China has approved one domestic coronavirus vaccine for commercial use. Four more are in late stage human trials, and a nationwide vaccination campaign is already underway.
But the vaccine rollout is happening more slowly than expected. Only about 24 million doses have been administered, but those numbers represent only the first dose of a two-dose vaccine. That means at most, only 1.6% of China's population received their first shot by the end of January. Beijing's modest goal is to inoculate 50 million people — or about 3.5% of the total population — by mid-February, right before Lunar New Year.
China excels at mobilizing hundreds of millions of people for home isolation or mass COVID-19 testing. So why is it struggling with vaccination?
China has a lot of people to vaccinate
Experts estimate that even with a perfect vaccine that is completely effective in all cases and provides life-long protection, around 60-72% of a country's residents must be vaccinated for herd immunity.
But no vaccine is that effective, including China's, so the country will need to vaccinate nearly all 1.4 billion of its citizens for herd immunity.
The first commercially approved vaccine in China is produced by Sinopharm, a state vaccine firm, and is effective about 79% of the time at preventing recipients from contracting COVID. Sinovac, another major firm, is completing trials for another two-shot vaccine, which has reported efficacy rates ranging from 50% to 91% depending on the trial.
China is currently prioritizing health-care and transportation and shipping workers for the first round of vaccinations. Unlike most other countries, it is not vaccinating anyone above the age of 59 because it did not test the vaccine on this demographic.
China's vaccines are slower to make
Two of China's leading coronavirus vaccine candidates — made by Sinopharm and Sinovac — use inactivated virus, a vaccine process that is more well-understood – but that takes more time and is harder to scale-up compared to the mRNA method used by the Pfizer and Moderna vaccines.
China says in 2020, vaccine makers produced 610 million shots — enough two-shot vaccines for about 300 million people. Sinopharm, the state vaccine maker, says they are adding production lines to make another 1.8 billion shots by the end of 2021.
Speaking to state media in early January, Sinopharm's chairman Yang Xiaoyun explained that his company could produce one billion doses in 2021, which would provide inoculation for 500 million people. But as of now, "the supply [of the vaccine] doesn't meet the demand," he added.
China is exporting hundreds of millions of vaccine doses to other countries
About 85% of Chinese citizens could theoretically get a coronavirus vaccine by the end of this year if every dose made was administered in China.
But China is exporting about 400 million of its doses to other countries, according to Duke Global Health Innovation Center and the British research firm Airfinity. For example, Indonesia has ordered more than 125 million doses from Sinovac and 60 million doses from Sinopharm. China has also donated millions of doses to allies such as Pakistan and to countries it's trying to build closer relations with, such as Serbia.
Vaccine hesitancy may be keeping some people from showing up for the inoculation
A December survey of Ipsos, another market research firm, in conjunction with the World Economic Forum found China had the highest vaccine acceptance rates among 15 countries, including the U.K. and the U.S.
But not everyone is eager in China, where new case counts remain low and skepticism about the vaccine still exists.
"People perceive there's a low risk of COVID infection, so there are really not a lot of people that feel like there's the urgency of getting vaccinated," says Yanzhong Huang, a public health expert at Seton Hall University.
In an August online survey of 20,000 people conducted by Harbin Medical University and China's national natural science foundation, fewer than 70% said they would be willing to take a coronavirus vaccine. Last November, only 61% of respondents in China told British market research firm YouGov they wanted a vaccine. (In comparison the same survey found only 47% of American adults were willing to be vaccinated.)
But even those who want the vaccine may have to wait to the end of this year before their turn comes.
Then again, with only a handful of new cases this week, China can afford a leisurely vaccine campaign – and score diplomacy points for selling their vaccines to other, more desperate countries.
Amy Cheng contributed reporting from Beijing.
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