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A worker checks syringes on the production line at Sinovac Biotech in Beijing, China. Photo: TNS

This Week in Asia Health & Environment

China’s coronavirus vaccines: is Southeast Asia ready to trust them?

A soft power victory beckons if Beijing can help nurse its neighbours back to health – but the stakes are high, trust is low and failure would be disastrous
Key to its drive is Indonesia, which has secured doses of three potential vaccines from China. If they work, success could be contagious

Coronavirus vaccine

Resty Woro Yuniar

Published: 9:00am, 14 Nov 2020

Why you can trust SCMP

Fadli Barjadi Kusuma was petrified when he arrived in a grand, leafy building of a university medical school in his hometown of Bandung, Indonesia, in mid August.

The motorcycle-taxi driver was there to take part in the late-stage clinical trial of a Covid-19 vaccine made by Beijing-based Sinovac Biotech.

“I was very scared, because my life was at risk. But I had set my mind to be a volunteer, I knew the risks, so I was finally ready. God willing, I would be fine,” Fadli, 32, said.

Fadli, who learned about the trial from a relative, wanted to volunteer because his job requires physical contact with other people.

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“I want to protect myself and help the government. I am really affected by this pandemic. I can’t set up my own business because I have no money, jobs are scarce so it’s hard just to afford to eat,” said the father of three, who earns about two million rupiah (US$140) a month.

Fadli has received two doses in the vaccine trial. Three months after his second dose, Fadli says he feels great and confident enough to drive the tree-lined streets of Bandung on his two-wheeler.

He has persuaded loved ones to sign up for the trial too – his wife, sister-in-law and her three relatives have received two shots, though his mother and elderly sister weren’t allowed to take part due to high blood pressure.

Indonesia, which has recorded more than 450,000 coronavirus infections and over 15,000 deaths, has become a linchpin in Beijing’s efforts to assure Southeast Asian neighbours that China – rather than Western countries or Russia – should be their first choice to supply them with an effective, trustworthy vaccine. Winning over Southeast Asia’s biggest country and its population of 270 million would put China well on the way to a public relations victory in a region already at the centre of a struggle between Washington and Beijing for influence over the South China Sea and Mekong region.

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For Beijing the early signs have been encouraging. Last month, after meeting Chinese Foreign Minister Wang Yi, Indonesian minister Luhut Pandjaitan – who oversees Chinese investment in the country and is a trusted aide of President Joko Widodo – said Beijing was supporting Jakarta in its attempt to become a regional hub for vaccine production.

China now accounts for four of the 11 vaccine candidates in the final stages of clinical trials around the world. It has also announced it will join Covax, the World Health Organization’s drive to ensure the fair distribution of vaccines worldwide, especially to poorer countries.

Beijing is currently negotiating the launch of final-stage vaccine trials in the Philippines, while promising access to Malaysia and the Mekong countries of Vietnam, Laos, Cambodia, Thailand and Myanmar.

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“In the months to come, China will continue to stand firmly by Asean countries to [provide them with] the vaccines. [All countries] think vaccines will be the final solution to Covid-19,” Deng Xijun, China’s ambassador to Asean, said last month in a webinar by the NGO, Foreign Policy Community of Indonesia.

“China’s vaccines are being proven safe and effective with no serious adverse reactions. And China has made pledges on multiple occasions to provide Asean countries with vaccines on a priority basis, when their development is complete and they are available for use.”

But while the opportunities for the world’s second largest economy to boost its soft power in the region are high, so are the stakes.

Indonesian suspicions towards Beijing have been heightened by the presence of Chinese fishing vessels near the Natuna Islands, in waters Beijing views as part of its traditional fishing grounds but Jakarta sees as within its exclusive economic zone.

Indonesia’s involvement with a Chinese vaccine would therefore provide a great public relations victory for Beijing if it succeeded, said Teuku Rezasyah, an international relations lecturer at Indonesia’s Padjadjaran University.

“If the clinical trials [in Bandung] deliver decent results, China could medically work together with other Asian or African countries and provide vaccines for more countries. But if the trials failed, China’s soft power in Indonesia would tank,” Teuku said.

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Vaccine diplomacy could also help shape views in the Philippines, said Aaron Jed Rabena, a research fellow at the Asia-Pacific Pathways to Progress think tank. Philippine fishing vessels have also had run ins with their Chinese counterparts, while the two countries have a long-running territorial dispute in the South China Sea.

Success with a vaccine might also go some way to combating suggestions that China was somehow to blame for the virus because the Chinese city of Wuhan was where the first confirmed cases were discovered.

“I think China is eager to make up for the negative image that it has got all over the world because of Covid-19,” Rabena said.

FULL STEAM AHEAD

The Bandung trial has gone smoothly so far, continuing even after Brazil temporarily halted its trial this week after the death of a volunteer. It emerged later that the death – a suicide – was not related to the trial, raising suspicions that the delay might have been politically motivated. Brazil’s far-right President Jair Bolsonaro, who has criticised the vaccine “from that other country” and questioned its safety, has previously claimed Brazilians were being used as guinea pigs.

In Indonesia Sinovac has licensed its vaccine to the state-owned pharmaceutical company Bio Farma. Together the firms hope to deliver three million doses by the end of this year and 260 million next year. As each person must receive two shots, this would cover around half of Indonesia’s population.

Indonesia will also become Sinovac’s production hub, giving the firm a springboard to marketing its products throughout the region.

There are 1,620 volunteers in Bandung, half of whom were randomly selected to receive the vaccine, while the rest got a placebo. Since the start of the trial in August, volunteers have been required to return to the medical facility once a month to be checked for adverse effects.

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The clinical trial organiser is expected to deliver its preliminary report in January. This will analyse whether immunogenicity – the vaccine’s ability to provoke an immune response – has been shown in a subset of 540 vaccinated volunteers, said Rodman Tarigan, a spokesman for a clinical trial team at Padjadjaran University that is working with Bio Farma.

The full report, which will analyse the efficacy of the vaccine among all participants, is expected to be published in May 2021, said Rodman.

“I heard there are no major cases of adverse effects in Sinovac’s clinical trials in Bandung, so I think we just need to wait for the efficacy analysis report,” Septian Hario Seto, an official at the Coordinating Ministry for Maritime Affairs and Investment said last month.

In addition to Sinovac, Indonesia has secured pledges from the Chinese vaccine producers CanSino and Sinopharm.

CanSino, based in Tianjin, has pledged to supply 15 million to 20 million doses next year, while Sinopharm has promised 15 million this year and 50 million next year.

But Jakarta has chosen not to put all its eggs in one basket and has also signed a letter of intent for 100 million vaccine doses made by the British firm AstraZeneca, and 30 million doses produced by US company Novavax.

On Friday, Widodo told Reuters he expected to start a mass emergency vaccination process by the end of the year, after the country’s food and drug agency granted its approval for the vaccine. The Sinovac and Sinopharm vaccines are expected to be used in the early stages of the campaign, and health workers, police and military personnel will be the first to get them.

In the Philippines, which has recorded nearly 400,000 infections and more than 7,600 deaths, President Rodrigo Duterte said in September he preferred to purchase vaccines from China and Russia as Western countries were “asking for advance payments”.

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The Philippines is reviewing Sinovac’s application to hold trials in the country. Science and technology secretary Fortunato dela Peña has said these could commence in late November.

The Philippines also hopes to launch clinical trials for Russia’s Sputnik V vaccine. Developers of the Russian vaccine said on November 11 that its efficiency rate was 92 per cent – a claim that came shortly after the American drug maker Pfizer had claimed a rate of 90 per cent for the vaccine it had developed with BioNTech.

ISSUE OF TRUST

Despite encouraging signs, analysts said trials of Chinese vaccines might struggle to attract volunteers in countries that had complicated relations with China.

This was especially so in the Philippines, given its territorial dispute with Beijing over the South China Sea. In 2016 an international tribunal in The Hague backed the Philippines in its case against China, essentially rejecting Beijing’s claims to about 90 per cent of the disputed waters. While Duterte, who took office shortly after the ruling, has played down the dispute in favour of brokering economic ties with Beijing, suspicions about China’s intentions linger among the general public. At the same time, there is also an active anti-vax movement, with misinformation and disinformation campaigns linked to vaccinations for polio and other deadly diseases credited for a plunge in childhood immunisation rates.

Physical therapist Mikaela Abamonga would likely be among the first to get a vaccine in the Philippines as she is a medical frontliner. But the 25-year-old, who works at the Philippine General Hospital in Manila, said she remained wary.

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“I think the vaccine may have been done too fast and would need better and more in-depth research prior to people being inoculated. I am not confident about the Chinese government as they gave the vaccine there even without completing all phases of the trial,” she said, referring to how Sinovac obtained emergency use approval from Chinese authorities to vaccinate high-risk groups, such as medical staff in July.

There are also concerns among the Malaysian public, though Prime Minister Muhyiddin Yassin has said the country hopes to access Chinese vaccines by the end of the year and has boosted the government’s immunisation budget from one billion ringgit (US$241 million) to three billion ringgit. Total infections in Malaysia have tripled to more than 40,000 in the last two months, with many new cases linked to the Sabah state election in late September.

During Thursday’s Asean-China summit, Malaysia’s Foreign Minister Hishammuddin Hussein said Malaysia had expressed its appreciation to China for prioritising it as a vaccine recipient.

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“We are now ready to receive successfully developed Covid-19 vaccines,” he said on Twitter.

But unlike the Philippines and Indonesia, Malaysia has steered clear of signing up for trials of Chinese vaccines.

Dr Adriel Chen, a Malaysian health expert based in Britain, said this was because the country was wary of becoming a “guinea pig” for Chinese pharmaceutical companies.

“There’s growing concern among Asian nations and Malaysia that we’re selling out to China. Readily agreeing to be part of a clinical trial for a vaccine might be part of that slippery slope. The other question is about having skin in the game – so we’ve stuck our necks out for China and exposed our population to the vaccine. Do we get the benefits? Do we get early access to the vaccines at cost?” he asked.

Malaysian Prime Minister Muhyiddin Yassin. Photo: Reuters

Cambodia has been more welcoming and has indicated it would embrace any Chinese vaccine that is approved by the World Health Organization.

“Cambodian people now seem to have more trust in Chinese products and believe in Chinese ability to handle the pandemic well. Thus, the Chinese vaccine should be as good as or even better than the Western one,” said Sovinda Po, a senior research fellow at Cambodian Institute for Cooperation and Peace.

Meanwhile Vietnam, which has been relatively successful in containing the pandemic, is hoping that home-grown vaccines could be commercially available by the last quarter of 2021. Four Vietnamese companies are developing vaccines, including the Ho Chi Minh City-based Nanogen Biopharmaceutical Biotechnology.

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Kelly Vo, 30, who works in a non-profit organisation in Ho Chi Minh City, said she would sign up for the Chinese vaccine as long as she was confident it met internationally-recognised scientific standards.

But Dr Ha Hoang Hop, a visiting senior fellow with the Vietnam Studies Programme at Singapore’s ISEAS-Yusof Ishak Institute said: “People in Vietnam do not feel trusting enough of the Chinese vaccines. They trust home-made vaccines much more.”

NO SILVER BULLET

Epidemiologists caution that vaccines – whoever develops them – are no silver bullet, particularly for countries such as Indonesia that lack proper test-and-trace systems.

Pandu Riono, an epidemiologist at the University of Indonesia, questioned the wisdom of backing three vaccines from the same country, especially when they remained unproven.

“Why did we agree to buy [vaccines] whose efficacy is not yet clear? This will make us lose our focus on strengthening the surveillance system,” Riono said.

Manufacturing the vaccines will also be costly, particularly for Indonesia which has entered recession for the first time in over two decades. The government has said that Bio Farma will need over 45 trillion rupiah (US$3 billion) to produce the 260 million doses of Sinovac’s vaccine.

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On the other hand, successful vaccines would be a shot in the arm for the economy and the government has estimated a half-year delay in delivery would cost Southeast Asia’s largest economy US$44 billion.

Dr Jennifer Bouey, a senior policy researcher and Tang Chair in China Policy Studies at the RAND Corporation said she was not surprised that Indonesia collaborated with China on the human trials. It is one of the few vaccine producing countries in Asia, and operates under a WHO-approved system where its national regulatory authority (NRA) guarantees vaccine quality for the population.

Bouey, who is also an epidemiologist, said the US and major European countries had not shown interest in China’s Covid-19 vaccines possibly because vaccines given to their populations required approval from an internationally recognised Stringent Regulatory Authority (SRA)and thus they rarely accepted medical products that were regulated under an NRA system.

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“China’s vaccine targets the domestic market and developing countries. Whether the local public will accept the Chinese vaccine or not depends on domestic politics,” she said.

For Fadli, the volunteer, and many other Indonesians seeking a return to some sort of normality, the Sinovac vaccine is his biggest hope – at least for now. Indonesia also has plans to mass produce its own vaccine, named Merah Putih after the colours of its flag, though this is not expected to arrive until 2022.

So Fadli has cast aside any lingering suspicions.

“At first I hesitated [to volunteer], because the coronavirus originated from China, and this vaccine is made by China. But after I did some research, I shook off negative thoughts because this vaccine could very well be effective. China was agile and its handling of Covid-19 was proper.”

Additional reporting by Yuli Saputra in Bandung, Elyssa Lopez in Manila, Tashny Sukumaran in Kuala Lumpur, and Sen Nguyen in Ho Chi Minh City

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