health Studies at New Jersey’s Seton Hall University. “Now it seems we’ve been optimistic.”

China’s lack of momentum isn’t being caused by the distribution hiccups or production shortfalls seen in places like Europe, with vaccines being rolled out at more than 25,000 sites, including re-purposed stadiums, museums and community centers. It’s also been giving out some shots under emergency authorization since mid-2020.

Vaccines made by local developers Sinovac Biotech Ltd. and Sinopharm’s China National Biotec Group Co. can also be easily stored at refrigerator temperatures for over a year, avoiding the logistical challenges of the high-tech mRNA vaccines used in the U.S., which need to be kept in deep freeze and risk spoiling if thawed too early.

Instead, the slowness appears to be due to widespread hesitation across the Chinese population, for reasons ranging from concern over the safety and level of protection promised by the local vaccines, to a lack of urgency, with COVID-19 largely confined to winter flareups in parts of the north. That could pose a problem for nations and companies that need China — with its more than 1 million overseas students and world-leading consumer market — to open up, and for the country’s own growth outlook, despite its resilience thus far.

At current vaccinating speeds, China will reach herd immunity only in 5.5 years, compared to 11 months for the U.S. and six months for the U.K., according to Bloomberg’s tracker.

“If vaccination is not ramped up, this could further delay the opening of China’s borders and weigh on economic growth in the coming years, since it will keep the frequency and intensity of COVID-19 outbreaks and government restrictions higher than necessary,” said Louis Kuijs, head of Asia economics at Oxford Economics in Hong Kong. He expects China to accelerate its rollout at some point, mindful of any potential disadvantage.

But unlike with testing, traveler quarantines and lockdowns, Chinese officials don’t seem to be forcing the issue — for now.

Vaccination remains voluntary, even for key groups like medical workers. While other world leaders roll up their sleeves to get COVID-19 vaccines for the cameras, it’s unclear whether China’s — including President Xi Jinping — have received shots that have been given to port workers and state-company employees headed overseas since mid-2020.

Tasked with gauging demand for vaccines among their workers, Chinese firms Bloomberg spoke to reported interest ranging from a third to less than half of their employees.

Anne Zhu, an office clerk at a state-owned airline in Wuxi, Jiangsu province, said she got a shot because some flight attendants prioritized for vaccines didn’t want them, pushing administrative staff up the queue. Zhu said just 13% of the airline’s 1,200 employees at the Wuxi branch have been vaccinated, citing internal information. This will go up to a third when another batch of staff get shots over the coming weekend.

At the Shanghai American School, social studies teacher Kirk Irwin said only about 30% of school faculty, which includes both Chinese citizens and foreigners, got Sinovac’s vaccine when it was offered.

“Some people were thinking, if I can get it in April or May then I’ll wait, because everybody feels pretty safe in Shanghai and nobody is traveling overseas,” said Irwin, who is originally from Canada.

China’s vaccine developers have been criticized for their lack of transparency on the safety and effectiveness of their shots, releasing less data than their western counterparts. That’s fueled skepticism in countries like Pakistan and Indonesia that have vaccine deals with China. As in other countries, medical workers in China are also concerned about being guinea pigs for the first vaccines.

Sophia Qu, a doctor at a hospital in Guangdong province, southern China, didn’t take up the vaccine offer because she’s worried about negative side effects. Fewer than half her colleagues got vaccinated, she said.

Some in China would also rather wait for a foreign-made vaccine, given past scandals over shoddy Chinese-made shots.

Jason, a graduate student in Beijing who only wanted to use his first name, said he would wait for the Pfizer Inc. vaccine to be approved in China, with drugmaker Shanghai Fosun Pharmaceutical Group Co. licensed to distribute it. He’s concerned the locally developed vaccines don’t provide the same level of protection as the mRNA ones, with ongoing uncertainty over their true efficacy rates, given spotty and conflicting disclosures.

Also contributing to the lower-than-expected uptake is China’s decision to limit shots only to those aged 18 to 59, leaving out nearly a fifth of the population that’s over 60, in contrast to the approach in the U.S. and places like Norway, which are prioritizing nursing home residents.

Given its containment success, China has a very low level of immunity from people contracting the virus, meaning it is more reliant than countries like the U.S. on vaccination to protect its people, especially if it wants to re-open its borders and allow citizens to travel freely again.

At the current pace of vaccination, international travel would need to be limited for years, said Nicholas Thomas, an associate professor in health security at the City University of Hong Kong.

While China’s zero-tolerance strategy for snuffing out the coronavirus has been validated by the results, that success risks being discounted if the country can’t keep up on vaccination, said Huang at Seton Hall.

“The West has done a very poor job of containing the virus but if they attain herd immunity ahead of China, it will send a strong message,” he said. “If the West begins to lift lockdowns and open to each other, it will pose a big challenge to that China model.”