POST 152. April 15, 2021. CORONAVIRUS. “The Chinese Center for Disease Control and Prevention’s director said Saturday authorities are considering mixing COVID-19 vaccines because the country’s domestically made doses “don’t have very high protection rates,”

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“Why it matters: The remarks by the Gao Fu at a news conference in the southwestern city of Chengdumark mark the first time a Chinese health official has spoken publicly about the low efficacy of vaccines made in China.

China has sent millions of doses of its coronavirus vaccine around the world.

Driving the news: Gao said officials were looking at two options designed “to solve the problem that the efficacy of … existing vaccines is not high,” according to the South China Morning Post.

One is mixing vaccines, known as “sequential immunization,” and the other is to “adjust the dosage, the interval between doses or increase the number of doses,” the SCMP reports… 

The big picture: China’s government has only approved locally made vaccines for use against the virus.

Sinopharm announced just before its coronavirus vaccine was approved for use late last year that its vaccine was 79.3% effective, though experts said important data was missing.

China’s health regulator approved Sinovac’s vaccine last February. Several phase 3 trials in Brazil, Turkey and Indonesia have shown efficacy rates of 50.38% to 91.25%, Axios’ Shawna Chen notes.”  (A)

“Chinese vaccines “don’t have very high protection rates,” said the director of the China Centers for Disease Control, Gao Fu, at a conference Saturday in the southwestern city of Chengdu.

Beijing has distributed hundreds of millions of doses abroad while trying to promote doubt about the effectiveness of the Pfizer-BioNTech vaccine made using the previously experimental messenger RNA, or mRNA, process.

“It’s now under formal consideration whether we should use different vaccines from different technical lines for the immunization process,” Gao said…

Experts say mixing vaccines, or sequential immunization, might boost effectiveness. Researchers in Britain are studying a possible combination of Pfizer-BioNTech and the traditional AstraZeneca vaccine.” (B)

“Everyone should consider the benefits mRNA vaccines can bring for humanity,” Gao said. “We must follow it carefully and not ignore it just because we already have several types of vaccines already.”

Gao previously questioned the safety of mRNA vaccines. He was quoted by the official Xinhua News Agency as saying in December he couldn’t rule out negative side effects because they were being used for the first time on healthy people, saying “there is a safety concern.”

Chinese state media and popular health and science blogs also questioned the safety and effectiveness of the Pfizer-BioNTech vaccine, though large-scale trials and the rollout of the vaccines in the U.S. have established its safety.

China currently has five vaccines in use in its mass immunization campaign, three inactivated-virus vaccines from Sinovac and Sinopharm, a one-shot vaccine from CanSino, and the last from Gao’s team in partnership with Anhui Zhifei Longcom.

The effectiveness of the vaccines range from just over 50% to 79%, based on what the companies have said.

The shot from Gao’s team, was given emergency use approval a month ago, and has not publicly disclosed data yet about its efficacy.

Pfizer and Moderna’s vaccines, which are primarily being used in developed countries, have both been shown to be about 95% in protecting against COVID-19 in studies…

Vaccines made by Sinovac, a private company, and Sinopharm, a state-owned firm, have made up the majority of Chinese vaccines distributed to several dozen countries including Mexico, Turkey, Indonesia, Hungary, Brazil and Turkey.

However, the companies have not publicly published peer-reviewed data on the final stage clinical trial research and been criticized for a lack of transparency.

Sinovac’s vaccine, for example, raised concerns when it was found to have different efficacy rates from each of the trials it conducted in different countries, ranging from around 50% to over 83%.

A Sinovac spokesman, Liu Peicheng, acknowledged varying levels of effectiveness have been found but said that can be due to the age of people in a study, the strain of virus and other factors.

Beijing has yet to approve any foreign vaccines for use in mainland China.

The Sinovac spokesman, Liu, said studies find protection “may be better” if time between vaccinations is longer than the current 14 days but gave no indication that might be made standard practice.” (C)

“At the time of writing, no phase III trial data for any of the Chinese vaccine candidates have been published in a peer reviewed journal. CanSinoBIO has said it intends to but has given no timeframe…

Which of China’s vaccines have been approved outside of China?

Sinopharm’s first vaccine has received the most emergency use approvals so far, nearly 30, including in Bahrain, Guyana, Hungary, Serbia, and the UAE. Hungary was the first EU country to approve use of a Chinese vaccine, with Prime Minister Viktor Orbán among those who have received it.

Several countries have approved Sinovac’s CoronaVac jab for emergency use, including Brazil, Chile (where the vaccine has been trialled), Indonesia, Laos, Mexico, and Turkey.

Mexico and Pakistan have given emergency use approval to the CanSinoBIO vaccine.

The Anhui Zhifei Longcom vaccine has received approval for use in Uzbekistan.

Which cuntries have received Chinese vaccines?

Chinese firms have appeared keen to supply countries with plenty of doses of their vaccines, beyond those merely required to carry out clinical trials. For example, 223 million doses of Sinopharm jabs have already been distributed to various countries around the world. In some countries, the value of deals remains undisclosed but the New York Times reported that Hungary paid $36 per dose for the Sinopharm jab.21 In Senegal, a lower price was achieved22—just $19 per dose in a deal supplying 200 000 Sinopharm doses to the African country.”  (D)

“As potentially more dangerous coronavirus variants spread worldwide, scientists and clinicians have raced to discover how well the available COVID-19 vaccines protect against the mutant strains. Preliminary results from a large study of health care workers now suggest one dose of CoronaVac, a vaccine developed by a Chinese company, is still about 50% effective against symptomatic COVID-19 in a Brazilian city where more than three-fourths of new cases are caused by the highly transmissible variant known as P.1.

That real-world protection is about the same level clinical trials saw with two doses of CoronaVac against the standard, or “wild type,” pandemic coronavirus in the country, suggesting the variant’s mutations have not increased SARS-CoV-2’s ability to evade vaccine-evoked immune responses”  (E)

“In an interview on Sunday with the Communist Party-run Global Times newspaper, Mr. Gao said his earlier comments had been misunderstood, and that discussion of how to improve the effectiveness of vaccines should be a universal question.

“The protection rates of all vaccines in the world are sometimes high, and sometimes low,” he said. “How to improve their efficacy is a question that needs to be considered by scientists around the world.”

Officials in Brazil said in January that the efficacy rate for the CoronaVac vaccine from the Beijing-based company Sinovac was just over 50 percent, which is the threshold that the World Health Organization has said would make a vaccine effective for general use. By comparison, Moderna and Pfizer-BioNTech were found to be 90 percent effective in real-world conditions, researchers said last month.

Last month, the distributor in the United Arab Emirates of vaccines from China’s Sinopharm said it was offering a third dose in addition to the standard two-dose regimen for a “very small number” of people who were “not really responsive” to the vaccine.” (F)

“Beijing has yet to approve any foreign vaccines for use in China, where the coronavirus emerged in late 2019.

China has administered about 161m doses since vaccinations began last year – most people will require two shots – and aims to fully inoculate 40% of its 1.4 billion population by June.

Last month, authorities in Beijing resumed issuing visa processing for foreigners from dozens of countries, but only if they have been inoculated against Covid-19 with a Chinese-made vaccine.

The move raised questions about the motivations behind the demand, given China’s vaccines are not approved in many of the countries to which it has opened travel and that it will not accept foreign vaccines made elsewhere, including those approved by the World Health Organization.

By the middle of last month, China had approved five vaccines for either general or emergency use, including three that are also being distributed to other countries either through trade or aid.

The push to supply internationally has been labelled a “vaccine diplomacy” campaign to boost China’s place as a global health contributor, with take-up mostly in Asia, Africa and South America.” (G)

“Scientists say mixed results are not surprising for a vaccine with lower efficacy that has been tested in relatively small numbers of people. Mixed results have also been reported from trials of the COVID-19 vaccine developed by the University of Oxford, UK, and drug firm AstraZeneca. “If you’ve got a vaccine with really high efficacy, you don’t need a whole lot of numbers to get a clear picture. But when it’s complicated, then you really need bigger numbers to get a better handle on what’s going on,” says Bastian…

The roll out of CoronaVac, which uses an inactivated version of SARS-CoV-2 to induce an immune response1, could see more widespread use in other nations, says Adrian Esterman, a biostatistician at University of South Australia in Adelaide. Compared with the Pfizer–BioNTech vaccine, which must be stored at −70 ºC, CoronaVac is stable at fridge temperatures and easier to distribute.

On the basis of the data reported so far, the vaccine seems safe, with only a few people experiencing mild symptoms such as headache.

A World Health Organization (WHO) team in China is reviewing manufacturing practices for Sinovac’s vaccine, and those produced by Chinese state-owned Sinopharm. If the WHO lists the vaccines for emergency use, that will accelerate their global distribution, says Bastian.” (H)

“China’s vaccine rollout has gotten off to a slow start. Now, as Beijing tries to boost vaccination rates across the country, citizens are having doubts about the safety and efficacy of the available inoculations.

As countries around the world try to combat the latest wave of coronavirus infections by expanding vaccine access, China is trying to boost its vaccination rate through a combination of rewards and punishments.

As of April 11, Beijing had administered 167.3 million doses of vaccine across the country but that’s still far from the goal of vaccinating 560 million people, or about 40% of the population, by the end of June.

Different cities and institutions have deployed different tactics to reach that goal. In some, citizens can get freebies for getting vaccinated, in others, teachers have asked parents to share whether they have been vaccinated, and in extreme cases, private companies have forced employees to get the jab or be fired…

Some Chinese citizens have cited concerns over safety and efficacy as grounds for refusing vaccination. On April 11, China’s leading disease control official said existing vaccines in China offered a low level of protection and that mixing different vaccines was one of the strategies being considered to boost their effectiveness…

While some Chinese citizens are loath to get vaccinated due to safety concerns, others say the relatively low efficacy of Chinese coronavirus vaccines is not really an issue. One thing that seems to have convinced many people to get the jab is the fact that large parts of the country haven’t reported any new cases in months.”…

China’s state-run Xinhua news agency reports that major vaccine manufacturers in the country have all increased manufacturing capacity and Gao Fu says China aims to vaccinate 70-80% of its citizens between the end of this year and the middle of next year.

But experts say that won’t help unless other countries vaccinate the majority of their population with effective vaccines, too.

“Otherwise, once the border is open, it’s like opening up a can of worms, people coming from the outside start to infect citizens and they have to start all over again,” said Wang.” (I)

“China’s locally developed COVID-19 vaccine candidate that uses messenger RNA (mRNA) technology could start late-stage clinical trial overseas as early as next month, official media said on Tuesday.

ARCoV, the China-developed mRNA vaccine candidate that is furthest along the clinical trial process, may get overseas approval to conduct Phase III clinical trial by as early as end-April, China National Radio said in an article on its website.

China has approved four locally developed coronavirus vaccines for general public use and a fifth for smaller-scale emergency use but none of them uses the mRNA platform. The country has administered more than 170 million vaccinations, the second-highest number of doses in the world after the United States.

The mRNA technology is used by rival shots developed by Pfizer Inc and its partner BioNTech, as well as by Moderna Inc. It contains instructions for human cells to produce proteins that mimic part of the coronavirus…

Ying said early stage trial data has shown that its vaccine is “fully comparable with two overseas mRNA vaccines,” without elaborating on the specific readings.” (J)

“As the coronavirus spread globally last year, New York-based Pfizer raced to partner with Germany’s BioNTech, an mRNA frontrunner that had hired Kariko as a senior vice president. Massachusetts-based Moderna, meanwhile, had $2.5 billion in funding from the U.S. government.

By contrast, several Chinese companies focused on older technologies that have proved far less potent…

Old-school Chinese-made Covid vaccines now in use from Sinovac Biotech Ltd. and China National Biotec Group Co. rely on particles from inactivated viruses and have protection rates much lower than the mRNA vaccines’ more than 90% effectiveness in preventing infections….

When Sinovac began working on a vaccine, it focused on a familiar method in order to develop a shot quickly, after efforts at exploring other alternatives didn’t yield promising results…

hile China has largely contained the spread of the coronavirus within its borders, more effective vaccinations and a wider take-up among its population would enable the country to reopen sooner, reducing the need for quarantines and lockdowns. China risks losing the edge gained by stamping out the virus if its inoculation drive is less effective than places where mRNA shots are the backbone of rollouts.

In Israel, where nearly 60% of the population has received the Pfizer/BioNTech vaccine, Covid cases, hospitalizations and deaths are plunging. As more adults get their shots in the U.S., which also relies largely on mRNA vaccines, President Joe Biden has predicted Americans will be celebrating July 4th with backyard barbecues once again.

China isn’t the only country that missed the boat with mRNA. While companies in Japan, India and Australia are significant players in fighting diseases like flu and polio, no company in the Asia-Pacific region now makes mRNA shots. “Basically, mRNA was put in the ‘too-hard’ basket for many years,” said Nigel McMillan, Program Director for Infectious Diseases & Immunology at Griffith University in Southport, Australia. (K)

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    A lot has changed since early 2020, when countries around the world first realized the potential threat of a highly contagious, and still mysterious, flulike virus. In the early days of the coronavirus pandemic, no one knew for sure how the virus spread. People were scrubbing their groceries. Governments urged people to stay home, to wash their hands frequently and to avoid touching their faces. Masks quickly emerged as a point of confusion, as public health officials at first discouraged people from wearing them, citing shortages, and then endorsed them. Mask mandates became a flash point in the culture wars as states, counties and cities across the country adopted a patchwork of policies. On Tuesday, the Centers for Disease Control and Prevention said that it was no longer necessary for fully vaccinated people to wear masks in small groups outdoors, bringing the public guidance in line with a growing body of research indicating that the risk of spreading the coronavirus is much greater indoors. Here is how the public health guidance on masking in the United States has shifted since the start of the pandemic. FEBRUARY 2020 Stop buying masks, surgeon general pleads Seriously people STOP BUYING MASKS! the surgeon general at the time, Dr. Jerome M. Adams, wrote on Twitter in February 2020. They are NOT effective in preventing general public from catching #Coronavirus, but if health care providers can t get them to care for sick patients, it puts them and our communities at risk! APRIL 2020 A change in policy, with more mixed messaging In April, officials reversed course, with the C.D.C. urging all Americans to wear a mask outside their homes to supplement other public health measures, such as social distancing and hand washing. SEPTEMBER 2020 Health officials speak out for masks Many officials have emphasized the public health benefits of masks. In September, Dr. Robert R. Redfield, then the C.D.C. s director, told a Senate committee that masks were the most important, powerful public health tool we have for fighting the pandemic, adding that the universal use of face coverings could bring the pandemic under control in months. JANUARY 2021 President Biden imposes some masking rules President Biden in January used his executive authority to impose mask requirements where he could including on federal property and in interstate travel. MARCH 2021 The C.D.C. issues its first guidelines for vaccinated people In March, almost exactly a year since the pandemic first gripped Americans in fear, the C.D.C. said that people who had been fully vaccinated against the coronavirus could gather in small groups indoors without masks or social distancing. Vaccinated adults could begin to plan mask-free dinners with vaccinated friends, the agency said. MARCH 2021 States begin lifting mask mandates With vaccinations on the rise, some states began lifting mask mandates. Others, including Florida and South Dakota, never had one. Gov. Greg Abbott of Texas, a Republican, lifted the mask mandate and capacity limits on all businesses starting March 10. The order ensured that all businesses and families in Texas have the freedom to determine their own destiny, Mr. Abbott said. APRIL 2021 C.D.C. relaxes masking advice for people who gather outdoors On April 27, the C.D.C. said that fully vaccinated people generally no longer needed to wear masks outdoors, but should continue to wear them at indoor gatherings or at crowded outdoor events. People who haven t gotten their shots can also go without a mask in small gatherings held outside as long as they are with fully vaccinated friends and family, the agency said. Vaccinated adults should continue to wear masks and stay at least six feet from others in large public spaces such as at outdoor performances or sporting events, or in shopping malls and movie theaters where the vaccination and health status of others would be unknown, the agency said. And they should still avoid medium-size and large gatherings, crowds and poorly ventilated spaces, officials said.

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