When Egypt’s health ministry sent out an invitation to doctors to be vaccinated against Covid-19, they neglected to make clear it was a clinical trial.
Instead, it assured them that two Covid-19 vaccines developed by China’s National Biotec Group, part of a state-owned conglomerate known as Sinopharm, had no side-effects and that “the minister of health was vaccinated today, and orders were issued to vaccinate all doctors and workers who wish to be vaccinated”.
Many were sceptical. “When my colleagues and I got that message, none of us participated, as we cannot trust it,” said one worker at a state hospital, who said there was a “lack of credibility” in the government’s approach to the pandemic and the vaccines.
The doctor, who cannot be named to protect their safety, described Egypt’s extensive publicity campaign around the vaccines, featuring a well-known actor driving to a sunlit clinic to get his jab, as “government propaganda intended to boost people’s morale”.
About 3,000 Egyptian volunteers eventually participated in the trial, half the number that researchers wanted. That was in September.
This week, the government says it will start vaccinating medical workers, primarily using Sinopharm’s vaccines, aiming to eventually provide 10m doses .
“It’s now a trade-off between the risk of the virus, especially with the current surge in cases, and the risk of an untrusted vaccine with not enough supporting data at all,” said the doctor.
A lack of transparency from China over data from late-stage trials has raised concerns, but the country is confidently pushing ahead with its “vaccine diplomacy” – using its cheaper options and availability to build bridges with countries in the Middle East and north Africa.
Sinopharm’s two vaccines offer attractive solutions to countries in need of protection against Covid-19. Even with support from Gavi, the vaccine alliance, countries will need to source extra supplies to cover all their citizens and many will struggle.
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For China, Sinopharm’s vaccines represent an added opportunity to strengthen relations and use the Middle East’s manufacturing and distribution capabilities.
Sinopharm’s vaccines are expected to be part of national rollouts in Egypt, Morocco, United Arab Emirates and Bahrain. Both UAE and Bahrain granted emergency approval for their use on frontline workers before clinical trials ended.
Egypt has previously said it wants to become a production centre for the Chinese vaccine in Africa, while Sinopharm is to build a manufacturing plant in Morocco next year. UAE gifted Egypt at least 100,000 free doses as part of its quest to become a “global logistics hub” for distribution. This month UAE became the first country in the world to officially register Sinopharm’s vaccines, stating that one of the inactivated vaccines was found to have an 86% efficacy.
Bahrain also recently announced its own rollout. The kingdom separately approved registration for at least one of Sinopharm’s two vaccines.
Sinopharm and its Emirati partner G42 said 45,000 people participated in phase-3 trials for efficacy and safety, although Sinopharm has yet to release the data. Part of the appeal of Sinopharm’s vaccines is they require storage at the standard 2C-8C (35.6F to 46.4F), in contrast to newer mRNA vaccines, which require a cold storage chain.
“Health systems in all countries are used to systems of storing vaccines at 2C-8C,” said Charlie Weller, head of the Wellcome Trust’s vaccines programme. “Minus-twenty or -70C presents a logistical challenge, not just for lower- and middle-income countries but any country.”
Sinopharm’s chair Liu Jingzhen recently announced that almost 1 million people had received vaccines under an emergency use authorisation. “We have not received any reports of serious adverse reaction, and only a few have some mild symptoms,” he said.
A separate study cited data from Sinopharm’s phase-2 trials that suggested a 19% incidence of adverse reactions after two doses .
Weller stressed that any vaccines administered under emergency-use authorisation do not contribute data to clinical trials. “This is why clinical trials are needed: we need data to be analysed and to understand the efficacy and safety of any vaccine. We heard that many people had this vaccine under emergency use outside a clinical trial, but until we get that trial data we’re not getting any further information from those individuals outside,” she said.
Throughout the summer, leaders across the region were photographed getting their shots, including Dubai’s ruler Mohammed bin Rashid al-Maktoum and Bahrain’s crown prince.
“We’re doing a good thing and everyone is hopeful,” said a hospital doctor in Bahrain’s capital, Manama, who asked not to be named. “A lot of people from Bahrain and even the crown prince participated in the trials. It was a good experience overall; at least I can say I helped somehow.
“I wouldn’t say there’s politics involved, I’d say everyone needs the Covid-19 pandemic to be over, and we’re all in this whether you’re a big guy or a small guy.”
Morocco began a programme this month to immunise 70% of its population after trialling Sinopharm’s vaccines on 600 volunteers and also securing vaccines from AstraZeneca.
“The majority of the vaccines distributed will be Sinopharm,” said Bouchra Medda, director of medicines at the health ministry. “But Morocco is still in negotiations for other types of vaccine, as we don’t know how different brands will complement one another.”
Meddah said Morocco preferred Sinopharm’s vaccines due to their use of the inactivated coronavirus, rather than newer mRNA technology. “This type of inactivated vaccine has been used by humanity for years, for flus and other illnesses. It has a well known and established method of production, which we found extremely reassuring,” she said.
“This [vaccine] will reinforce the historic partnership between Morocco and China ,” said Meddah. “We’re thinking about saving lives, meaning we must find vaccines wherever they are.”
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