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(CNN) Inside a gray warehouse at Shenzhen International Airport in southern China, a row of white chambers sits in a cordoned off corner, each equipped with a display showing the custom temperature inside.
A security worker in a mask, surgical gown and rubber gloves stands guard. Anyone entering this part of the warehouse must complete two weeks of quarantine or wear a protective suit from head to toe.
These climate-controlled rooms, totaling an area of 350 square meters (3,767 square feet), will soon be filled with rows and rows of Chinese-made Covid-19 vaccines, after receiving approval from the country’s drug regulators. From there, they will be loaded into temperature-controlled compartments of cargo planes and flown to continents around the world.
In the coming months, China will ship hundreds of millions of doses of coronavirus vaccines to countries that have conducted late-stage trials for their top candidates. Chinese leaders have also promised a growing list of developing countries with priority access to their successful vaccines.
This global campaign presents China with an opportunity to repair its image, which was damaged by its initial mishandling of the coronavirus outbreak, rather than being blamed for the primary spread of the virus, it can potentially be estimated for helping to end the pandemic. . .
Vaccines can also be used by Beijing as “a foreign policy instrument to promote soft power and project international influence,” said Yanzhong Huang, senior global health researcher at the Washington-based Council on Foreign Relations.
Early in the pandemic, China’s efforts to gain favor by donating masks and other supplies to countries hardest hit by the virus were marred by reports of poor-quality supplies and allegations that Beijing was launching a campaign of misinformation to change the coronavirus narrative.
Beijing’s vaccine diplomacy, Huang said, could give it another chance.
“Vaccine Diplomacy”
China currently has five candidates for the coronavirus from four companies that have reached phase 3 clinical trials, the last and most important testing step before regulatory approval is sought.
Having largely eliminated the coronavirus within their borders, Chinese drug makers had to look abroad for places to test the efficacy of their vaccines. Together, they have implemented phase 3 trials in at least 16 countries.
In return, many of the host countries have been promised early access to successful vaccines and, in some cases, the technological know-how to manufacture them locally.
Sinovac Biotech, a Nasdaq-listed pharmaceutical company based in Beijing, has signed agreements to provide 46 million doses of its Covid-19 vaccine to Brazil and 50 million doses to Turkey. It will also supply 40 million doses of vaccine in bulk (the vaccine concentrate before dividing it into small vials) to Indonesia for local production.
CanSino Biologics, which developed a coronavirus vaccine with a Chinese military research unit, will deliver 35 million doses of its vaccine to Mexico, one of the five host countries for its trials.
China National Biotec Group (CNBG), a unit of state-owned pharmaceutical giant China National Pharmaceutical Group (Sinopharm), has been less open about its deals. The company’s two candidate vaccines are undergoing phase 3 trials in 10 countries, primarily in the Middle East and South America. In the United Arab Emirates, the ruler of Dubai, Sheikh Mohammed bin Rashid Al Maktoum, volunteered to be vaccinated in trials and the vaccine was approved for emergency use. The Emirati company, in partnership with Sinopharm, expects to produce between 75 and 100 million doses next year.
Sinopharm Chairman Liu Jingzhen said last month that dozens of countries have applied to buy the company’s vaccines. He did not mention the countries or elaborate on the number of doses they proposed, but said the CNBG was capable of producing more than 1 billion doses in 2021.
“China not only has the political will (for its vaccine diplomacy), but it also has the strong capacity to make that happen,” Huang said.
Because China has largely contained the virus, there is no urgent need to vaccinate every one of its 1.4 billion people. “That gives it this leverage … to do deals with countries that need the vaccines,” he said.
“Silk Road of Health”
China’s global vaccine campaign is in stark contrast to the Trump administration’s “America First” approach, which focuses on vaccinating its own citizens before those elsewhere.
“So far we have not heard the United States say or suggest that they will use a percentage of their vaccine to support poor countries. That puts China in an even better position to use the vaccine to meet its foreign policy goal,” Huang said. . said.
In October, China joined a global initiative backed by the World Health Organization to ensure the rapid and equitable distribution of Covid-19 vaccines to rich and poor countries alike.
The project, known as COVAX, is designed to deter governments from stockpiling coronavirus vaccines and instead focus on vaccinating high-risk groups in all countries. But it was rejected by the United States, in part because President Donald Trump did not want to work with the WHO, leaving a leadership vacuum in global public health for China to fill.
From the beginning, Chinese leaders have repeatedly emphasized that China’s vaccines are for sharing, especially with the developing world.
In May, Chinese President Xi Jinping told the WHO annual assembly that China would make its coronavirus vaccine a “global public good,” calling it the “country’s contribution to ensuring the accessibility and affordability of the vaccine in developing countries “.
At a video summit with African leaders in June, Xi promised that “once the development and deployment of a Covid-19 vaccine in China is completed, African countries will be among the first to benefit.”
In August, Chinese Premier Li Keqiang said that Beijing would also give priority access to Cambodia, Myanmar, Laos, Thailand and Vietnam. Other countries to which Chinese officials have promised priority access include Afghanistan and Malaysia.
Many of these countries are also in the Beijing Belt and Road Initiative, a multi-billion dollar trade and infrastructure program that has lost some of its steam during the pandemic. Recently, Chinese officials have intensified talks on a “Health Silk Road.” At the WHO meeting in May, Xi pledged to donate $ 2 billion over two years to help countries cope with the pandemic. Beijing has also offered a $ 1 billion loan to Latin America and the Caribbean to access its coronavirus vaccines.
But there are signs that China’s vaccine diplomacy will not always be easy. In Brazil, Sinovac’s vaccine, CoronaVac, has been embroiled in a political dispute between President Jair Bolsonaro, known for his anti-China stance, and Sao Paulo Governor Joao Doria, who is expected to compete against Bolsonaro. in the country’s next presidential election in 2022. In Bangladesh, Sinovac’s trial has stalled due to a funding dispute.
International public health experts have also questioned China’s emergency use program, which inoculated nearly a million Chinese with experimental vaccines before clinical trials proved their safety.
Then there is the question of effectiveness. Last month, Pfizer and Moderna announced that early results showed their vaccines were more than 90% effective, while another candidate jointly produced by the University of Oxford and AstraZeneca had an average effectiveness of 70%. So far, none of the Chinese vaccine candidates have announced preliminary efficacy results, although company executives have repeatedly emphasized their safety, insisting that no serious adverse effects have been observed in the vaccinated volunteers.
Cold storage
Compared to Pfizer and Moderna, Chinese vaccines have a crucial advantage: most of them do not require subzero temperatures for storage, making transport and distribution much easier, especially in developing countries that lack storage capacity. cold.
Kate O’Brien, director of the WHO immunization and vaccines department, compares vaccine development to building a base camp on Everest. “But the rise to the top is really about delivering the vaccines,” he said at a news conference this month.
Both Pfizer’s and Moderna’s vaccines use pieces of genetic material called messenger RNA (mRNA) to drive the body to produce synthetic pieces of the coronavirus and stimulate an immune response, a new technology that has not been used in existing vaccines.
But mRNA is vulnerable to degradation at room temperature. Moderna vaccine should be stored at -20 degrees Celsius (-4 degrees Fahrenheit), or in the refrigerator for up to 30 days, while Pfizer vaccine should be stored at an ultra cold temperature of -75˚C (-103 ˚F) and is used within five days once refrigerated at higher temperatures.
Meanwhile, Sinopharm and Sinovac use an outdated approach that has long proven effective in other vaccines, such as the polio and flu vaccines. Their coronavirus vaccines use an inactivated whole virus to cause the body to develop immunity, and should only be stored at standard refrigerator temperatures of 2 ° C to 8 ° C (36 ° F to 46 ° F). CanSino’s vaccine, which uses a common cold virus called adenovirus 5 to carry genetic fragments of the coronavirus into the body, can also be kept between 2˚C and 8˚C.
Still, the required temperatures must be maintained throughout transportation, from leaving the production facility to storage at the airport and finally to global distribution.
Cainiao, the logistics arm of Chinese e-commerce giant Alibaba, will help with the distribution of Chinese vaccines as soon as they are cleared. It says your end-to-end climate controlled infrastructure is in place and ready.
The company has partnered with Shenzhen Baoan International Airport, which recently received pharmaceutical logistics certification from the International Air Transport Association. In 2019, a cold chain warehouse was built for food and frozen products. Earlier this year, it was converted to store coronavirus test kits, and now vaccines. The airport said on its website that it wants to make Shenzhen a “global distribution base for the Covid-19 vaccine.”
Cainiao is also associated with Ethiopian Airlines, which will ship the Chinese vaccines to the Middle East and then Africa. Since the pandemic, the airline has transported more than 3,000 tons of medical supplies from Shenzhen to Europe, Africa, the Middle East and South America.
But Cainiao is also looking to add more routes for greater global reach, according to its CEO Wan Lin.
“Of course, we are still not quite sure about the exact demand for that, but we are definitely developing our capacity to be prepared for that,” Wan said.
This story was first published on CNN.com. China has promised millions of coronavirus vaccines to countries around the world. And is ready to deliver
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