One month into the national roll-out of Covid-19 vaccinations for priority groups, foreigners in China are still confused about how and when they can get vaccinated. With only a few countries approving vaccines from China and other nations, they are also struggling with the possible impact on their travel plans. “European citizens in China are asking a lot of questions and they don’t get answers,” said Nicolas Chapuis, the European Union’s ambassador in Beijing. “Some companies only vaccinated the Chinese employees, but not foreigners. Some other companies vaccinated everybody.” Ker Gibbs, president of the American Chamber of Commerce (AmCham) in Shanghai, said the group was also confused about whether a person’s nationality determined whether they qualified for vaccination in the current roll-out. “Some of the high priority industries, like international schools, have been offered the vaccine and there is no distinction between foreign or local passport holders. Then, in other high priority industries, there is a distinction made. We’re a little bit confused about that.” Some countries, such as the United States and France, have no plan at the moment to vaccinate individual citizens in foreign countries and instead advise them to follow local guidelines. The strict quarantine and travel restrictions in China make it difficult for foreigners to travel home or abroad to be vaccinated. In December, China started offering Covid-19 vaccine jabs to people at high risk of infection, such as those working at airlines, ports, hospitals, cold-chain workplaces, and people engaged in jobs to ensure basic city functions – like taxi drivers, market vendors and restaurant staff – with an aim to vaccinate 50 million people before mid-February. So far, more than 22 million doses have been administered, Zeng Yixin, deputy director of the National Health Commission, said on Tuesday. How the Covid-19 vaccines compare and who can get them The current vaccination drive is open to “work entities”, not individual residents, and guidelines do not distinguish between nationalities, but local health authorities appear to be taking different approaches. Some companies in Beijing given the opportunity to register for vaccination can only apply for their Chinese employees. And neighbourhoods that make appointments for people who are about to go overseas register only Chinese nationals, the South China Morning Post found. The Shanghai Health Commission confirmed that the Covid-19 vaccination plan for priority groups did not include foreigners and citizens of Hong Kong, Macau and Taiwan. It said it would need further direction from the central government on vaccination for those groups as the programme expanded. An official in charge of vaccination at a provincial-level centre for disease control and prevention, who declined to be named because he was not authorised to speak to the media, said his province would not exclude foreigners if they were in priority groups, but in practice he had not seen foreigners being given a Covid-19 vaccine. “We are still under emergency use of Covid-19 vaccine and only one product has been approved [for this],” the official said. “The number of doses available is limited so it needs to be prioritised. But once vaccines are approved for a full market launch, they will be available for everyone to take, including foreigners, just like flu vaccines.” According to the foreign ministry, Beijing “attaches high importance to the health of foreign citizens staying in China and has been actively providing assistance to them”. But the ministry did not elaborate when asked about vaccination plans for foreigners. An Italian restaurant chain executive in Beijing’s Chaoyang district who requested anonymity said his foreign staff had not been offered the vaccine but Chinese employees had been vaccinated. He said he would like to get a jab but understood that availability was limited. “At least people I work with have been vaccinated and I am protected in a way, so that’s good. I am hoping I will be vaccinated soon,” the manager said. For foreigners keen to travel, there are concerns about how their plans could be affected by the vaccination roll-out. “Our members in China are not concerned about dropping dead due to Covid-19 in China because of good public health management. Our main concern is how quickly we can get reopened for travel,” said Gibbs from AmCham. “We see that [is] only possible through widespread vaccination and a government policy that links vaccination with travel restrictions, a sort of a vaccine passport system in place.” Travellers also face the possibility of getting vaccinated and then returning a positive antibody test that would cause them to be barred from entering China under the current policy. China requires inbound passengers to present documents to prove double negative results from a nucleic coronavirus test and an antibody test before they go into quarantine for 14 to 28 days, depending on the destination city. “The problem right now is that there’s a lack of coordination between the vaccines and the testing and that’s creating a negative incentive to take the vaccine. In other words, somebody who’s expecting to travel out and back into China might like to get a vaccine, but have a false positive on the test and therefore not be able to travel,” Gibbs said. Wang Bin, an official with the National Health Commission, said earlier this month that China’s prevention and control measures for people entering the country would take vaccinations into account, but she did not elaborate on what changes would be made or when. AstraZeneca vaccine shortage sets Britain and EU on collision course Chapuis said the European Union was keen to find out the Chinese government’s position on recognising vaccines because none of the three vaccines approved for emergency use in China was certified in Europe and vice versa. “What happens if you are vaccinated in China? You go to Europe but the Chinese vaccine is not recognised because it’s not certified. You cannot have two vaccines but one. That’s the problem,” he said. “There needs to be a global concerted effort to virtually recognise [domestic] vaccines and foreign vaccines,” Chapuis said, adding that Chinese vaccines should go through full certification procedures in Europe instead of only the fast track application process for emergency use. A vaccine developed by China National Biotec Group was approved in December for market launch with conditions and approved for emergency use in Hungary. Neighbouring Serbia is already inoculating with CNBG vaccines. The CNBG vaccine and one by Beijing’s Sinovac are being assessed by the World Health Organization for emergency use but they have not applied for emergency use permission from the European Medicines Agency. One approved for emergency use in Europe – a vaccine by Pfizer-BioNTech – is going through human trials in China and will be released by Shanghai Fosun Pharmaceutical through a licence deal, which Chapuis said could be a quick answer. Phase 3 trials have been completed in the United States. “We’re waiting for the certification of the vaccine produced by Fosun in China. That seems to fit everybody,” he said. AmCham, which has reached an agreement with Fosun to supply Covid-19 vaccines to its members once approved, also hopes for more foreign vaccines to be approved in China so there are more options. “I think the more choices and the more information you give, meaning sharing data and making it available for experts to interpret, the more comfortable people are with taking vaccines,” Gibbs said. Additional reporting by Jun Mai