Six months ago, China was the biggest exporter of Covid-19 vaccines to developing countries. That was partly down to its huge production capacity, but also because other major vaccine manufacturing countries were less focused on exports.

Most of the Chinese vaccines were supplied through bilateral commercial deals and priority was given to Asia, where Beijing wants to expand its soft power. But China also ramped up donations from late last year - either through bilateral arrangements or the World Health Organization-backed Covax Facility - as the United States too began to donate more doses after its domestic needs were met.

Workers handle a shipment of donated Sinovac doses in Pasay City, the Philippines in December. Photo: Xinhua alt=Workers handle a shipment of donated Sinovac doses in Pasay City, the Philippines in December. Photo: Xinhua>

But this year, the picture has changed. China's vaccine exports - both commercial deals and donations - have dropped sharply since January. Chinese vaccines no longer make up the bulk of supplies in low- and middle-income countries, according to the Unicef Covid-19 Vaccine Market Dashboard and other major vaccine trackers.

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One reason for this is the availability of other vaccines with better efficacy data than the Chinese ones, according to analysts. However, a slump in vaccine exports across the board in March also points to a new situation: developing countries now have more than enough vaccines but their vaccination rates remain relatively low.

All of this is affecting China's vaccine diplomacy, analysts say.

According to British analytics firm Airfinity, overseas deliveries of Chinese vaccines made by Sinopharm, Sinovac and CanSino peaked in November at 235 million doses, with 202.9 million of those commercial deals. By December, shipments of commercial deals had dropped to 89 million doses but the total exports were still high at 199 million - boosted by an increase in deliveries to Covax.

Exports then plunged in the first three months of this year - to 51.6 million doses in January, 36 million in February and 11.5 million in March.

Last year, most of the Chinese vaccines went to developing countries, while mRNA vaccine makers like Pfizer and Moderna mainly supplied to wealthy nations. But in the first three months this year, Pfizer for the first time surpassed Chinese drug makers as the largest supplier to low- and lower middle-income countries, with monthly shipments of 91 million doses in January, 85.7 million in February and 46.6 million in March, UN data shows.

Data from Beijing-based Bridge Consulting, which tracks Chinese vaccine distribution overseas, also shows a significant drop in shipments from China this year. It puts that down to an increase in exports from Pfizer and Moderna and more from India via Covax. In addition, two key buyers of Chinese vaccines - Brazil and Indonesia - have not renewed purchase deals that ended in 2021.

Nicholas Thomas, a professor with City University of Hong Kong, said it was clear from the vaccine approval data that "most countries around the world prefer the Pfizer and AstraZeneca vaccines".

"As Omicron becomes the dominant global strain, it would be only natural that countries would prefer more effective vaccines in order to safeguard their populations," Thomas said.

Many scientists and studies have suggested that while Chinese vaccines are less effective than mRNA and protein ones, they could still reduce deaths and severe illness. But with more options now available, some countries are less likely to choose the Chinese vaccines. That is the case in Africa, according to Oladoyin Odubanjo, a public health doctor and executive secretary of the Nigerian Academy of Science.

"With low coronavirus cases in most African countries, countries are unlikely to buy Chinese vaccines as more and more other vaccines have been made available," Odubanjo said.

Places that were key markets for Chinese vaccines last year - such as Indonesia and the United Arab Emirates - are now seeking to diversify their sources and buying from Western drug makers.

In Brazil, while Chinese vaccine exports have been small, the country has been an important base for Sinovac to expand its presence in South America through cooperation in clinical trials and production. However, Brazil too has diversified its partners to include BioNTech, AstraZeneca and the Mount Sinai Hospital in the US to develop or produce vaccines, based on the Chinese model, according to a report by American think tank the Atlantic Council.

China has the capacity to produce 5 billion doses of Covid-19 vaccines a year. Huang Yanzhong, a senior fellow for global health at the New York-based Council on Foreign Relations, said that should be enough to cover both exports and domestic demand, even as the booster programme is accelerated amid the latest wave of cases.

He said the decline in vaccine exports was partly to do with "efficacy concerns".

"The Omicron variant may create even greater problems for countries dependent on Chinese doses," he said. "But while efficacy concerns may prompt some countries to reconsider Chinese vaccines, it is too early to predict a global rejection."

While efficacy is one issue, another is demand. For the first time, Covax - which aims to ensure poorer countries receive fair and equitable access to Covid-19 vaccines - had more supply than demand in January.

And last week the African Union and Covax even turned down an option to obtain 110 million Moderna doses in the first two quarters, and 332 million in the third and fourth quarters.

With less demand, vaccine exports have fallen worldwide - the total went from 1.55 billion doses shipped in December to 550 million in March, according to UN data.

Jerome Kim, director general of the International Vaccine Institute, said there was an "absorption capacity" problem in many low- and middle-income countries.

"First [having] the logistical capability to get vaccines where they needed to go. Second [having] a sufficiently robust healthcare delivery service to transition from 'vaccines for children' to 'vaccines for all' ... Third, the dimension of demand for vaccination," Kim said.

"We would have expected that people would line up for this, but the perception of risk is not there," he added, referring to vaccine hesitancy in many developing countries.

To address these issues, global vaccine alliance Gavi, which co-leads Covax, said it would turn its focus to capacity-building for inoculation.

"The fact that ... doses are now easily available in large volume represents a triumph of science and manufacturing. It also means that Covax is now able to do what it always planned for; offer lower-income economies a range of options so they can best protect their populations," Gavi said in a written reply.

"Our focus now is to help countries turn vaccines into vaccinations. Many lower-income countries have reached the limits of their capacity to absorb doses and they need urgent support now if they are to build capacity and remove bottlenecks preventing them from being able to protect more people."

A crate of Chinese vaccines is loaded onto a refrigeration truck at the Phnom Penh International Airport in Cambodia last month. Photo: Xinhua alt=A crate of Chinese vaccines is loaded onto a refrigeration truck at the Phnom Penh International Airport in Cambodia last month. Photo: Xinhua>

Some analysts say this new scenario could spell the end for vaccine diplomacy, not just for China.

"I think for the moment the high time of vaccine diplomacy is over - with the exception of countries where supply is still insufficient, which is not the case of Latin America," said Detlef Nolte, a professor who researches Latin America at the German Council on Foreign Relations.

Huang from the Council on Foreign Relations also suggested that if the trend continues, it could be the end for China's vaccine diplomacy.

But that has not stopped Beijing seeking to engage with its neighbours on Covid-19 vaccine supply - in March, President Xi Jinping said China would send another 20 million doses to Cambodia.

"Despite the drop-off, China is still actively pursuing its vaccine diplomacy; indeed - if anything - it is deepening its efforts," said Thomas from CUHK, noting that Xi had pledged to donate another 150 million doses to Southeast Asian countries in November.

"This comes on top of an additional 350 million doses that China has pledged to Central Asian and African states," he said. "Given that China's total vaccine donations to date are only 222 million doses, this is a significant increase in its vaccine commitment."

Additional reporting by Jevans Nyabiage

This article originally appeared in the South China Morning Post (SCMP), the most authoritative voice reporting on China and Asia for more than a century. For more SCMP stories, please explore the SCMP app or visit the SCMP's Facebook and Twitter pages. Copyright © 2022 South China Morning Post Publishers Ltd. All rights reserved.

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