China was the first country hit by the coronavirus, among the earliest to recover and the fastest to begin rolling out homegrown vaccines.

But its focus on exporting vaccine doses — partly because of their effectiveness as diplomatic currency — could prevent China from achieving herd immunity this year, leaving the country in a more drawn-out battle against virus flare-ups.

China’s approach contrasts with the United States and other Western nations, which have focused on achieving the 70 percent vaccination levels dubbed “herd immunity” at home first. The United States plans to reach that over the summer, with President Biden announcing this week the purchase of 200 million more doses, for a total 600 million.

The European Union also aims for herd immunity before autumn. Following AstraZeneca’s supply delays, the E.U. has threatened export controls if the company doesn’t prioritize deliveries to the bloc.

According to official forecasts, China will produce just about enough doses by the year’s end to cover 70 percent of its 1.4 billion people. But reaching that threshold this year would require keeping nearly all its projected 2 billion doses at home. China has instead shipped millions of doses to developing nations and pledged hundreds of millions more.

Zhang Yuntao, a senior executive at Sinopharm, one of China’s two major vaccine makers, said to state media this month that it would probably take “a year or two” to vaccinate 500 million people domestically. That would be 36 percent of the population.

Beijing officials have declined to say when China will reach herd immunity, and what proportion of its vaccine doses will be sold abroad.

“While fulfilling domestic demand, China will, within the scope of our powers, develop international vaccine cooperation in different ways with other countries, especially developing nations,” China’s Foreign Ministry said in a statement to The Washington Post.

China’s National Health Commission and the Chinese Center for Disease Control and Prevention did not immediately respond to requests for comment.

A ‘long waiting list’
That China is falling behind in domestic vaccination is counterintuitive, given its head start over the West. Hundreds of thousands of Chinese had received vaccinations by September, while the rollout did not begin in the United States and Britain until December.

Since then, China has slipped behind the United States, Britain and much of Europe in terms of shots per 100 people, because of its massive population and its overseas shipments. Its target of vaccinating 50 million essential workers by mid-February would cover less than 4 percent of its population; by that time, Britain aims to get at least a first dose to 15 million people, or about 22 percent of its population.

China Vaccine Industry Association President Feng Duojia told the state-run Xinhua News Agency this month that he expected China’s total vaccine output to exceed 1.8 billion doses by the end of this year. At two doses per person, that would cover nearly 1 billion people.

But China has committed to delivering half a billion doses to other countries, according to state media, with millions of doses flown in recent weeks to Turkey, Chile, Serbia and elsewhere. It’s unclear what proportion of Beijing’s pledged doses will arrive this year, with some agreements, such as Chile’s for 60 million doses of Sinovac’s vaccine, spanning multiple years.

“Everyone is trying to get higher on the list for China’s vaccines,” said a Beijing-based diplomat from one of the countries seeking Chinese vaccines, speaking on the condition of anonymity because he wasn’t authorized to comment publicly. “There is a long waiting list.”

On Monday, Brazilian President Jair Bolsonaro — long a harsh critic of China’s coronavirus vaccines — publicly thanked China for fast-tracking a delivery due to arrive within days. The shipment of active ingredients could produce 8.5 million shots, following 6 million doses sent earlier to Brazil, according to Chinese state media.

Peru has announced a deal to purchase 38 million doses from Sinopharm, with the country’s officials saying they hoped for quick delivery in coming months.

Beijing’s “vaccine diplomacy” has raised concerns from rivals. But China maintains it’s doing the humanitarian thing by not hoarding vaccine doses like wealthier nations.

“It is the right thing to do,” said Victor Gao, a former Chinese Foreign Ministry official, of Beijing’s strategy. “The motto is leaving no one behind.”

Much of the developing world will fall short of herd immunity in 2021, with the World Health Organization aiming for 20 percent coverage this year in its Covax program for low-income countries.

India — the only other nation with more than 1 billion people — has taken a page from China’s playbook, donating millions of doses to bolster diplomatic ties, even as its own vaccination drive remains in early stages.

Hunkering down
Meanwhile in China, officials are battening down the hatches against new outbreaks. Tens of millions of people are under renewed lockdown, more invasive testing has been introduced, and the quarantine period for travelers has extended from 14 to 21 days.

Next month will be Lunar New Year, China’s largest holiday. More than 3 billion trips are made on a usual year, as people take the rare opportunity to visit family across the country. But fewer than 1 in 25 Chinese people will be vaccinated by then, and officials are asking residents to spend the holiday, like last year, sheltering in place.

Unlike the United States and Britain, China did not roll out doses to the elderly in the first wave. Feng, the vaccine industry association president, told state media this month that vaccinations will be made available to people over 60 and under 18 after Phase 3 tests are complete for those groups.

“It shouldn’t take very long,” he said, without giving a time frame.

China’s first wave of vaccination covers an array of essential workers, including medical, delivery and food preparation workers, as well as government officials and those whose jobs or studies require international travel.

There has been little public pushback within China about the delayed rollout to the broader public, or the sale of vaccines to other countries. Then again, Beijing has strictly controlled the narrative, with some critics jailed after they criticized the government’s pandemic response.

As of Wednesday, about 23 million people in China had received doses, according to the National Health Commission.

Compounding China’s challenge is the lower efficacy of its vaccines. The Pfizer-BioNTech and Moderna vaccines have efficacy rates of about 95 percent, while Sinopharm’s is 79 percent and Sinovac’s was barely above 50 percent in its largest clinical trial in Brazil. That means a larger proportion of the population will need to be vaccinated to achieve herd immunity.

Ih-Jen Su, former director general of the Taiwan Centers for Disease Control, said it has been hard to gauge from the outside how many vaccine doses China really has.

“For China, what we know is limited, mainly because they haven’t handled it in an open and transparent way,” he said. “How much they can actually produce in the end is unclear.”

—By Eva Dou in The Washington Post, Jan. 29, 2021 at 3:30 p.m. GMT+5:30
https://www.washingtonpost.com/world/asia_pacific/vaccines-coronavirus-china-herd-immunity/2021/01/29/405d1070-5eb9-11eb-a177-7765f29a9524_story.html