Apathy, suspicion at China’s new foray into vaccine diplomacy

There was a sense of euphoria in Zanzibar, Tanzania’s semiautonomous archipelago, this past week when a public Covid-19 vaccination drive got underway, with Health Minister Nassor Ahmed Mazrui leading the way in taking a jab of the Chinese Sinovac vaccine.

Tanzania is crawling out of Covid denialism, blamed on the administration of President John Magufuli, which last year declared the country Covid-free. After the death of Dr Magufuli in March this year and the ascendancy of Samia Suluhu Hassan, the government has been striving to reverse the sentiment around Covid and institute preventive measures, including vaccination.

Curiously, while the other East African countries have largely been administering AstraZeneca from the Serum Institute of India through the UN Covax facility, Tanzania started off its public vaccination drive with the Chinese Sinovac.

Most of sub-Saharan African countries have kept off the two Covid-19 vaccines from China, Sinopharm and Sinovac, an interesting development on a continent that has always looked East for aid for development, infrastructure and technological advancement.

As of July 1, data from the Africa Centres for Disease Control and Prevention (Africa CDC) showed African countries have acquired about 65 million Covid-19 vaccines so far, largely from the West. The latest data from Bridge Consulting shows that Africa has received 55.05 million doses from China -- less than 4 per cent of its vaccine exports -- mostly due to apathy among the states. Beijing’s involvement in Africa’s vaccine programmes, through donations and sales, has been the slowest among all regions where its vaccines are in use.

China has donated 27 million vaccine doses worldwide, of which 6.69 million went to Africa, according to the vaccine tracker. It has sold 884 million doses worldwide, with Africa purchasing only 55.05 million. Morocco, Egypt and Algeria account for 75 per cent of these purchases.

“Africa has 35 countries receiving sales and donations from China, but it has received the least number of Chinese vaccines doses,” says Bridge Consulting in its latest report. “In contrast to other regions, Africa has been receiving Chinese vaccines through more donations than sales. Issues of affordability and accessibility are particularly large for African countries with limited financial resources at their disposal.”

Beijing has announced financing packages that would make its vaccine deals more affordable in Africa, and this is also being cited as another contributing factor of the apathy of its vaccines in the continent.

Data shows that Chinese biopharmaceutical company Sinovac Biotech Ltd has donated 1.2 million doses of Sinovac to Africa, with its orders from the continent standing at a paltry 5.9 million, out of the 551.2 million doses it has sold across the world. Asia and Latin America have been its biggest market, ordering 22.4 million and 214.5 million doses respectively.

Beijing Bio-Institute of Biological Products Co-Ltd under the China National Pharmaceutical Group Corporation, has so far received orders for 49.05 million doses of Sinopharm from Africa, out of its overall 226.15 million orders globally as of July 20. It has delivered 26.15 million to Africa, out of the 93.7 million doses produced, data shows.

The Chinese vaccine received approval for emergency use from the World Health Organisation on May 7. Donations to the continent stand at 5.49 million doses, out of the 22.38 million donated across the globe.

Lead countries

In sub-Saharan Africa, Zimbabwe, Nigeria and Senegal have led in purchasing, and administering the Chinese vaccines.

In April, the Africa CDC said that they were at an advanced stage of discussions to acquire Sinopharm vaccines.

“We will be holding a meeting with the WHO to discuss the Sinopharm vaccine. We are hopeful the discussion will lead to a favourable pronouncement on the emergency use authorisation of Sinopharm’s vaccine. This will increase the pool of our recommended vaccines,” said Dr John Nkengasong, Africa CDC director.

Africa CDC has signed a contract with America’s Johnson and Johnson to deliver over 200 million doses to the continent.

Uganda and Tanzania through Zanzibar are the only East African countries receiving Chinese vaccine donations but have shied away from direct purchases.

Zanzibar started its Covid-19 vaccination campaign using the Sinovac vaccine received as a donation. Nassor Ahmed Mazrui, Zanzibar’s Minister of Health, said the vaccines were initially meant for the Haj pilgrims.

“The Sinovac vaccines were originally meant to be administered to people who wanted to attend the annual Hajj pilgrimage. After Saudi Arabia prohibited foreign visitors, we decided to give those vaccines to our front-line workers,” he said.

On Thursday, the minister took his second jab of Sinovac, having taken the first one on July 9, and announced that 10,000 doses were available to the public and an additional 100,000 doses were expected to arrive “anytime soon”.

Uganda is expected to roll out its Sinovac vaccination campaign in August after receiving a 300,000-dose donation from Beijing. The country has been using AstraZeneca from the Covax facility, having received over 96,000 doses. It is expecting a further 668,000 doses from the Covax.

In May, Ombeva Malande, director of the East Africa Centre for Vaccines and Immunisation, which advises Kampala, said that the Museveni administration had “seriously considered” buying Chinese vaccines but was now focused on Covax, mostly due to their cost and the availability of data.

“We will only consider the affordable vaccines approved by the WHO,” Diana Atwine, Permanent Secretary in the Health Ministry said.

In December 2020, Kampala approved a request by Chinese residents to import over 4,000 doses of their own vaccines into the country.

“They wanted it for themselves, so we told them to limit it within themselves. We do not want it to spread in the population. Uganda imports vaccines that are World Health Organisation prescribed, assessed for safety. That is the vaccine we bring for the population and we have applied for it through GAVI,” said Ugandan Health Minister Jane Ruth Aceng.

So, is the Chinese vaccine diplomacy then failing?

Under its “Health Silk Road” programme, Beijing aims to supply Covid-19 vaccines to at least 80 countries, particularly in the developing world, many of which are members and supporters of the Belt and Road Initiative. But its charm offensive has been impacted by bad press, especially with its European and American rivals saying the efficacy of the doses is not known due to unavailability of clinical trials data to scientists. While China has been donating the vaccines to poor countries, the majority have had to buy their supplies, in some instances using loans offered by Beijing.

Health Silk Road

China’s “Health Silk Road” initiative is an emerging diplomatic programme to promote health co-operation. Critics of this “vaccine diplomacy” do not view it as altruistic. They say Beijing’s plan is underpinned by geopolitical motivations. According to an April 2021 report by Think Global Health, of the 56 countries to which China pledged doses, 55 were participants in the Belt Road Initiative, the ambitious infrastructure and connectivity project China is using to dominate the world’s commerce, military and politics.

China’s detractors say it is trying to give its pharmaceutical industry, which has been criticised for having low efficacy rates and poor credibility, a degree of legitimacy. To achieve its geopolitical objectives and regain its global standing, China has sought to provide its vaccines to almost every continent. Its Covid vaccines have been shipped to at least 60 countries for emergency use, according to its Commerce Ministry.

But its Western rivals are not sitting on their laurels. Pfizer and BioNTech have announced that they will start to manufacture their Covid-19 vaccines in South Africa, after China announced its manufacturing plans in Egypt and Morocco.

On June 1, the WHO Strategic Advisory Group of Experts on Immunisation (SAGE) validated the Sinovac-CoronaVac Covid-19 vaccine for emergency use. But even this validation is yet to convince African countries to accept the virus in their mainstream vaccination plans, even under donations terms that Beijing is willing to offer.

“China has provided more than 350 million doses of vaccines to the international community, including vaccine assistance to over 80 countries and vaccine exports to 40 plus countries,” Chinas Foreign Ministry Spokesperson Wang Wenbin said.

Last month, and while the Covax facility was still facing serious shortage of the Covid-19 jabs because of the Indian export blockade, Beijing announced that it will provide the first batch of 10 million doses of vaccines to the Covax.

“China will continue to work with all parties to enhance the equitable distribution and accessibility of vaccines and make positive contributions to the global anti-epidemic endeavour,” Mr Winbin said. “We hope that the international community will take more concrete actions to increase vaccine accessibility in developing countries so as to secure an early victory in the fight against the epidemic.”

Sinovac in Egypt

On Monday, Egypt announced that it had produced the first one million doses of vaccines developed by China’s Sinovac, using local facilities, with the daily output reaching 300,000 doses. Egyptian Prime Minister Mostafa Madbouly said this vaccine would be used locally, adding that he country still looking at Beijing to provide more support for the expansion of Egypt’s production capacity. “

“The Egypt facility will not only be beneficial to the country but the rest of world because it will help promote the global vaccine supply capability,” Wu Peng, the Director General of the Africa Department at the Chinese Ministry of Foreign Affairs said.

Moroccan pharmaceutical firm Sothema, announced that it will start production of 5 million doses a month of China’s Sinopharm Covid-19 vaccine.

On Thursday, Pfizer and BioNTech announced a “fill and finish” deal with South Africa’s Biovac Institute. This will see South Africa carry out the final stages of vaccine manufacturing where the product is processed and put into vials. South Africa, through its Aspen Pharmacare, has a similar deal with Johnson & Johnson.

Lastweek, the European Union said it was “providing assistance to African countries to help manufacture vaccines and medicines in order to reduce the continent’s dependence on imports.”

So far, Africa has reported almost six million Covid-19 cases and fully vaccinated less than 1.2 per cent of its population, according to the Africa CDC.

On Thursday, the EU said it will donate more than 200 million doses of Covid-19 vaccines to middle and low-income countries before the end of the year.

“The EU takes its responsibility in helping the world fight the virus, everywhere. Vaccination is key – that’s why it is essential to ensure access to Covid-19 vaccines to countries worldwide,” European Commission president Ursula von der Leyen said. 

*Written by Allan Olingo