In December, China announced that it planned to inoculate 50 million people against COVID-19 by Feb. 11. Although it was an ambitious goal, it wasn’t outlandish for a country that seemed to have done better than most in bringing the pandemic under control.
Yet vaccination turns out to be the one virus benchmark where China has fared badly: As of Feb. 22, it had managed just 2.89 doses per 100 people (or 40.5 million shots), according to Bloomberg’s vaccine tracker. By contrast, the United States has administered 19.33 doses for every 100 people (a world-beating 64.18 million).
Manufacturing issues and vaccine export diplomacy have certainly played a role in this underperformance. But a far more important factor is longstanding Chinese concerns over vaccine safety and side-effects. Bloomberg News recently reported that the proportion of employees at Chinese firms it contacted who were interested in getting the shot ranged from one-third to less than half. For China to hit its goals, and achieve herd immunity, it will need to encourage more citizens to get over their fears.
China hasn’t always been so hesitant when it comes to vaccines. Government immunization campaigns dating to the 1950s gained widespread acceptance among a mostly rural citizenry that had long been ravaged by infectious diseases. In the 1970s, investments in rural health care produced historic results: Polio incidence dropped by 77% over that decade and measles by 60%. As of 2019, China’s basic childhood vaccination rate exceeded 90%, among the highest in the world.
Amid the successes, though, there are reasons for concern. One is the corrosive effect of numerous safety scandals dating back a decade. In 2016, the government shut down an illegal vaccine manufacturing ring that had been in operation since 2011 and had sold as many as 2 million improperly stored doses. A survey conducted two months after the incident found that 16% of parents were not vaccinating their children due to it.
Two years later, Changsheng Bio-technology Co., a vaccine manufacturer, was accused of faking data on its rabies vaccine and selling ineffective childhood diphtheria, tetanus and whooping-cough shots. Fines and prison sentences were imposed, but the damage was lasting. A survey following the scandal found that about 70% of respondents lacked confidence in vaccinations, and more than half were dissatisfied with the government’s response.
For months, China has promoted its COVID-19 vaccine development program as proof that its pharmaceutical industry has reached world-class standards. But there’s little evidence that its citizens are primed to agree. Although studies show that most parents still elect to vaccinate their children with the government-recommended (free) vaccines, for example, a majority of those same parents report serious concerns about side-effects (74%), safety (64%), and effectiveness (52%).
Such worries have likely carried over to the COVID-19 vaccine. Interestingly, polling from last year suggested that intent to get the shot was higher in China than anywhere else. But Abram Wagner, an epidemiologist at the University of Michigan who studies Chinese vaccine hesitancy, told me he wasn’t entirely surprised that this hasn’t translated into high vaccination rates.
“It’s very different to be in a survey going,’I want to get a vaccine,’ versus you’re at work and they’re offering a COVID vaccine,” he said.
One factor that may account for the difference is recent reporting on the sale of fake COVID-19 shots. In one case, the authorities broke up a ring of counterfeiters who had sold 58,000 phony doses (netting around $2.8 million). That news alone was likely enough to cause some Chinese to hesitate when faced with a vial and needle.
The good news is that China doesn’t need to be a vaccine laggard, and in the long term it won’t be. Few countries have demonstrated greater success with public-health campaigns in the past; a campaign tailored to countering COVID-19 vaccine hesitancy would likely be just as effective. It would also help if China’s leaders took a more public stand in support of the vaccine, including publicized events at which they get the jab. Doing so would go a long way toward building confidence in the shots, and in the country’s long-beleaguered vaccine companies.
It’s the kind of trust-building exercise that China’s elites don’t generally undertake. But in the midst of a pandemic, it’s surely worth a shot.
Adam Minter is a Bloomberg Opinion columnist.
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