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.
STEVE INSKEEP, HOST:
Now let's get an update on vaccinations in the country where the coronavirus spread first. China has overcome the pandemic more quickly than other countries. But getting people vaccinated has been a struggle. NPR's Emily Feng asked why.
EMILY FENG, BYLINE: Across Beijing, long lines are forming for the country's first commercially approved coronavirus vaccine.
FENG: It's made by state firm Sinopharm. And Chinese companies and hospitals are now jostling to get their employees the vaccine.
UNIDENTIFIED GUARD: (Non-English language spoken).
FENG: A guard at this Beijing vaccination site reassures the unvaccinated their turn will soon come. China is great at mobilizing hundreds of millions of people into home isolation or for mass COVID testing. But like many countries, China is struggling with vaccines. Less than 1.6% of people in China have been inoculated so far. And Beijing's goal is modest, to get about 50 million - or less than 4% - of people vaccinated by mid-February. Part of the reason is it's had very few outbreaks over the last few months.
YANZHONG HUANG: People perceived as low risk of COVID infection. So - you know, there are, really, not a lot of people, you know, that feel like it is urgency of getting vaccinated.
FENG: That's Yanzhong Huang, a public health expert at Seton Hall University. Right now, surveys show 60 to 80% of people in China are willing to be vaccinated. That's a problem. China needs to vaccinate basically everyone. That's because its two main vaccines are only between 50 and 80% effective. To inoculate 1.4 billion people with two-shot vaccines means manufacturing will be the biggest bottleneck.
HUANG: China made vaccines based on, you know, the inactivated viruses, you know? So - you know, that is subject to constraints of scale-up.
FENG: By contrast, mRNA vaccines like Pfizer and Moderna's are faster to make. China says it's made about 600 million shots already. Sinopharm says they're adding production lines to make another 1.8 billion COVID shots by the end of this year.
HUANG: But even based on that number, given the vast needs of domestic vaccination, you know, that number is still not sufficient.
FENG: And about 400 million of those doses have been promised to other countries. So for now, the vaccine is a hot commodity. Beijing is prioritizing health care and transportation workers. Unlike other countries, it is not vaccinating anyone above the age of 59 yet. Chinese students studying abroad can also be part of this lucky first batch to get the vaccine. Amy is one of them. She's hoping to get her second shot in Beijing soon so she can return to the U.K. for her master's program.
AMY: I think it's as normal as taking other vaccines that I have taken before.
FENG: Though, she did have some muscle soreness. Amy did not want to give a last name because her parents are government workers and could get in trouble because they pulled strings at Sinopharm to get her her second vaccine shot faster.
AMY: The reason why my mother, she found someone for me, is maybe there are too many people in Beijing want to take the vaccine. And she don't want me to queue for a very long time.
FENG: For others in China, they might have to wait to the end of this year before their turn comes. Emily Feng, NPR News, Beijing.
(SOUNDBITE OF FREDDIE JOACHIM'S "MULLED WINE") Transcript provided by NPR, Copyright NPR.