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What do we know about China’s covid-19 vaccines?

BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n912 (Published 09 April 2021) Cite this as: BMJ 2021;373:n912

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China's COVID-19 vaccine: not just about efficacy and price, but also its access in 2021; beware of discrimination by vaccine origin

Dear Editors

As we discovered from various sources, the cost of COVID-19 vaccine varies significantly and does not necessarily equate to reported efficacy/effectiveness.

This article cited sources which place the sale price per dose of Sinopharm's vaccine as between $19-$36 ($30 in China), which contrasts with the reported prices of other vaccines used in the EU and the US (Ref 1).

Specifically Oxford-AstraZeneca vaccine is reported to be under $6 (as low as $2.15), while the vaccines from Moderna and Pfizer are generally sub $20 range per dose.

Russia's Sputnik V costs under $10 per dose according to the deal made with the African Union (Ref 2).

Johnson & Johnson/Janssen's vaccine also costs under $10 per dose, but unlike all other vaccines mentioned here so far, only requires a single dose rather than 2 doses.

Hence not withstanding the uncertainty about reported efficacy of Sinopharm vaccines and potential discounts afforded to sponsoring countries (EU.UK/US) who financially supported vaccine development by pharmaceutical companies, the pricing of Sinopharm vaccine is higher than expected.

If there is any immediate advantages for using Sinopharm vaccine, it is its availability to various third-world countries, particularly those in the the African Union. At least 223 million doses of Sinopharm vaccine have been reported to be already distributed worldwide (including 120 million in China), compared to 92 million doses of vaccine doses in EU (from various companies - Ref 3) whereas the US saw 238 million doses being distributed (ref 4).

It is evident that the inequity in geographic access (according to manufacturing sites) and advanced orders placed months ahead by various countries, compounded by export restrictions placed by countries where vaccine factories are located, pretty much dictated the availability of vaccines in 2021. There is some allegations that the Chinese government may be using vaccine diplomacy (Ref 5) to advocate or coerce their agenda to various developing countries, but frankly the antics of vaccine export restriction/delay from the EU, US and India leaves very little room for the China-skeptics to provide a viable alternate solution.

I foresee some dangers in such skewed distribution of vaccine. Some media reporting has already reflected the trend whereby vaccines from China and Russia, due to the lack of information, are being hinted at or even denigrated as second-class even though these products do fulfill WHO's guidelines of 50% efficacy threshold for vaccine against COVID-19 (Ref 6).

As the world starts to open for international travel toward the end of 2021, there may be much potential for vaccine casteism by various countries, to discriminate those vaccinated with products from China and Russia. As I pointed out, vaccine access in less-developed countries is not merely due to vaccine prices (Sinopharm vaccine in fact costs significantly more than others) but also relative availability for distribution.

There are dangers that discrimination by vaccine origin may not be due to local government border policies; airlines may also impose requirements upon passengers wanting to travel between continents to deny boarding to avoid potential penalties from local authorities at some destinations. As 'immunity passport' becomes a political hot potato within the UK and the US, I seriously doubt foreign citizen arrivals to these countries will be immune from similar controversy.

The WHO and the UN would need to pre-emptively address potential member country nationalism by vaccine origin.

References
1. https://www.bmj.com/content/372/bmj.n281
2. https://www.themoscowtimes.com/2021/02/26/russias-coronavirus-vaccine-mo...
3. https://www.euronews.com/2021/04/02/how-many-vaccine-doses-have-arrived-...
4. https://www.usnews.com/news/top-news/articles/2021-04-10/us-has-administ...
5. https://thediplomat.com/2021/03/the-logic-of-chinas-vaccine-diplomacy/
6. https://www.afro.who.int/news/what-covid-19-vaccine-efficacy

Competing interests: No competing interests

12 April 2021
Shyan Goh
Orthopaedic Surgeon
Sydney, Australia