China is reportedly considering using a foreign vaccine as a booster shot for people who have been fully inoculated with Chinese vaccines such as Sinovac and Sinopharm.
According to Caixin, a respected Chinese financial magazine, drug regulators in China have completed an expert panel review of the booster vaccine jointly developed by China's Shanghai Fosun Pharmaceutical (Fosun Pharma) and German company BioNTech. The booster shot, Fosun-BioNTech COVID-19, is now in the administrative review stage.
The report came days after Thailand and Indonesia announced they would switch from doses made in China to Western vaccines.
For Beijing, which has been touting the effectiveness of its vaccines for months and donating and selling doses to low- and middle-income countries eager for protection in an effort often referred to as "vaccine diplomacy," the possibility of a booster shot may be seen as a blow.
"It is implicitly an admission that they are not doing well with their own vaccines," Steve Morrison told VOA Mandarin. Morrison is the senior vice president and director of the Global Health Policy Center at the Center for Strategic and International Studies (CSIS), a Washington think tank.
VOA Mandarin contacted the Chinese Embassy in Washington, D.C., and the Foreign Ministry in Beijing for further comment on the possibility of a booster for Chinese-made vaccines. Embassy staff referred VOA to the two companies as well as "competent authorities in China." VOA did as suggested but received no responses.
Dr. Amesh Adalja, an infectious disease physician at Johns Hopkins Bloomberg School of Public Health, told VOA Mandarin in a virtual online interview that although the data on the Chinese vaccines are not widely available and China has yet to publish its phase 3 data in a peer-reviewed journal, "We've anecdotally seen lower efficacy with Chinese-made vaccines, and that may be prompting the need for a booster."
Shih Shin-ru, director of the Research Center for Emerging Viral Infections and professor at the department of medical biotechnology and laboratory science at Chang Gung University in Taiwan, said a "good" vaccine should be safe and immunogenic (able to produce enough neutralizing antibody) and protect against real infection. At the start of developing any vaccine, scientists cannot know "how good" the vaccine in development might be, she said. But recently, as more studies have been conducted, scientists can correlate immunogenicity to protection rate, Shih added.
"Therefore, I think scientists in China also realized the fact of low antibody [levels] in the serum of Sinovac or Sinopharm vaccines. Therefore, they may suggest the Chinese government has another shot as a booster," Shih told VOA Mandarin in an email.
According to a World Health Organization study published early last month, in a large phase 3 trial in Brazil, two doses of the vaccine developed by Sinovac/China National Pharmaceutical Group, administered 14 days apart, had an efficacy rate of 51% against symptomatic SARS-CoV-2 infection, 100% against severe COVID-19 and 100% against hospitalization, with protection starting 14 days after the second dose.
Earlier this month, the American news outlet CNBC reported that of the six countries worldwide with the highest rates of inoculation, adjusted for population, five countries that relied on vaccines from China showed elevated weekly numbers of COVID-19 cases.
In contrast, real-world data gathered by Israel's Ministry of Health show that the Pfizer-BioNTech vaccine's effectiveness was at least 97% in preventing symptomatic disease, severe-to-critical disease and death, according to an article on Pfizer's website in March.
The Moderna COVID-19 vaccine had an efficacy rate of 94.1% after two doses, according to U.S. Centers for Disease Control and Prevention research published on January 1.
Earlier this month, however, as the delta variant caused an increase in Israel's number of COVID-19 cases, the Ministry of Health announced that the effectiveness of the Pfizer-BioNTech vaccine dropped to 64% against all coronavirus infections from about 95% in May. Israel has more than 852,940 confirmed cases, according to the Johns Hopkins University of Medicine Coronavirus Resource Center, and 6,450 deaths as of Tuesday.
Jin Dong-Yan, a professor at Hong Kong University's School of Biomedical Sciences, said in a phone interview with VOA Mandarin that the plummeting effectiveness of the Pfizer-BioNTech vaccine in the face of variants meant that Chinese vaccine efficacy could drop to well under 50% in preventing infections by new variants. This, he said, would make booster shots "imperative."
Jason Li, a research associate with the East Asia program at the Stimson Center in Washington, told VOA Mandarin in an email that "China's move [to consider a Pfizer booster] could be a positive sign against the worst fears of unproductive 'vaccine diplomacy' competition — at least from the Chinese side" and could indicate that "the Chinese authorities may be putting public health above politics, for now."
On June 2, Wang Wenbin, a spokesperson for China's Ministry of Foreign Affairs, said during a news conference that China had provided "more than 350 million doses of vaccines to the international community, including vaccine assistance to over 80 countries and vaccine exports to more than 40 countries."
China provided vaccines either by donation or sale to 102 countries in Africa, the Asia-Pacific region, Europe and Latin America, according to a vaccine tracker published by BridgeBeijing.com, a global health advocacy group affiliated with the New York-based Global Health Strategies group. In the Asia-Pacific region, 38 countries have received Chinese vaccines, and in Latin America, 19 countries. In Africa, 35 countries received vaccines from China, but the number of doses was the lowest.
China expert Ian Chong of the National University of Singapore told the BBC that Beijing's push to sell or donate vaccines worldwide had been "an effort to change the narrative away from the fact that infections were first detected in Wuhan, and to show that [China is] a scientific powerhouse."
Health experts expect those countries will need booster shots if China's plan moves forward.
Thailand, which has used Sinovac vaccines, is now experiencing new highs in cases and fatalities. In Indonesia, where cases are surging, less than 7% of the population of 271 million has been vaccinated, according to Johns Hopkins. Indonesia had placed one of the world's biggest orders for Sinovac vaccines, purchasing 125 million doses.
Both Asian nations will stop using Sinovac vaccines once supplies are depleted, a step Malaysia will also take, according to The Diplomat. The Philippines and Chile are researching the possibility of using the Fosun-BioNTech booster and vaccines that are not Chinese.
In Thailand, public anger over the government's handling of the pandemic and its use of Chinese vaccines prompted street protests in Bangkok on July 18, with people demanding that the government import Western vaccines.
Chong told the BBC that nations stopping the use of Chinese vaccines "in effect calls into question the technical prowess of China."
However, analysts don't see the gains from China's vaccine diplomacy being eliminated.
"At a time of scarcity and slow distribution of vaccines to the Global South, diplomatic relations between vaccine recipients and China will mostly remain appreciative," said Li, of the Stimson Center. "Front and center in China's initial vaccine diplomacy efforts was an emphasis on South-to-South 'brotherhood.' "
Morrison of CSIS said: "It certainly begins to erase the gains that were made diplomatically. I don't know that it hurts the gains entirely because, you know, the Chinese have been very generous with these vaccines."