Tuesday, March 2, 2021

March 2: Covid-- Act Now-- Daily Download

Covid Act Now Daily Download

Covid Act Now Daily Download

21:00 ET 02 March 2021

U.S. COVID Map & Risk Levels

Risk Levels*

Dark red=severe outbreak; red=active or imminent outbreak; orange=at risk of outbreak; yellow=slow disease growth; green=on track to contain

U.S. Vitals

Cases: 28,453,529
+54,248 /24h

Deaths: 506,373
+1,885 /24h

Tests: 357,068,278
+1,349,529 /24h

Data derived from The Covid Tracking Project

The Day’s Top COVID Stories

  • STAT News covers the Biden administration's new announcement that the U.S. will have enough vaccines for all adults by the end of May. Previously, the administration pledged to have enough vaccines to inoculate roughly 300 million adults by the end of July. The increase in expected supply is driven by a new agreement between the administration and Merck, a pharmaceutical company that halted research on its own COVID vaccine earlier this year. To help speed up rollout, Merck will help manufacture the recently approved Johnson & Johnson vaccine. While the accelerating timeline is exciting, it does not necessarily mean that all adults will be vaccinated by the end of May. The U.S. still must overcome distribution challenges, like the need for vaccinators, before the shots can all go into arms.

  • The New York Times explores how the P.1 variant (first identified in Brazil) is driving reinfections. A record-breaking recent case surge in Manaus, a Brazilian city that some experts believe had reached herd immunity last spring, led researchers to investigate whether the new variant could evade previous immunity. In Manaus, researchers found that up to 61 percent of people who previously had COVID could be reinfected with P.1. The variant shares some mutations with B.1.1.7 (first identified in U.K.) and B.1.351 (first identified in South Africa) that allow it to spread more easily, as well as additional mutations that help it escape antibodies. Researchers also found that CoronaVac, a Chinese vaccine currently being distributed in Brazil, is less effective against P.1. than other variants.

  • USA Today dives into a new nationwide initiative to study COVID long-haulers. Dr. Fauci announced the initiative last week, along with a new name for long COVID, Post Acute Sequelae of SARS-CoV-2 (PASC). The initiative seeks to answer questions about why some patients, known as long-haulers, continue to experience persistent symptoms months after recovering from COVID infections. While symptoms vary, the most commonly reported is “brain fog,” which includes memory problems, difficulty focusing, and intense fatigue. The launch of the initiative follows a recent study finding that 30 percent of all COVID patients still reported residual symptoms up to nine months after their illness.

New COVID Literature & Studies

  • A study mathematically analyzes the effectiveness of various interventions aimed at limiting COVID transmission in retail stores. These interventions include reductions in customer density and restricting movement of customers in stores to one-way flow. The researchers assess two mechanisms of transmission: 1) close contact and 2) wake exposure, which refers to spread of viruses from one person by airflow to someone behind. Restricting customer movement to one-way flow is only effective if COVID spreads by close contact, while reducing customer density is very effective with either mechanism. Read the study.

  • A pre-peer reviewed study offers preliminary results showing that one dose of the Pfizer COVID vaccine can reduce the risk of COVID by 75%, 12 days after vaccination. One dose of the vaccine was also able to reduce even asymptomatic infection by the same amount. The full data of this study has not been released yet. Read the study.

March 2: 1577 New COVID 19 Cases in Illinois

May be an image of text that says 'DAILY REPORT COVID-19 March 2, 2021 Public Health Boone County Health COVID-19 COMMUNITY UPDATE Boone County Boone County Positivity Rate Daily Case Count 2.3% 0 Seven Day Rolling Average Boone County Daily Death Count 0 5,924 Cumulative Cases Illinois Positivity Rate 2.8% 71 Cumulative Deaths Illinois Daily Case Count 1,577 Illinois Daily Death Count 47 Seven Day Rolling Average 1,189 1,189,416 Cumulative Cases 20,583 Cumulative Deaths All data are provisional and subject to change.'

March 2: Johns Hopkins COVID 19 Report

COVID-19

Updates on the COVID-19 pandemic from the Johns Hopkins Center for Health Security.

Additional resources are available on our website.

The Center also produces US Travel Industry and Retail Supply Chain Updates that provide a summary of major issues and events impacting the US travel industry and retail supply chain. You can access them here.

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EPI UPDATE The WHO COVID-19 Dashboard reports 114.14 million cases and 2.54 million deaths as of 5:30am EST on March 2.

The global weekly incidence increased for the first time since the early January 2021. Last week, the global weekly incidence increased 6.6% compared to the previous week, up to 2.65 million new cases. Global weekly mortality continues to decline, down to 63,370 deaths, the lowest weekly total since the week of November 9, 2020.

Our World in Data reports that 249.26 million vaccine doses have been administered globally, a 17% increase compared to this time last week. The daily average increased to 5.18 million doses, 7% higher than this time last week. Vaccination efforts have been reported in at least 114 countries and territories.

UNITED STATES

The US CDC reported 28.41 million total cases and 511,839 deaths. The US reported 3,240 deaths on February 25, the highest single-day total in 2 weeks. This included 806 previously unreported deaths in Los Angeles County, California. Without these extra deaths, the mortality for February 25 would have been 2,434 deaths—on par with the previous day (2,407).

The daily incidence in the US has fallen considerably from its highest peak—249,303 new cases per day on January 11—but the current average (66,594) still remains equal to or greater than both of the previous 2 peaks (67,316 on July 23, 2020, and 31,936 on April 12, 2020).

The average daily mortality is currently 2,050 deaths per day, slightly less than the first peak in April 2020 (2,857*) but nearly double the peak in August 2020 (1,148). Mortality has also declined considerably over the past several weeks before leveling off in recent days. The decline in daily mortality is less marked than the decline in incidence; however, this difference could be due to lags in mortality data.

*This peak included April 15, when New York City reported more than 3,700 previously unreported probable deaths from the onset of its epidemic. Without these deaths, the peak average would have been closer to 2,300 deaths per day.

This week, we will look at the most severely affected states in terms of cumulative incidence and mortality and put them in the global context.

At the national level, the per capita cumulative incidence is 85,560 cases per million population, which ranks #8 globally*. In total, 31 US states are reporting higher per capita cumulative incidence than that. Notably, Utah (115,800) and Rhode Island (118,580) would each rank #3 globally, ahead of Czechia (115,795), and North Dakota (131,030) and South Dakota (127,080) would each rank #2 globally, ahead of Montenegro (121,458). Only Andorra (140,930) is reporting higher per capita cumulative incidence than all US states. Rhode Island was among the most severely affected states during the first US surge in spring 2020 and then experienced a much higher peak late during the autumn/winter 2020 surge. North and South Dakota were the most severely affected states during the early part of the autumn/winter surge, peaking at more than 1,600 daily cases per million population, higher than any of the top 10 countries in terms of per capita cumulative incidence.

The US ranks #10 globally* in terms of per capita cumulative mortality, with 1,540 deaths per million population. Five US states would each rank #1 globally, ahead of San Marino (2,180): New Jersey (2,610), Rhode Island (2,360), Massachusetts (2,320), Mississippi (2,240), and Arizona (2,190). Another 4 states would rank #2 globally: South Dakota (2,130), Connecticut (2,130), Louisiana (2,060), and Alabama (2,020). Additionally, New York City**—which reports data to the CDC separately from New York state—is reporting 3,500 cumulative deaths per million, 60% higher than San Marino. The high cumulative mortality in New York City, New Jersey, Rhode Island, and Massachusetts are driven largely by the severe impact of the initial surge, at a time when health systems were overwhelmed, especially in New York City, and little was known about effective clinical care for COVID-19 patients. Arizona was the most severely affected state during the summer surge, followed by a higher peak in the autumn/winter 2020 surge. Mississippi was also severely affected during the summer surge, but its daily mortality remained elevated through September and October before surging again in the autumn/winter.

*The Our World in Data website utilizes the Johns Hopkins CSSE COVID-19 dashboard as opposed to the official US CDC data, so the numbers do not match exactly.

**The COVID Tracking Project does not include separate data for New York City, so New York state is displayed.

US Vaccination

The US CDC reported 96.40 million vaccine doses distributed and 76.90 million doses administered nationwide (79.8%). In total, 50.73 million people (15.3% of the entire US population; 19.9% of the adult population) have received at least 1 dose of the vaccine, and 25.47 million (7.7%; 10.0%) have received both doses. The average daily doses administered is rebounding from its brief decrease, which was likely caused by severe winter weather and now stands at 1.42 million doses per day*. The breakdown of doses by manufacturer remains relatively steady, with slightly more Pfizer-BioNTech doses administered (39.26 million; 51%) than Moderna (37.52 million; 49%). No doses of the J&J-Janssen vaccine have been reported, but we expect the first of those doses to be reported this week.

*The US CDC does not provide a 7-day average for the most recent 5 days due to anticipated reporting delays for vaccine administration. This estimate is the most current value provided.

A total of 7.15 million doses have been administered at long-term care facilities (LTCFs)**, including residents and staff. This covers 4.65 million individuals with at least 1 dose and 2.47 million with 2 doses. Approximately 59% of the doses have gone to residents, and 41% to staff.

**The dashboard only includes data for doses administered through the Federal Pharmacy Partnership for Long-Term Care (LTC) Program. It does not report data from West Virginia, which opted out of the program.

The Johns Hopkins CSSE dashboard reported 28.68 million US cases and 515,195 deaths as of 12:30pm EST on March 2.

J&J-JANSSEN VACCINE EUA On February 27, the US FDA issued an Emergency Use Authorization for the Johnson & Johnson (J&J)-Janssen Biotech SARS-CoV-2 vaccine. The EUA closely followed the review and recommendations by the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC). Additionally, the US CDC’s Advisory Committee on Immunization Practices recommended the vaccine for use in all adults aged 18 years and older. The ACIP recommendations were approved by CDC Director Dr. Rochelle Walensky on February 28.

Reportedly, the US government could begin shipping available inventory of the J&J-Janssen vaccine across the country early this week, with some deliveries arriving as early as today. The federal government currently has 3.9 million doses available, and it expects to receive “another 16 million doses...by the end of March.” Because only one dose is required, there will be no need to schedule follow-up appointments for booster doses or maintain stockpiles at the state and local level to cover second doses. Vaccinators will be able to administer all of the available J&J-Janssen doses, without needing to reserve any for booster vaccinations, which could further accelerate vaccination efforts. Additionally, the vaccine is stable at normal refrigerator temperatures and does not require on-site dilution.

Janssen Biotech’s briefing materials submitted for the VRBPAC review indicated that plans for future clinical trials for the vaccine include children under the age of 18, pregnant women and infants, and immunocompromised individuals (pages 34 and 93).

VACCINATION & TRANSMISSION RISK While multiple vaccines have demonstrated efficacy in terms of preventing COVID-19 disease, including severe disease and death, evidence is continuing to emerge regarding their ability to mitigate infection or transmission risk.

Last week, researchers from the University of Cambridge and Public Health England published (preprint) findings from a study on the efficacy of the Pfizer-BioNTech vaccine in preventing asymptomatic SARS-CoV-2 infection. The researchers evaluated PCR-based diagnostic test results for vaccinated and unvaccinated healthcare workers (HCWs) several weeks after the initiation of vaccination efforts. The researchers identified 26 positive results out of 3,252 total tests in unvaccinated healthcare workers (0.80%), compared to 13 positive tests out of 3,535 tests (0.37%) among HCWs vaccinated less than 12 days after their first dose and 4 out of 1,989 tests (0.20%) among HCWs who received their first dose 12 days or more before the test. This corresponds to a statistically significant decrease in infection risk among vaccinated HCWs. Viral loads in vaccinated HCWs tended to be lower than in unvaccinated HCWs, although these results were not statistically significant. While not a placebo-controlled and randomized clinical trial, this study does provide real-world evidence that the Pfizer-BioNTech vaccine could provide protection against infection.

A nationwide study conducted in Israel also found evidence of lower infection risk in individuals vaccinated with the Pfizer-BioNTech vaccine. The study, published in The New England Journal of Medicine (NEJM), included nearly 1.2 million participants, pairing nearly 600,000 vaccinated individuals to unvaccinated individuals (1:1 ratio) based on “demographic and clinical characteristics.” The researchers evaluated SARS-CoV-2 infection and COVID-19 disease during 2 periods: 14-20 days after the first dose and 7 or more days after the second dose. Between 14 and 20 days after the first dose, the vaccine demonstrated 46% efficacy in preventing SARS-CoV-2 infection. At Day 7 or later after the second dose, the vaccine efficacy was 92% in terms of preventing infection. The vaccine also demonstrated high efficacy (>90%) in preventing COVID-19 disease, including severe disease, at Day 7 or longer after the second dose. Like with the UK study, this provides real-world evidence that the Pfizer-BioNTech vaccine can mitigate infection risk.

CONVALESCENT PLASMA In a systematic review and meta-analysis published in JAMA, researchers evaluated treatment with convalescent plasma compared to standard of care or use of a placebo in randomized clinical trials (RCTs)—published through January 29, 2021. The researchers identified 10 total RCTs—4 published peer-reviewed studies and 6 unpublished studies—including a total of 11,782 COVID-19 patients. Overall, convalescent plasma did not significantly differ from placebo or standard of care for any of the major outcomes of interest: all-cause mortality, length of hospital stay, mechanical ventilation use, clinical improvement, clinical deterioration, and serious adverse events. The researchers noted that there was limited data available regarding clinical improvement, clinical deterioration, and serious adverse events in these studies.

POST-ACUTE SEQUELAE OF COVID-19 Last week, the US NIH announced a new initiative focused on learning more about COVID-19 patients who experience persistent symptoms or develop new symptoms after recovery from acute SARS-CoV-2 infection. Formerly known as “long COVID,” the condition is now being referred to as post-acute sequelae of SARS-CoV-2 infection (PASC). PASC can include fatigue, shortness of breath, “brain fog,” sleep disorders, fevers, gastrointestinal symptoms, anxiety, and/or depression. The NIH study will use US$1.15 billion in funding over 4 years to address PASC from multiple perspectives, including the underlying biological cause of PASC, the prevalence of PASC among those who recover from SARS-CoV-2 infection, and the risk factors for PASC, including the interaction between SARS-CoV-2 infection and pre-existing health conditions (e.g., cardiac and neurological disorders).

During the February 24 White House COVID-19 Press Briefing, White House Chief Medical Advisor and NIAID Director Dr. Anthony Fauci said the magnitude of the problem is not yet clear. But he cited a research letter published in JAMA: Network Open by researchers at the University of Washington (US), who found that approximately 30% of COVID-19 patients experienced persistent symptoms for up to 9 months following illness. That could correlate to more than 8 million Americans to date. According to a report by NBC News more than 80 specialized “post-COVID” clinics have been established across the US to provide support to individuals suffering from PASC and gather information to better understand the condition.

OXYGEN SHORTAGE Access to affordable and sustainable oxygen supplies has been a challenge, particularly in low- and middle-income countries (LMICs). These challenges have been exacerbated by the shift from mechanical ventilation to high-flow oxygen therapy for patients with severe disease. To address the shortages, the WHO’s Access to COVID Tools Accelerator (ACT-A) launched the COVID-19 Oxygen Emergency Taskforce. The taskforce falls under ACT-A’s therapeutics pillar, co-led by Unitaid and the Wellcome Trust. The taskforce estimates that US$90 million in immediate funding is needed to address oxygen shortages across 20 LMICs, and an estimated US$1.6 billion will be needed over the next 12 months. Unitaid and Wellcome committed a total of US$20 million for the effort.

Experts note that oxygen shortages are leading to unnecessary deaths in LMICs, with 500,000 patients in need of 1.1 million oxygen cylinders daily. Dr. Peter Piot, Director of the London School of Hygiene and Tropical Medicine, highlighted disparities in the availability of medical oxygen as “one of the defining health equities...of our age.” Notably, oxygen production capacity “met less than half the need” in sub-Saharan Africa. A number of countries are constructing oxygen production facilities in order to scale up production capacity; however, this process is taking time. According to a report by the Associated Press, many countries view oxygen production from the perspective of industrial uses, rather than medical. India is leveraging its existing industrial production capacity and repurposing industrial oxygen storage tanks for use at healthcare facilities.

GLOBAL VACCINE ACCESS & DISTRIBUTION Today, Gavi published updated information regarding the first round of COVAX allocations. The first allocation includes 237 million doses of the AstraZeneca-Oxford vaccine to 142 countries, with projected deliveries through May 2021. Additionally, the publication accounts for an “exceptional distribution” of 1.2 million doses of the Pfizer-BioNTech vaccine to countries that requested it and demonstrated the ability to manage the additional logistical requirements (e.g., ultra-cold freezer capacity).

COVAX began shipping vaccines last week, including 600,000 doses to Ghana and 504,000 doses to Côte d'Ivoire, and both of those countries began vaccinations on Monday. Today, the COVAX delivered 624,000 doses to Angola and 3.94 million doses to Nigeria, and on Monday, Colombia became the first of 36 COVAX countries in the Americas to receive the vaccine, with 117,000 doses of the Pfizer-BioNTech vaccine.

Even with the acceleration in vaccine distribution through COVAX, questions remain over how the world will achieve global vaccine equity. A recent report by The Economist Intelligence Unit estimates that some parts of South America, Africa, and Asia will not achieve widespread vaccination coverage until 2023. And many experts remain cautious that COVAX will hit its goal of delivering 1.8 billion vaccine doses in 2021, as funding and supply shortages persist.

Some governments and experts, including at the WHO, are calling for vaccine manufacturers to share technology, intellectual property, and data in order to expand production capacity. Sharing access to the information and technology necessary to produce the vaccines could be achieved in several ways. One option, supported by the WHO, is a “patent pool,” similar to the platforms used for HIV, tuberculosis, and hepatitis treatments. To date, no companies have offered to participate. Another proposal involves suspending intellectual property rights during the pandemic. This plan is opposed by vaccine developers, and it was rejected in the World Trade Organization by the US and European countries, despite support from at least 119 countries and the African Union.

Pharmaceutical companies argue that wealthier nations should donate more vaccine doses, including through COVAX. Some countries are doing that, including bilateral agreements with China, Russia, and India to obtain those nations’ locally developed and approved vaccines. India has launched a 49-nation “friendship program,” and China is shipping vaccine supplies across Africa nations, Turkey, and Afghanistan. As many as 50 countries have finalized agreements with Russia for its Sputnik V vaccine. WHO Director-General Dr. Tedros Adhanom Ghebreyesus has repeatedly warned against a focus on bilateral or selective vaccine supply deals, arguing that they could result in further inequities among lower-income countries. Instead, he continues to call for more investment in the COVAX facility. Even with the recent donations, including US$2 billion from the US, COVAX remains US$800 million short of its 2021 goals.

US COVID-19 PROTECTIVE MEASURES & RELIEF Despite warnings from White House and US CDC that emerging SARS-CoV-2 variants pose a growing risk, governors across the US are lifting and relaxing restrictions on businesses, schools, and social activities following substantial decreases in daily incidence over the past several weeks. Governors in several states, both Democrat and Republican, have announced efforts to remove or relax capacity limits on restaurants, reopen bars and performance venues, and end mask mandates. At a White House briefing on Friday, CDC Director Dr. Rochelle Walensky warned that the recent decline in COVID-19 incidence does not mean that the US can relax. Daily incidence is still at the same level as the peak of the summer 2020 surge.

Even with its calls for states to continue their mitigation efforts, the federal government continues efforts to support economic recovery. On Saturday, the US House of Representatives narrowly passed a US$1.9 trillion COVID relief bill, called the American Rescue Plan, which includes funding for vaccination programs, direct stimulus payments, expanded unemployment benefits, state and local governments, and schools as well as additional funding for the global response. The Senate is expected to vote on a similar bill in the near future, possibly as early as this week. If approved, the plan would represent the sixth round of federal aid during the COVID-19 epidemic. Speaking from the White House on Saturday, US President Joe Biden called for quick action from the Senate, saying that decisive action can help reinvigorate the US economy.

J&J-MERCK PARTNERSHIP Industry competitors Johnson & Johnson (J&J) and Merck & Co. are expected to announce that they will work together to manufacture the J&J-Janssen SARS-CoV-2 vaccine. Currently, there are only approximately 4 million doses available for distribution. J&J was supposed to produce 12 million doses by the end of February, but it fell behind schedule.

In order to augment production, the US government worked with the 2 pharmaceutical companies to establish a joint partnership to manufacture the vaccine. Merck will convert 2 of its manufacturing facilities to produce the new vaccine. Merck developed its own vaccine candidate, but it abandoned the effort after the candidate did not produce a sufficient immune response in early clinical trials.

Officials from J&J have indicated that the company is on track to produce an additional 16 million total doses by the end of March and more than 100 million total doses by the end of 2021. It is unclear whether those projected numbers factor in production at the Merck facilities.

NEW ZEALAND New Zealand has received praise for its aggressive, science-led response to its COVID-19 epidemic, but a recent outbreak in Auckland continues into its third week. New Zealand officials are conducting extensive contact tracing and surveillance efforts, including genomic sequencing for all detected cases. In response to recent cases linked to the outbreak that was first reported on February 14, the Auckland region has been moved back to Alert Level 3, which is scheduled to end on March 4. The rest of the country is at Alert Level 2.

Individuals in the Auckland region are expected to remain in their household bubbles outside of work or school obligations, and mask use and physical distancing are mandatory in public spaces. Additionally, the government implemented travel restrictions for the Auckland region. Public venues are directed to close, and gatherings are heavily restricted. In accordance with these restrictions, the first weekend of the 36th America’s Cup has been postponed.

Chinese vaccines sweep much of the world, despite concerns

Chinese vaccines sweep much of the world, despite concerns

AP NEWS

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    Chinese vaccines sweep much of the world, despite concerns

    By HUIZHONG WU and KRISTEN GELINEAU

    today

    TAIPEI, Taiwan (AP) — The plane laden with vaccines had just rolled to a stop at Santiago’s airport in late January, and Chile’s president, Sebastián Piñera, was beaming. “Today,” he said, “is a day of joy, emotion and hope.”

    The source of that hope: China – a country that Chile and dozens of other nations are depending on to help rescue them from the COVID-19 pandemic.

    China’s vaccine diplomacy campaign has been a surprising success: It has pledged roughly half a billion doses of its vaccines to more than 45 countries, according to a country-by-country tally by The Associated Press. With just four of China’s many vaccine makers claiming they are able to produce at least 2.6 billion doses this year, a large part of the world’s population will end up inoculated not with the fancy Western vaccines boasting headline-grabbing efficacy rates, but with China’s humble, traditionally made shots.

    Amid a dearth of public data on China’s vaccines, hesitations over their efficacy and safety are still pervasive in the countries depending on them, along with concerns about what China might want in return for deliveries. Nonetheless, inoculations with Chinese vaccines already have begun in more than 25 countries, and the Chinese shots have been delivered to another 11, according to the AP tally, based on independent reporting in those countries along with government and company announcements.

    In this Thursday, Sept. 24, 2020 file photo, a worker inspects syringes of a vaccine for COVID-19 produced by Sinovac at its factory in Beijing. (AP Photo/Ng Han Guan)

    It’s a potential face-saving coup for China, which has been determined to transform itself from an object of mistrust over its initial mishandling of the COVID-19 outbreak to a savior. Like India and Russia, China is trying to build goodwill, and has pledged roughly 10 times more vaccines abroad than it has distributed at home.

    MORE ON THE PANDEMIC

    “We’re seeing certainly real-time vaccine diplomacy start to play out, with China in the lead in terms of being able to manufacture vaccines within China and make them available to others,” said Krishna Udayakumar, founding director of the Duke Global Health Innovation Center at Duke University. “Some of them donated, some of them sold, and some of them sold with debt financing associated with it.”

    China has said it is supplying “vaccine aid” to 53 countries and exports to 27, but it rejected a request by the AP for the list. Beijing has also denied vaccine diplomacy, and a Ministry of Foreign Affairs spokesperson said China considered the vaccine a “global public good.” Chinese experts reject any connection between the export of its vaccines and the revamping of its image.

    “I don’t see any linkage there,” said Wang Huiyao, president of the Centre for China and Globalization, a Beijing think tank. “China should do more to help other countries, because it’s doing well.”

    China has targeted the low- and middle-income countries largely left behind as rich nations scooped up most of the pricey vaccines produced by the likes of Pfizer and Moderna. And despite a few delays of its own in Brazil and Turkey, China has largely capitalized on slower-than-hoped-for deliveries by U.S. and European vaccine makers.

    Like many other countries, Chile received far fewer doses of the Pfizer vaccine than first promised. In the month after its vaccination program began in late December, only around 150,000 of the 10 million Pfizer doses the South American country ordered arrived.

    It wasn’t until Chinese company Sinovac Biotech Ltd. swooped in with 4 million doses in late January that Chile began inoculating its population of 19 million with impressive speed. The country now has the fifth highest vaccination rate per capita in the world, according to Oxford University.

    Chilean Vilma Ortiz got her Sinovac shot at a school in Santiago’s Nunoa neighborhood, along with about 60 other people. Although she considers herself “kind of a skeptical person,” she said she researched the Chinese vaccines on the Internet and was satisfied.

    “I have a lot of faith and confidence in the vaccine,” she said.

    ___

    In Jakarta, the sports stadium was abuzz as masked healthcare workers filed in to receive their Sinovac shot. Wandering the rows of vaccination stations was Indonesian President Joko Widodo, the first person in the Southeast Asian country to get the Chinese shot, 140 million doses of which he has ordered for his people.

    Among those at the stadium was Susi Monica, an intern doctor receiving her second dose. Despite questions over its efficacy, getting the shot was worth it to her, particularly because she didn’t have any adverse reactions to the first dose.

    Besides, she said, “Do I have another choice right now?”

    The choices are limited for Indonesia and many other low- and middle-income countries clobbered by COVID. Vaccine deployment globally has been dominated by wealthier countries, which have snapped up 5.8 billion of the 8.2 billion doses purchased worldwide, according to Duke University.

    China’s vaccines, which can be stored in standard refrigerators, are attractive to countries like Indonesia, a sweltering nation that straddles the equator and could struggle to accommodate the ultracold storage needs of vaccines like Pfizer’s.

    In this Thursday, Feb. 4, 2021, file photo, medical workers receive the COVID-19 vaccine during a mass vaccination in Jakarta, Indonesia. (AP Photo/Achmad Ibrahim)

    The bulk of Chinese shots are from Sinovac and Sinopharm, which both rely on a traditional technology called an inactivated virus vaccine, based on cultivating batches of the virus and then killing it. Some countries view it as safer than the newer, less-proven technology used by some Western competitors that targets the coronavirus’ spike protein, despite publicly available safety data for the Pfizer, Moderna and AstraZeneca vaccines and none for China’s.

    “The choice was made for this vaccine because it is developed on a traditional and safe inactivated platform,” said Teymur Musayev, an official with the Ministry of Health in Azerbaijan, which has ordered 4 million Sinovac doses.

    In Europe, China is providing the vaccine to countries such as Serbia and Hungary -- a significant geopolitical victory in Central Europe and the Balkans, where the West, China and Russia are competing for political and economic influence. This stretch of Europe has offered fertile ground for China to strengthen bilateral ties with Serbia and Hungary’s populist leaders, who often criticize the EU.

    Serbia became the first country in Europe to start inoculating its population with China’s vaccines in January. The country has so far purchased 1.5 million doses of Sinopharm’s vaccine, which makes up the majority of the country’s supply, and smaller amounts of Russia’s Sputnik V and Pfizer’s vaccines.

    Donning heavy coats against the winter chill, masked-up Serbians have been waiting in long lines for their turn to get the vaccine.

    “They have been vaccinating their own people for (a) long period, I assume they have more experience,” Natasa Stermenski, a Belgrade resident, said of her choice to get the Chinese shot at a vaccination center in February.

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    In what some are calling “vaccine diplomacy,” China is offering its vaccines to dozens of poorer nations around the world. (AP Video)

    Neighboring Hungary, impatient over delays in the European Union, soon became the first country in the EU to approve the same Chinese vaccine. On Sunday, Hungarian Prime Minister Viktor Orban got the Sinopharm shot, after recently saying he trusted the Chinese vaccine the most.

    Many leaders have publicly supported the Chinese shots to allay concerns. Early on, “people had all these microchip theories in their heads, genetic modification, sterilization, running around on social media platforms,” said Sanjeev Pugazhendi, a medical officer in the Indian Ocean island nation of the Seychelles, whose president recently received a Sinopharm shot on camera. “But the moment we started giving out the vaccines to leaders, religious leaders and health workers, that started to subside.”

    Beijing’s vaccine diplomacy efforts are good for both China and the developing world, experts say.

    “Because of the competition for influence, the poor countries can get earlier access for vaccines,” said Yun Jiang, managing editor of the China Story Blog at the Australian National University. “Of course, that’s assuming that all the vaccines are safe and delivered in the right way.”

    ______

    China’s vaccine diplomacy will only be as good as the vaccines it is offering, and it still faces hurdles.

    Ahmed Hamdan Zayed, a nurse in Egypt, was reluctant to receive a vaccine, especially a Chinese one. The frontline health worker would be among the first in the country to get Sinopharm’s shot as part of a mass vaccination campaign. Over 9 million Sinopharm shots have been given outside China.

    “We had concerns about vaccines in general,” the 27-year-old father of two said in a phone interview from the Abu Khalifa hospital in the northeastern part of the country. “The Chinese vaccine, in particular, there was insufficient data available compared to other vaccines.”

    But Zayed ultimately decided to get the shot after conducting more research. A doctor at his hospital called colleagues in the United Arab Emirates, which had approved the same shot, and they met with Egyptian health officials.

    Sinopharm, which said its vaccine was 79% effective based on interim data from clinical trials, did not respond to requests for an interview. Sinopharm’s chairman has said they have not had a single severe adverse event in response to their vaccine.

    In this Monday, Feb, 15, 2021 file photo, an official from the Chinese embassy in Zimbabwe holds a Chinese flag next to a plane carrying Sinopharm COVID-19 vaccine from China upon arrival at Robert Mugabe International Airport in Harare. (AP Photo/Tsvangirayi Mukwazhi)

    Chinese vaccine companies have been “slow and spotty” in releasing their trial data, compared to companies like Pfizer and Moderna, said Yanzhong Huang, a global health expert at the U.S. think tank Council for Foreign Relations. None of China’s three vaccine candidates used globally have publicly released their late-stage clinical trial data. CanSino, another Chinese company with a one-shot vaccine that it says is 65% effective, declined to be interviewed.

    China’s pharmaceutical business practices also have raised concerns. In 2018, it emerged that one of China’s biggest vaccine companies falsified data to sell its rabies vaccines. That same year, news broke that a Sinopharm subsidiary, which is behind one of the COVID-19 vaccines now, had made substandard diphtheria vaccines used in mandatory immunizations.

    With Chinese vaccines, “for a lot of people, the first thing you think about is ‘Made in China,’ and that doesn’t give you much assurance,” said Joy Zhang, a professor at the University of Kent in the UK who studies the ethics of emerging science.

    Russia and India have faced similar skepticism, partly because people have less trust in products made outside the Western world, said Sayedur Rahman, head of the pharmacology department at Bangabandhu Sheikh Mujib Medical University in Bangladesh.

    “China, India, Russia, Cuba, whenever they develop a vaccine or conduct research, their data is questioned, and people say their process is not transparent,” he said.

    A December YouGov poll of 19,000 people in 17 countries and regions on how they felt about different vaccines found that China’s received the second-lowest score, tied with India’s. In the Philippines, which has ordered 25 million Sinovac doses, less than 20% of those surveyed by a research group expressed confidence in China’s vaccines.

    Those concerns have been exacerbated by confusion around the efficacy of Sinovac’s shot. In Turkey, where Sinovac conducted part of its efficacy trials, officials have said the vaccine was 91% effective. However, in Brazil, officials revised the efficacy rate in late-stage clinical trials from 78% to just over 50% after including mild infections.

    In this Monday, Jan. 18, 2021, file photo, Terezinha da Conceicao, 80, left, and Dulcinea da Silva Lopes, 59, become the first women in the country to receive the COVID-19 vaccine produced by China's Sinovac Biotech Ltd, during the start of the vaccination program in front of the Christ the Redeemer statue in Rio de Janeiro, Brazil. (AP Photo/Bruna Prado)

    A senior Chinese official said Brazil’s numbers were lower because its volunteers were healthcare workers who faced a higher risk of infection. But other medical experts have said exposure would not affect a vaccine’s effectiveness.

    Sinovac’s trials were conducted separately in Turkey and Brazil, and the differences in efficacy rates arise from differences in the populations, a spokesman for the company said in a previous interview with the AP. The company declined to be interviewed for this article. An expert panel in Hong Kong assessed the efficacy of the vaccine at about 51%, and the city approved its use in mid-February.

    Globally, public health officials have said any vaccine that is at least 50% effective is useful. International scientists are anxious to see results from final-stage testing published in a peer-reviewed science journal for all three Chinese companies.

    It’s also unclear how the Chinese shots work against new strains of the virus that are emerging, especially a variant first identified in South Africa. For example, Sinopharm has pledged 800,000 shots to South Africa’s neighbor, Zimbabwe.

    In this Tuesday, Feb. 23, 2021, file photo, a health worker holds a box containing a dose of China's Sinopharm vaccine during the start of the vaccination campaign against the COVID-19 at the Health Ministry in Dakar, Senegal. (AP Photo/Leo Correa)

    There are concerns among receiving countries that China’s vaccine diplomacy may come at a cost, which China has denied. In the Philippines, where Beijing is donating 600,000 vaccines, a senior diplomat said China’s Foreign Minister, Wang Yi, gave a subtle message to tone down public criticism of growing Chinese assertiveness in the disputed South China Sea.

    The senior diplomat said Wang did not ask for anything in exchange for vaccines, but it was clear he wanted “friendly exchanges in public, like control your megaphone diplomacy a little.” The diplomat spoke on condition of anonymity to discuss the issue publicly.

    Philippine President Rodrigo Duterte publicly said in a news conference on Sunday that China did not ask for anything, as the donations were flown in.

    Meanwhile, opposition legislators in Turkey are accusing Ankara’s leaders of secretly selling out Uyghurs to China in exchange for vaccines after a recent shipment delay. The legislators and the Uyghur diaspora community fear Beijing is trying to win passage of an extradition treaty that could see more Uyghurs deported to China.

    Despite all the worries, the pandemic’s urgency has largely superseded hesitations over China’s vaccines.

    “Vaccines, particularly those made in the West, are reserved for rich countries,” said one Egyptian official, who spoke on condition of anonymity to discuss the matter. “We had to guarantee a vaccine. Any vaccine.”

    ___

    Gelineau reported from Sydney.

    Associated Press researcher Chen Si in Shanghai, and AP reporters Patricia Luna in Santiago, Chile; Sam Magdy in Cairo; Jim Gomez in Manila, Philippines; Niniek Karmini in Jakarta, Indonesia; Aida Sultanova in London; Justin Spike in Budapest, Hungary; Dusan Stojanovic in Belgrade, Serbia; Cara Anna in Nairobi, Kenya; Allen G. Breed in Raleigh, North Carolina; and Diane Jeantet in Rio de Janeiro contributed to this report.

    Above is from: https://apnews.com/article/china-vaccines-worldwide-0382aefa52c75b834fbaf6d869808f51