China is reportedly considering using a foreign vaccine as a booster shot for people who have been fully inoculated with Chinese vaccines such as Sinovac and Sinopharm.

According to Caixin, a respected Chinese financial magazine, drug regulators in China have completed an expert panel review of the booster vaccine jointly developed by China's Shanghai Fosun Pharmaceutical (Fosun Pharma) and German company BioNTech. The booster shot, Fosun-BioNTech COVID-19, is now in the administrative review stage.

The report came days after Thailand and Indonesia announced they would switch from doses made in China to Western vaccines.

For Beijing, which has been touting the effectiveness of its vaccines for months and donating and selling doses to low- and middle-income countries eager for protection in an effort often referred to as "vaccine diplomacy," the possibility of a booster shot may be seen as a blow.

"It is implicitly an admission that they are not doing well with their own vaccines," Steve Morrison told VOA Mandarin. Morrison is the senior vice president and director of the Global Health Policy Center at the Center for Strategic and International Studies (CSIS), a Washington think tank.

VOA Mandarin contacted the Chinese Embassy in Washington, D.C., and the Foreign Ministry in Beijing for further comment on the possibility of a booster for Chinese-made vaccines. Embassy staff referred VOA to the two companies as well as "competent authorities in China." VOA did as suggested but received no responses.

Dr. Amesh Adalja, a virologist and an assistant professor at Johns Hopkins Bloomberg School of Public Health, told VOA Mandarin in a virtual online interview that although the data on the Chinese vaccines are not widely available and China has yet to publish its phase 3 data in a peer-reviewed journal, "We've anecdotally seen lower efficacy with Chinese-made vaccines, and that may be prompting the need for a booster."

Shih Shin-ru, director of the Research Center for Emerging Viral Infections and professor at the department of medical biotechnology and laboratory science at Chang Gung University in Taiwan, said a "good" vaccine should be safe and immunogenic (able to produce enough neutralizing antibody) and protect against real infection. At the start of developing any vaccine, scientists cannot know "how good" the vaccine in development might be, she said. But recently, as more studies have been conducted, scientists can correlate immunogenicity to?protection rate, Shih added.

"Therefore, I think scientists in China also realized the fact of low antibody [levels] in the serum of Sinovac or Sinopharm vaccines. Therefore, they may suggest the Chinese government has another shot as a booster," Shih told VOA Mandarin in an email.

According to a World Health Organization study published early last month, in a large phase 3 trial in Brazil, two doses of?the vaccine developed by Sinovac/China National Pharmaceutical Group,?administered 14 days apart, had an efficacy rate of 51% against symptomatic SARS-CoV-2 infection, 100% against severe COVID-19 and 100% against hospitalization, with protection starting 14 days after the second dose.

Earlier this month, the American news outlet CNBC reported that of the six countries worldwide with the highest rates of inoculation, adjusted for population, five countries that relied on vaccines from China showed elevated weekly numbers of COVID-19 cases.

In contrast, real-world data gathered by Israel's Ministry of Health show that the Pfizer-BioNTech vaccine's effectiveness was at least 97% in preventing symptomatic disease,?severe-to-critical disease and death, according to an article on Pfizer's website in March.

The Moderna COVID-19 vaccine had an efficacy rate of 94.1% after two doses, according to U.S. ?Centers for Disease Control and Prevention research published on January 1.

Earlier this month, however, as the delta variant caused an increase in Israel's number of COVID-19 cases, the Ministry of Health announced that the effectiveness of the Pfizer-BioNTech vaccine dropped to 64% against all coronavirus infections from about 95% in May. Israel has more than 852,940 confirmed cases, according to the Johns Hopkins University of Medicine Coronavirus Resource Center, and 6,450 deaths as of Tuesday.

Jin Dong-Yan, a professor at Hong Kong University's School of Biomedical Sciences, said in a phone interview with VOA Mandarin that the plummeting effectiveness of the Pfizer-BioNTech vaccine in the face of variants meant that Chinese vaccine efficacy could drop to well under 50% in preventing infections by new variants. This, he said, would make booster shots "imperative."

Jason Li, a research associate with the East Asia program at the Stimson Center in Washington, told VOA Mandarin in an email that "China's move [to consider a Pfizer booster] could be a positive sign against the worst fears of unproductive 'vaccine diplomacy' competition — at least from the Chinese side" and could indicate that "the Chinese authorities may be putting public health above politics, for now."

On June 2, Wang Wenbin, a spokesperson for China's Ministry of Foreign Affairs,?said during a news conference that China had provided "more than 350 million doses of vaccines to the international community, including vaccine assistance to over 80 countries and vaccine exports to more than 40 countries."

China provided vaccines either by donation or sale to 102 countries in Africa, the Asia-Pacific region, Europe and Latin America, according to a vaccine tracker published by BridgeBeijing.com, a global health advocacy group affiliated with the New York-based Global Health Strategies group. In the Asia-Pacific region, 38 countries have received Chinese vaccines, and in Latin America, 19 countries. In Africa, 35 countries received vaccines from China, but the number of doses was the lowest.

China expert Ian Chong of the National University of Singapore told the BBC that Beijing's push to sell or donate vaccines worldwide had been "an effort to change the narrative away from the fact that infections were first detected in Wuhan, and to show that [China is] a scientific powerhouse."

Health experts expect those countries will need booster shots if China's plan moves forward.

Thailand, which has used Sinovac vaccines, is now experiencing new highs in cases and fatalities. In Indonesia,?where cases are surging, less than 7% of the population of 271 million has been vaccinated, according to Johns Hopkins. Indonesia had placed one of the world's biggest orders for Sinovac vaccines, purchasing 125 million doses.

COVID-19 is taking a devastating toll on medical professionals in Indonesia, where 114 doctors have died so far this month, more than double the number of doctors who died in June, according to a physicians’ network known as the Mitigation Team of the Indonesian Medical Association, or IDI.

The rising number of doctor deaths comes as the government notes that 95% of health workers have received COVID-19 vaccines.

On Sunday, the chief of the mitigation team, Mahesa Paranadipa Maikel, told the press in Jakarta that the doctor monthly death toll is the highest since the start of the pandemic in March of 2020. The record was last set in January 2021, when 65 doctors died.

A total of 545 doctors in Indonesia have died since the beginning of the pandemic. The highest death toll is in East Java with 110, followed by Jakarta with 83 and central Java with 81.

In all of June, 51 doctors died, but that toll has jumped 123% so far this month.

“These numbers might be higher since there are hospitals or clinics that have not reported to us,” said Mahesa.

Most of the doctors who died due to COVID-19 were general practitioners, obstetricians, internists and surgeons. COVID-19 is the illness caused by the coronavirus.

The team also noted that hundreds of others health workers have died as a result of the pandemic, including 445 nurses, 42 pharmacists, 223 midwives and 25 laboratory workers.

Health Minister Budi Gunadi Sadikin says the government has started to use a batch of Moderna vaccines as booster shots to health workers who already received China's Sinovac vaccine. Sinovac is one of seven coronavirus vaccines that have received emergency use approval by the World Health Organization. Studies on the vaccine’s efficacy rate are ongoing, but Sinovac appears to be less powerful against the coronavirus than other COVID-19 vaccines.

Meanwhile, in the past week the number of daily infections among Indonesians has increased to more than five thousand, with more than a thousand new deaths.

Indonesia currently has more than 2.8 million confirmed cases and 72,000 deaths, according to the Johns Hopkins University, which is tracking the global outbreak. Indonesia is the world’s fourth most populous country, with more than 275 million people.

Windhu Purnomo is an epidemiologist who serves on the faculty of public health at Airlangga University. He told VOA that the situation might worsen due to three factors: the slow pace of vaccinations, the failure to curb people's mobility and the spread of the more virulent delta variant.

“We have just got many new vaccines like from the U.S., Japan, etc., so even if we increase the vaccinations program, it is still not optimal,” Purnomo said.

The country can’t impose a lockdown as has happened in other nations, because it doesn’t have the money to pay people to stay home. And the delta variant, which is sweeping the world, is hitting Indonesia hard as well.

“Our burden is too heavy,” he added.

The government imposed strict curbs on movements on July 3 to slow the spread of COVID-19. They include a work-from-home order for non-essential workers and the closure of shopping malls, markets, and all public facilities on the islands of Java, Bali, and 15 other cities across the archipelago.

Luhut Pandjaitan, senior minister who coordinates pandemic restrictions, told VOA on Friday that the government will decide within days whether to extend the timeline for lifting the restrictions, which are set to end on July 20.

“It is not easy and there are several other options. But we will most likely extend it because it’s impossible to reduce or control the spread of the delta variant in two weeks, he said. “But we'll see what happens first.”

Health facilities may break down, the mitigation team warned, because there may be too many people needing care, limited medicine and medical equipment available and a lack of doctors, nurses and other medical staff available to provide care.

“We are worried about the potential of a functional collapse. We must create a mapping to see the capabilities of each local health facility,” said Adib Khumaidi, another leader on the team.

The government says it plans to speed up the opening of a number of field hospitals, as well as mobilize 2,000 doctors and 20,000 nurses to cope with the surge in cases.

Source: Voice of America