This video was made possible by CuriosityStream. If you’ve already signed up for the CuriosityStream/Nebulabundle deal, make sure to watch the extended cut of this video on Nebula. If you haven’t signed up yet, you can getboth CuriosityStream and Nebula bundled together for just $15 a year with the current saleat CuriosityStream.com/Wendover. China has backed itself into a corner. About a year ago, in Spring 2020, it emerged triumphant—after months of devastation, it became the first country to coax life backto near-normal after a widespread COVID epidemic. Just as it emerged from lockdown, the restof the world was entering into it, so China started to focus its attention on not onlyrecovering from COVID, but also from the hit it took to its global image as a result ofperceived mismanagement in the virus’ early days. As the US and Europe struggled from far larger,far more devastating outbreaks, China sat on the sidelines, working on ways to be viewednot only as the country that crushed COVID within its borders, but also led the fightagainst it around the world. They wanted to be seen doing what the US andEurope couldn’t while they were focused on their problems at home. As hospital ships docked and intensive careunits ballooned in size throughout April in New York, planes were landing at JFK carryingthousands of desperately-needed ventilators from China.
As hospitals around the world ran out of suppliesand required healthcare workers to reuse masks for days or weeks on end, national airlineswere making special, dedicated trips to pick up medical supplies donated by China. As every corner in the world worked to rampup testing to get a more accurate picture of their problems, Chinese-made test kitswere streaming through their borders. China was at the center of the fight againstthe virus, but the center can be the riskiest place to be. As donations turned into purchases, it emergedthat there was a major quality problem. Some 90% of mask certifications from China,according to one measure, were fake; tests that were supposed to have 80% sensitivityactually had 30%; and stories emerged globally of Chinese officials demanding public displaysof thanks in exchange for donations. What was supposed to be a diplomacy coup rekindledan old narrative of Chinese-made as inferior. At best, this effort did little to rewriteChina’s role in the pandemic, but at worst, it seems very possible that it actually furtherdamaged their global image. However, while the start and the middle ofthe pandemic did not entirely go China’s way, in terms of global image, there was stillthe end. China still had the chance to recover whatthey’d lost and, more specifically, they had the chance to display their home-grownscientific skill and manufacturing might. China could be the country that supplies theshots that would end the world’s misery and put the pandemic in the history books.
They could make the world’s vaccine, but,of course, first, they needed a vaccine. Luckily, they had a head-start. As soon as the outbreak begun in China, anumber of private companies, state-owned enterprises, and government-run institutes started work on developing a vaccine. By Spring, there were some strong, viablecandidates, so the next step was testing. Just as most of the western world enteredtheir lockdowns, the first Chinese vaccine—Ad5-nCoV by CanSino Biologics—entered a Phase I clinicaltrial on March 17th, 2020, with 108 adults in Wuhan receiving the shot. After positive data, this same vaccine becamethe first in the world to enter Phase II trials on April 11th, with 508 participants. When the results from that trial were publishedon July 20th, they revealed that not only was the vaccine acceptably safe, but thatit was also generating the desired immune response—in short, it was seemingly bothsafe and effective. However, the next phase of clinical testingpresented a problem for CanSino. You see, Phase I vaccine trials are aboutseeing if they're safe, and then phase II trials are about seeing if they generate thedesired immune response in the body. Phase III, however, that’s about seeingif a vaccine works in the real world—to see if it actually protects humans. To do so, researchers divide the study participantsinto two equal-sized groups. One receives the actual candidate vaccine,the other receives a placebo shot—typically just a saline solution. Then, the two groups are tracked to see ifone is less likely to contract the virus than the other.
The problem for CanSino, the other Chinesevaccine makers, and the country at a whole was that, by late-summer, when the first Chinesevaccines were moving into Phase III trials, daily COVID cases in the country had beenreduced to double-digit levels in a country of well over a billion. Most Phase III vaccine trials have below 50,000participants, so it would take years, if not decades, at those case loads to get to thehundreds of infections needed in a trial to prove a vaccine’s efficacy. Essentially, it was impossible for Chinesecompanies to complete their COVID vaccines in China exactly because the country had doneso well at surprising the virus. Therefore, they had to move abroad. The CanSino Ad5-nCoV vaccine started PhaseIII trials in Russia, Pakistan, Saudi Arabia, Mexico, Argentina, and Chile, while the otherleading candidates moved to dozens of other countries with more severe COVID epidemics. However, with many of these, China and itspharmaceutical companies had to curry favor with each government. Typically, that took the form of offeringpriority access to the very vaccines that they were testing, which was fine… for themoment. As of now, five Chinese-made vaccines havebeen approved in the country. In general, there has been widespread criticismof the country’s vaccine development practices—they’ve started vaccinating the general public beforetheir Phase III trials reached their endpoints, they haven't been forthcoming with clinicaltrial data, they’ve misrepresented efficacy ratings from trials, and more—however, despitethat, there is evidence that these vaccines are acceptably safe and effective—even ifpotentially less so than other approved vaccines.
On December 30th, the BBIBP-CorV vaccine manufacturedby Sinopharm—a Chinese state-owned enterprise—was approved in the country, making it one ofthe first COVID vaccines in the world to be deployed in the general population. Despite the fact that this vaccine was developedand manufactured by a company owned by the Chinese government, and despite the fact thatthe country had some 1.4 billion people to inoculate, many of the first doses of the Sinopharm vaccine were sent beyond their borders. Chinese state-owned media reports that the company has orders for its vaccine from over 100 countries, although the details of suchorders are not publicly known, leading to some skepticism over the numbers. We do know details for certain orders, though,and in some cases, we might know more than China wants us to. In general, though, China’s goal with itsglobal vaccine distribution is essentially to do what it failed to do with masks, ventilators,and tests in 2020—China wants to be the country that ended other country’s epidemics. Now, even though Western vaccines from Modernaand Pfizer have a 95% efficacy rating compared to 50% to 83% in Chinese vaccines, those Westernvaccines have order obligations taking up their inventory until well into 2022. However, that's not the case with certainChinese vaccines, so some countries are making the calculation that it's better to have less-effectivevaccines sooner than the alternative.
Of course, for China, this is a major diplomacycoup—countries historically allied with the West, such as Hungary and Mexico, areturning to China. In their narrative, China is doing what theWest cannot. Of course they want this to continue, andeven ramp up. That’s why they’ve been sending theirvaccines all around the world, for free. Mongolia and Sri Lanka received 300,000 dosesof the Sinopharm vaccine; Algeria, Sierra Leone, and Zimbabwe—200,000; and Belarus,Equatorial Guinea, Gabon, Mozambique, Namibia, and Bolivia—100,000. Now, a couple hundred thousand doses isn’tgoing to end any of these country’s epidemics, but it’s enough for clips of healthcareworkers receiving Chinese-made and donated vaccinations to make the evening news. It’s also enough for each of these countriesto see that these vaccines are acceptably safe and effective, giving them little reasonto not order more when China is offering them months or years before the big Western manufacturers.
However, the fact that many of China’s vaccinesare made and distributed by state-owned enterprises has led many to wonder whether the countryis choosing who gets these life-saving inoculations based on diplomatic intentions. It’s leading many to wonder whether wholives and who dies in this pandemic is starting to be based on how friendly the country ona given person’s passport is to the People’s Republic of China. The answer to this question is not hard tofind. On the read-out of the call between ChineseState Councilor and Foreign Minister Wang Yi and Algerian Foreign Minister Sabri Boukadoum,the Chinese official brought up Algeria’s vote 50 years ago to switch Chinese representation at the UN from the Republic of China government, now known as Taiwan, to the People’s Republic of China, which most now refer to as China. In addition, the Chinese official noted Algeria’sparticipation in China’s Belt and Road infrastructure development initiative, before announcingthe country’s intention to donate 200,000 Sinopharm vaccine doses to Algeria.
Elsewhere, in South America, ten of its twelvecountries have vaccinated their populations with either purchased or donated Chinese vaccines. The only two exceptions are Suriname—thelowest population country on the continent—and Paraguay. Now, Paraguay’s absence on the list of countriesto have received Chinese vaccines is not tough to figure out—it’s because of anotherlist that they are on. Paraguay is one of just 15 countries worldwidethat recognizes Taiwan as an independent nation—something that undermines China’s claims of the island. In fact, there is zero overlap between thelist of countries that recognize Taiwan and those that have received Chinese COVID vaccines. However, the cases of Algeria and Paraguaysimply show China rewarding its allies, and ignoring its foes. This is not at all different from how theUS, for example, has operated so far regarding COVID vaccine donations—it’s sent themto strong allies like Mexico and Canada—although, it’s quite possible that China is goingbeyond rewarding its key existing allies, and using vaccines to try and form new ones. Brazil and the US have gotten along ratherwell in recent years, especially over most of the past four as Brazilian president JairBolsonaro is an open admirer of former US president Donald Trump. That meant that Brazil followed the US’lead in banning the Chinese telecom giant Huawei from playing a part in building outtheir 5G cell network infrastructure—purportedly out of security concerns. Therefore, it was a bit of a surprise whenBrazilian communications minister Fábio Faria took a trip to Beijing in February and metwith Huawei executives.
According to Faria, he “took advantage ofthe trip to ask for vaccines, which is what everyone is clamoring for.” Soon after, he posted a letter on Twitterfrom the Chinese ambassador to Brazil which noted the request, reading “during yourvisit to China, you expressed the desire to continue to strengthen cooperation betweenour two countries regarding COVID-19 vaccines. I give this matter great importance.” A few weeks later, the Brazilian governmentannounced the rules and structure for its 5G auction and, in a change of course, Huaweiwas now allowed to participate. The company, in response to questions aboutthis, didn’t even directly deny that a tit-for-tat deal took place. In a statement, they said that while theycould not directly provide vaccines, they could facilitate, “communication in an openand transparent manner in a topic involving the two governments.” While there’s no direct evidence of Chinatrading vaccines for its foreign policy goals, people are starting to pay more attentionto situations like this, where countries are opening the door for such an action, and China’scertainly not closing that door. While its exact details might still be murky,it is clear that China is engaging in some form of vaccine diplomacy. This, however, presents a problem. You see, one of the main advantages of mRNAvaccine technology—the kind used in Moderna and Pfizer’s COVID vaccines—is that itsrelatively easy to manufacture. Most other types of vaccines include an attenuatedor dead version of the virus itself, or a portion of it, but growing and then processingthe virus itself is a time-consuming process that is harder to scale.
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August 25, 2021
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