Since the outbreak of the pandemic, China has committed to making its COVID-19 vaccines a global public good. On multiple occasions, high-level Chinese officials have declared that China is fulfilling this pledge by exporting and donating its COVID-19 vaccines to as many countries that it can. This has generated a great deal of interest and discussion amongst experts from various fields. As an independent, mission-driven consultancy that tracks China’s impact on global health, Bridge Consulting aims to examine and offer a comprehensive picture of China’s vaccine outreach, hopefully enabling more informed discussions on this issue worldwide.
China’s Vaccines Across Regions
China has directly provided vaccines to four geographical regions – a total of 115 countries around the world. Out of these four regions, Asia Pacific has received the most significant number of Chinese vaccines, with 39 countries receiving vaccines from China. Latin America has received the second most considerable number of Chinese vaccines, though only 20 countries have received them. In contrast, while Africa has 46 countries receiving vaccines from China, the region has received few Chinese vaccines.
Top 10 Countries (Deliveries): Indonesia (255M), Iran (114M), Pakistan (100M), Brazil (95M), Philippines (60M), Morocco (45M), Myanmar (43M), Mexico (42M), Bangladesh (41M), Vietnam (37M)
Top 10 Countries (Sales): Indonesia (259M), Pakistan (121M), Iran (110M), Turkey (100M), Brazil (100M), Bangladesh (95M), Mexico (75M), Chile (61M), Philippines (55M), Morocco (50M)
Top 10 Countries (Pledged Donations): Cambodia (11M), Myanmar (9M), Nepal (8M), Laos (7M), Vietnam (7M), Bangladesh (5M), Sri Lanka (5M), Philippines (5M), Pakistan (3M), Afghanistan (3M)
CHINA’S VACCINES IN AFRICA
As part of the South-South Cooperation, China pledged in late February 2021 to provide COVID-19 vaccines to 19 African countries. Following the 8th FOCAC Ministerial Meeting that took place on 30 November 2021, China made a new pledge to provide 1 billion doses of vaccines to Africa, including 600 million doses as donation and 400 million doses to be provided through such means as joint production by Chinese companies and relevant African countries. To date, 46 African countries have been receiving vaccines from China. While the pace of these deals has picked up on several occasions, China’s total number of vaccines delivered to Africa has constantly remained low.
Out of the 136 million doses sold and 24 million pledged donations to Africa, China has delivered 116 million, of which 21 million have been donations. However, issues of affordability and accessibility are particularly critical for African countries with limited financial resources at their disposal. Alongside bilateral agreements, Africa has also been receiving vaccines through the COVAX initiative.
CHINA’S VACCINES IN LATIN AMERICA
Latin America has received the second-largest quantity of Chinese vaccines, despite only 20 countries having vaccine deals with China. Like Africa, Latin America and China are also working under the South-South Cooperation and the Belt and Road Initiative. While China has donated only 4 million doses to the region, it has sold 396 million doses, and to date, delivered 280 million doses. China also provides the region with active ingredients to make Chinese and other vaccines, such as the AstraZeneca vaccine.
Latin America plays an especially significant role to Chinese vaccine developer Sinovac, which has sold 230 million doses (out of 823 million doses sold globally) to 8 Latin American countries.
CHINA’S VACCINES IN ASIA
Asia has received the most significant number of Chinese vaccines out of all regions in donations and sales. Thus far, the continent has received delivery of 832 million doses, out of the 906 million sold and 88 million donated. 69 million of the delivered doses have been donations.
In recent months, there has been a shift in the perception of Chinese vaccines in the region as local cases surge despite healthcare workers and citizens being inoculated with these vaccines. These surges have been attributed to the rise of the Delta variant, which is more contagious. In light of this, some countries are considering administering booster shots or mixing Chinese vaccines with other vaccine brands to enhance immunity, especially for vulnerable populations like the elderly and frontline workers. In November 2021, President Xi also pledged an additional 150 million doses to be provided to the ASEAN bloc as well as $5 million to its COVID-19 response fund.
CHINA’S VACCINES IN EUROPE
As a region, Europe has received the fewest number of deliveries of Chinese vaccines. Thus far, only 53 million doses of Chinese vaccines have been delivered to 10 European countries, of which less than 2 million are donations. However, altogether China has sold 120 million doses to the region, most of which came from Turkey who penned a deal in November 2020 to buy 100 million doses of Sinovac. Turkey has redistributed doses via donations and sales to Bosnia and Herzegovina, Azerbaijan, Albania, and more.
One possible factor why Chinese vaccines are not widely used in European countries is because they have not yet received approval from the European Medicines Agency (EMA). The EMA is an agency of the European Union in charge of the evaluation and supervision of medicinal products. However, national medical regulators may authorize the vaccines for emergency use which some Central and Eastern European countries have done.
China’s Vaccines by Manufacturers
Sinopharm and Sinovac have been the two most prominent manufacturers of Chinese COVID-19 vaccines sold and donated worldwide. Sinovac remains the leading supplier of vaccine sales by China, having sold 823 million doses and supplied vaccines to 44 countries in total.
On the other hand, Sinopharm has been the leading supplier of vaccine donations from China, supplying vaccines to 77 countries.
SINOVAC – CORONAVAC COVID-19 VACCINE
On June 1, 2021, the World Health Organization officially listed the inactivated COVID-19 vaccine developed by Chinese biopharmaceutical company Sinovac Biotech Ltd. for emergency use. This is the second Chinese COVID-19 vaccine to receive this approval after the inactivated Sinopharm COVID-19 vaccine was approved for emergency use in May 2021. While there have been multiple studies on the efficacy of this vaccine in different countries, the WHO has stated that overall results have shown that the vaccine prevented symptomatic disease in 51% of those vaccinated and prevented severe COVID-19 and hospitalization in 100% of the studied population. Sinovac is the fastest-growing Chinese vaccine manufacturer in terms of production capacity expansion outside China (See 5. Overseas Manufacturers of Chinese Vaccines section).
In the past months, numerous publications and studies on the Sinovac vaccine have made the vaccine’s effectiveness the center of Chinese vaccine discussions worldwide. Different results from vaccine effectiveness studies in other countries, notably between Chile and Turkey, and rising infections in places that have mainly administered the Sinovac vaccine have fuelled the debate over the actual effectiveness of the Sinovac vaccine, especially against the Delta variant. In October, the WHO Strategic Advisory Group Experts on Immunization released interim recommendations stating that “For the Sinovac and Sinopharm inactivated vaccines, an additional (third) dose of the homologous vaccine should be offered to persons aged 60 and above as part of an extended primary series”.
SINOPHARM – BEIJING BIO-INSTITUTE OF BIOLOGICAL PRODUCTS CO-LTD. (BBIBP) COVID-19 VACCINE
On May 7, the World Health Organization officially listed the inactivated COVID-19 vaccine developed by Beijing Bio-Institute of Biological Products Co-Ltd. (BBIBP) under the China National Pharmaceutical Group Corporation (Sinopharm) for emergency use, marking a significant milestone as the first Chinese COVID-19 vaccine to receive this approval. The vaccine’s less stringent storage requirement and expanding production capacity within and outside China can help countries and international organizations resolve some of the urgent problems facing the current global vaccine supply.
While the Sinopharm vaccine has received fewer media coverage than the Sinovac vaccine, there are still debates over its effectiveness. In May 2021, a spike in COVID-19 cases in Seychelles, despite being the world’s most vaccinated nation, raised concerns about the Sinopharm vaccine. In addition, the accessibility and affordability of the Sinopharm’s vaccine in developing countries still needs to be addressed.