China plans to mix COVID-19 vaccines to boost immunity

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COVID-19 vaccination site with slogan, "Timely vaccination to build the Great Wall of immunity together" In Beijing


The poster wasn’t the smartest marketing campaign, but it made its point: “Come get your eggs !!!”
Anyone over the age of 60 who received a COVID-19 vaccine at this Beijing community center would be entitled to two free boxes of eggs. The deal was part of a nationwide campaign to boost immunization rates in a country where successful pandemic containment has spurred complacency despite plentiful vaccine supplies.

Chinese authorities have set a target of vaccinating 40% of its 1.4 billion population by June. As of Wednesday, nearly 180 million doses had been administered, according to health officials, although the number of fully vaccinated people this represents is unknown.

To achieve their goal, authorities dispatched community-level workers across the country to knock on doors, broadcast calls over village loudspeakers, and provide benefits to those vaccinated.

Free eggs and park tickets are a common offer in Beijing. In a district of Shenzhen, companies donated 2,500 roast pigeon coupons and free soy milk to encourage people to roll up their sleeves. In another, patriotic films were shown to “warm the hearts” of those who were vaccinated.

One of the reasons for the slower initial vaccine rollout in China is its success in stopping the spread of the virus. China has only seen a handful of small outbreaks this year, all quickly contained thanks to severe lockdowns and quarantines. Most of the country has been living normally for months, with group gatherings, open schools and workplaces, and little sense of urgency around the vaccination.

At the same time, some skepticism has arisen around the effectiveness of Chinese vaccines, which, as part of Beijing’s vaccine diplomacy, have been sent to dozens of countries even though manufacturers have not released any public data on their final tests.

Experts from a World Health Organization advisory group recently said they saw data from Chinese companies Sinopharm and Sinovac that their vaccines meet WHO’s requirements for 50% efficacy and total harmlessness. The data was not made public, but Sinopharm claimed its vaccine was 79% effective, while Brazil, Turkey and Indonesia said trials of Sinovac in their countries showed efficacy of 50% to 83%.

On April 10, Gao Fu, head of the Chinese Center for Disease Control and Prevention, surprised some government officials when he told a medical conference that the efficacy of Chinese vaccines was “not high. And that it could be improved by adjusting the number of doses, changing the time between doses or mixing different types of vaccines.

He also said that mRNA vaccines – the type made in the United States by Pfizer-BioNTech and Moderna – have achieved remarkable levels of immunity and that China should not overlook such technology. It was a scientific observation that immediately became political. Gao was right in fact: Chinese vaccines are less effective than those produced by Pfizer-BioNTech and Moderna.

But to say so in China’s hyper-nationalistic environment, where vaccines have become a symbol of the country’s scientific prowess and global influence, was controversial. Chinese officials and state media have questioned the safety of foreign vaccines in recent months while promoting China’s offerings, despite the lack of transparency around their trial data.

Gao was soon quoted again in state-affiliated media, saying foreign reports of his admission that Chinese vaccines offer less protection were a “total misunderstanding.”

At the community vaccination site in Beixinqiao, a district in central Beijing, no one seemed to have heard of Gao’s statements or to have been discouraged from getting the vaccine.

“I believe our country will keep its people safe,” said Cui, 28, a woman who had just received her second vaccine and did not give her full name.

A volunteer named Qi Chao, 40, stood in the stairwell of the building, holding up QR codes that visitors could scan and register for their photos. They came in a steady stream: a young woman helping her bespectacled dad register on his cell phone, a street sweeper still in his uniform, a woman with a plastic bag of vegetables standing outside shouting questions to her friend upstairs before entering.

Some visitors had questions about their eligibility – a breastfeeding mother, an elderly woman with an arm injury, a man with high blood pressure – but there were few. Qi, the volunteer, said almost no one had asked him what vaccine he was receiving or inquired about its effectiveness.

“Either way, there is no difference between vaccines,” Qi said. “I don’t know how long it lasts, how it works, but of course it’s worth getting it and better to have it than not.”

Scientists agree.

“Having some protection is much better than having no protection,” said Keiji Fukuda, director of the School of Public Health at the University of Hong Kong. As COVID-19 continues to spread and mutate, it is likely that individuals will need additional vaccines regardless of which vaccine they are currently receiving, he said: “It is best to do so. vaccinate early with the approved vaccine available. “

Gao’s suggestion to mix vaccines – using different types that stimulate immune responses in different ways – is being seriously considered in several countries. Researchers at the University of Oxford are testing whether combinations of the Pfizer and AstraZeneca vaccines produce better immunity than either vaccine alone. Trials of combination of AstraZeneca with the Russian vaccine Sputnik V are also underway.

Scientists at China’s National Food and Drug Control Institutes experimented with vaccine combinations on mice and found that some produced a stronger immune response.

Gao, the head of the CDC, and researchers at the National Institutes for Food and Drug Control did not respond to requests for further comment from the Times. Official guidelines in China recommend using the same vaccine product for both injections. But it is possible that the “vaccine mix” paves the way for the use of foreign vaccines in China.

The Chinese company Fosun Pharma has entered into an agreement with BioNTech since last December to distribute 100 million doses of the mRNA vaccine that it has developed in collaboration with Pfizer. But mainland authorities have not approved the vaccine, despite its approval by the WHO and separate regulators in Hong Kong and Macao.

Clinical trials of the vaccine are underway, but it’s unclear whether China will approve it first or prioritize an mRNA vaccine made entirely in China.

The Wall Street Journal Chinese authorities reported on Friday to approve the BioNTech vaccine within the next 10 weeks, citing anonymous sources. But that depends in part on China’s overseas vaccine approvals, the Journal reported.

Choosing the vaccine is more complicated than simply comparing efficacy figures, said Sheng Ding, director of the Global Health Drug Discovery Institute, a joint venture between Tsinghua University and the Gates Foundation.

Even China’s low-potency vaccines have been shown to be helpful in preventing serious illness in those infected, he said. This is more important for individual protection, while more effective mRNA vaccines may work better to boost herd immunity. The cost of producing, transporting and storing different types of vaccines also influences the decisions of policy makers to use.

Political considerations of saving face shouldn’t come into play in a medical context, Ding said. Foreign drugs are widely used in China without politically sensitive implications, he said. Why should vaccines be different?

“At the end of the day, it’s about meeting people’s needs,” Ding said. After all, these are also political considerations.

Special Envoy Ziyu Yang of the Times Beijing office contributed to this report.

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