News in focus VCG VIA GETTY VCG Students are inoculated at a mass-vaccination hub at Peking University in Beijing. CHINA’S COVID VACCINES ARE GOING GLOBAL — BUT QUESTIONS REMAIN The WHO has approved one of China’s COVID-19 vaccines for use worldwide, and another is under review. But published trial data remain scarce. By Smriti Mallapaty Disease Research, Bangladesh, in Dhaka. before the Sinopharm vaccine was listed. He The first vaccine to be listed is made in Beijing said a positive response would be “good news he World Health Organization (WHO) by the Chinese state firm Sinopharm. The other for the vaccine developers and for the countries has authorized the first of China’s under review — named CoronaVac — is produced that are interested in getting these vaccines”. COVID-19 vaccines for emergency use, by the private company Sinovac Biotech, also The WHO approval process assesses safety, and another could be listed in the com- based in Beijing. Five COVID-19 vaccines have efficacy and manufacturing quality, says Qadri. ing days, potentially opening the door already been authorized by the WHO, but, unlike Approved products can be purchased by Tto widespread distribution in lower-income these, the Chinese ones use inactivated virus United Nations agencies. “Until that happens, it nations through the COVID-19 Vaccines Global and are not widely used in Western nations. will be up to the individual countries to procure Access (COVAX) initiative. Sinopharm and Sinovac’s vaccines account the vaccines, and most countries will be not be The listing will boost global confidence for the bulk of shots given in China, which has able to,” she adds. in these vaccines, say scientists. China’s five so far inoculated 243 million people. More The approvals could also help to address the different vaccines have not been used widely than 45 countries have already approved their shortfall in vaccines available through COVAX, in wealthy nations, but are already sustaining use, but the WHO is among the first stringent an initiative led by international partnerships immunization campaigns in the global south. regulatory authorities to review the data. and agencies, including the WHO, to ensure “There is big demand for the Chinese vac- “It is very important to have the support of COVID-19 vaccines are distributed equitably. cines,” says Firdausi Qadri, an immunologist the WHO,” said Rafael Araos, an epidemiologist By the end of April, COVAX had shipped only at the International Centre for Diarrhoeal at the University for Development in Santiago, about 50 million of the 2 billion doses it aims 178 | Nature | Vol 593 | 13 May 2021 ©2021 Spri nger Nature Li mited. All rights reserved. ©2021 Spri nger Nature Li mited. All rights reserved. to deliver globally in 2021. India is meant to HOW CHINA’S VACCINES COMPARE contribute one billion doses of its Covishield Five vaccines have been approved for use in China. Unlike RNA vaccines being rolled out elsewhere, all vaccine, but exports have halted, owing to the can be stored in a fridge at 2–8 °C. Although full efficacy results have not been published, interim data are country’s ongoing COVID-19 crisis. Deliveries available from clinical trials in more than a dozen nations, which have used these vaccines to protect tens of millions of people. to COVAX of another WHO-listed vaccine pro- duced by the pharmaceutical firm Pfizer have Vaccines: Sinopharm CoronaVac Sinopharm Convidecia Anhui Zhifei (Beijing) (Wuhan) been limited, and none of Johnson & Johnson’s vaccine has been shipped yet. Moderna’s vac- Produced by Sinopharm’s Sinovac Biotech Sinopharm’s CanSino Anhui Zhifei Beijing Institute Wuhan Institute Biologics; Longcom; cine was listed by the WHO on 30 April. of Biological of Biological Academy of Chinese As a result, Chinese vaccines are badly Products Products Military Medical Academy of needed, says Gagandeep Kang, a virologist at Sciences Sciences the Christian Medical College in Vellore, India, Efficacy at 79–86% 50–84% 73% 65–69% Unavailable and a member of a technical group on immu- preventing (2 doses) (2 doses) (2 doses) (1 dose) (2–3 doses) nization that advises the WHO. The group met COVID-19 on 29 April to review data on the two Chinese Technology Inactivated virus Inactivated virus Inactivated virus Adenovirus Protein-based vaccines, and will soon provide recommenda- vector tions on their use. Total doses >100 million* 260 million >100 million* Unavailable Unavailable Inactivated-virus vaccines have generally distributed proven less effective than others in use. How- Countries/ >55 (~50 million >40 (~156 million >55 (~50 million Unavailable Unavailable ever, they still exceed the WHO’s 50% efficacy regions doses)* doses) doses)* reached threshold for emergency-use approval, mak- ing them important in reducing the global Production 1 billion doses* 2 billion doses 1 billion doses* 100 million Unavailable shortfall, argues Murat Akova, a clinical goal in 2021 doses infectious-diseases researcher at Hacettepe Phase III UAE, Peru, Chile, Indonesia, UAE, Peru, Pakistan, Russia, China, University in Ankara. “If nothing else is avail- clinical trials Argentina, Brazil, Turkey, Bahrain, Jordan, Chile, Argentina, Uzbekistan Bahrain, Jordan, Philippines, Egypt, Morocco Mexico able, I think these vaccines are a good choice.” Egypt China Scattered data *Data for both Sinopharm vaccines are aggregated. Chinese researchers were among the first to cases of COVID-19 in its counting and because protection. Mixing vaccines or modes of entry, begin developing vaccines against COVID-19 there is circulation of the P.1 variant, which such as nasal sprays, might be useful, he adds. in early 2020, but have yet to publish full trial is more transmissible and might be better at China’s vaccines have already catalysed results. Some researchers have raised concerns evading immunity. Results of an analysis after immunization campaigns in more than 40 that a lack of transparency could fuel vaccine mass-vaccination campaigns in Chile have countries. The nation aims to produce to five hesitancy, but others say collating the data landed between these numbers, at 67%. billion doses this year, and more might come takes time, and information should be available from manufacturing deals with countries such for both front-runner vaccines within weeks. China’s vaccines have as the UAE, which is making a version of Sin- China’s vaccines (see ‘How China’s vaccines opharm’s Beijing vaccine, called Hayat-Vax. compare’) have had to be trialled elsewhere already catalysed For many countries, Chinese vaccines have because the country didn’t have enough trans- immunization campaigns been the only accessible ones. In others — such mission itself to conduct them, says George in more than 40 countries. as Brazil, Turkey and Chile, where tens of mil- Gao, who heads the Chinese Center for Disease lions of people have been vaccinated — they Control and Prevention in Beijing. make up some 80–90% of doses adminis- Hilda Bastian, an independent scientist CoronaVac and both Sinopharm vaccines tered. And researchers in these countries are who studies evidence-based medicine in Vic- are the mainstay of China’s own immuniza- beginning to see evidence of the jabs’ effect in toria, Australia, says that so far, only scattered tion drive, which aims to vaccinate 70% of its controlling the pandemic (C. G. Victora et al. Pre- information has been released on Sinopharm’s population of 1.4 billion by the end of 2021. print at medRxiv https://doi.org/gbh3; 2021). Beijing vaccine. (Sinopharm is producing a China approved its first COVID-19 vaccines for Anecdotal reports hint at a low incidence second inactivated-virus vaccine in Wuhan.) emergency use in June 2020 and began rolling of breakthrough infections, severe illness and In early December, both the United Arab out doses more widely in January. death among fully vaccinated individuals in Emirates (UAE) and Bahrain approved it — mak- So far, only Chinese vaccines have been Brazil, says Esper Kallas, an infectious-diseases ing it among the first COVID-19 vaccines to be listed by the country’s drug agency, which since researcher at the University of São Paulo, granted full clearance in any country. Approval December has approved both of Sinopharm’s Brazil. “Because we have access to CoronaVac, was based on late-stage trial data, including vaccines; CoronaVac; and a fourth vaccine pro- we’ve got to use it,” he says. “I’m not saying this a UAE study involving 31,000 participants. duced by CanSino Biologics in Tianjin, which will be the preferred vaccine in the future.” These showed that the vaccine was 86% effec- uses an adenovirus to introduce DNA encoding WHO emergency-use listing of CoronaVac tive at preventing COVID-19 after 2 shots, with the SARS-CoV-2 spike protein into human cells. would further validate the vaccine’s use in coun- no deaths among immunized individuals. The In March, China’s drug agency also gave tries that led with it. The decision to approve it WHO listed the vaccine on 7 May and reported emergency-use authorization to a vaccine pro- would “provide confidence”, says Akova. an efficacy of 79%. duced by Anhui Zhifei Longcom, a firm based But questions remain. Researchers want more Mixed data on CoronaVac have emerged in Hefei. It works by introducing part of the data on how well Chinese vaccine protect older from clinical trials and national vaccination virus’s receptor-binding domain protein to people, children, pregnant people and people campaigns. Trials from Brazil and Turkey have human cells, and is undergoing phase III trials. with compromised immune systems. They also revealed efficacy figures of 50.7% and 83.5%, Gao says the Chinese vaccines generally want to know what types of immune response respectively. Researchers say the lower fig- provide good protection, but that subsequent the jabs trigger, how long protection lasts and ure might be because Brazil includes mild boosters might be needed to induce stronger how well they work against emerging variants.