China’s Covid vaccination programme beset by delay and reluctance

While China has pledged to ship hundreds of millions of vaccines abroad, domestically the rollout of inoculations has been slow, raising concerns that restrictions on international travel will remain until at least next year.

China was the first country to begin Covid-19 vaccinations in July and had administered 40.5m doses by early February, the highest number of injections behind the US. But at 2.9 doses per 100 residents, it is far behind other big economies and the levels needed to form herd immunity in the population. It has only given four-fifths of the vaccinations it had hoped to achieve by this point.

In some ways China’s vaccination programme has been a victim of the success of its containment policies. Rapid interventions last year brought the pandemic under control and saw case numbers tumble, reducing the incentive to get vaccinated.

At the same time, the failure of vaccine manufacturers Sinopharm, Sinovac and CanSino to release comprehensive trial data has damaged confidence among some medical professionals, while many Chinese citizens are choosing to see first whether the vaccinations provoke unwanted side effects for others.

“In China today there is very little upside for anyone to take the vaccine,” said Chen Long, partner at Beijing-based research company Plenum. “What that all means is a very slow opening of borders.”

Chinese nationals who travel must quarantine for 14 days when they return, regardless of whether they have been vaccinated. Borders have been almost completely closed to foreign nationals since March 2020, with exceptions made only for some diplomats and a handful of business executives.

Global pollster Ipsos found that 85 per cent of Chinese people intend to get vaccinated, putting them among the world’s most willing. But the study did not ask the participations when. A survey of mostly urban professionals by Beijing-based market research firm Gavekal Dragonomics found that of 307 respondents, some of whom had not yet been offered the jab, more than half did not plan to join the current round of vaccinations.

As in some other countries, including Germany and parts of the US, vaccine hesitancy in China appears particularly high among health professionals. A survey published in February by a Chinese medical journal showed that medical workers are unlikely to want vaccinations: out of 756 medical workers in Zhejiang province, only 28 per cent were ready to get jabs.

For both the Gavekal and medical workers’ surveys, the most common reason to refrain from vaccination was fear of side-effects. Medical workers were also concerned about possible low efficacy, while both groups said they thought they did not need vaccination since the local risk of infection was so low.

“Initially, we know so little about the vaccine, and there’s a lack of evidence to support its safety and efficacy. Plus, the situation in Beijing has been well under control for a while,” said a Beijing-based doctor who asked to remain anonymous.

The doctor estimated that roughly a fifth of her hospital colleagues had not been vaccinated, though in many cases it was because their health status, such as taking other medication or attempting to get pregnant, had ruled them out.

Age restrictions on the use of the Sinopharm and Sinovac shots have also slowed the rollout. Both vaccines are recommended only for people in good health aged 18 to 59, which automatically excludes those who would most want a jab. Instead the government has focused on vaccinating those likely to spread the virus, such as taxi drivers.

At this rate, analysts estimate it will take well into 2022 to vaccinate most of the population.

Since January, Beijing’s city government has extended its vaccination campaign to more residential areas, sending texts to residents to encourage them to sign up.

Compulsory vaccinations have been enforced by some state-owned enterprises. In some parts of Beijing, local urban management officers have asked bar staff either to get vaccinated or be tested every week. The municipal government has also made vaccination mandatory for cab drivers.

Sinopharm and Sinovac together said they would have capacity to produce 2bn vaccines by the end of the year. Whether they achieve that target is uncertain: Sinovac is producing at a daily rate well below its stated capacity.

The manufacturers also face a shortage of glass vials to store vaccines, which are mostly imported. Supply is particularly constrained since the Sinopharm vaccine uses a single-dose vial. In contrast, each vial of BioNTech/Pfizer’s vaccine contains six doses, while a vial of Oxford/AstraZeneca’s vaccine contain 10 doses.

Sinopharm and Sinovac also have to balance domestic demand with their global commitments. China’s foreign ministry has pledged 10m doses to the global vaccination programme Covax, which will mainly supply low-income countries. In addition, Chinese vaccine makers have pledged more than 500m doses in bilateral deals and delivered approximately 21m doses, according to Gavekal.

But help is on the way. Before February 6, when Sinovac’s jab was approved, only a single vaccine developed by Sinopharm had been authorised for general use. Two additional candidates, one made by CanSino and a second shot from Sinopharm, were approved on Thursday bringing the total number of available vaccines to four.

Additional reporting by Nian Liu, Xueqiao Wang, and Christian Shepherd