Virus World

Background

Methods

Findings

Interpretation

Ministry of Civil Affairs scraps figure from delayed statistics release, and provinces also appear to be withholding the information, making it harder for public to understand impact of last winter’s Covid-19 surge. China did not release data on the number of cremation services held in the fourth quarter of 2022, blocking from public view a key indicator of death during the country’s first nationwide Covid-19 wave last winter. On the national level, the Ministry of Civil Affairs has scrapped the figure from its quarterly release of national civil affairs data, which was published on June 9. This defied the ministry’s long-time practice, dating back to 2007, of releasing cremation numbers on a quarterly basis. Before 2020, fourth-quarter cremation data was typically released in the first two months of the following year, along with other civil affairs data such as social welfare and marriage registrations. Thouh the time lag for data releases has increased slightly since 2020, when the country was first hit by Covid-19, the most recent release came after a longer-than-average delay of six months after the end of the quarter. Several provincial-level regions also scrapped the release of cremation services data for the fourth quarter of last year.

The new wave goes against the grain of Chinese health officials’ estimate that COVID-19 had peaked in April. L ast week when a Chinese senior health adviser projected 65 million COVID-19 cases per week in China by June, some health experts sounded the alarm. China has been facing a new COVID-19 wave fueled by the XBB variant since April. Data from Zhong Nanshan—a respiratory disease doctor who was among the first to confirm COVID-19’s easy transmissibility—provided a rare insight into how the disease could possibly be spreading in China almost six months after Beijing abruptly ended its draconian zero-COVID strategy. Since pivoting to “living with the virus” policy from early December, the Chinese Center for Disease Control and Prevention stopped updating weekly infections. But the sudden relaxation of anti-epidemic protocols also led to an estimated 37 million new infections a day weeks later. By January, experts said they believed almost 80% of China’s 1.4 billion population had already been infected in this first wave.

For the second wave since April, Zhong’s modeling revealed that the XBB variant is expected to cause 40 million infections weekly by May, going up to 65 million in June. This goes against the grain of Chinese health officials’ estimate that the wave had peaked in April. In Beijing, the number of new infections recorded between May 15 and 21 grew four times in four weeks. While Zhong said vaccines targeting this specific variant will be rolled out soon, the projection of new COVID-19 infections nonetheless frazzled markets. China’s collective immunity has always been in question: a refusal to use foreign-sourced mRNA vaccines meant the public got inoculated against COVID-19 with a jab that proved less effective in preventing infection during early clinical trials, say researchers, and the stringent virus containment protocols restricted the possibility of developing natural immunity. Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations, tells TIME that although only mass testing can detect the true extent of the COVID-19 surge, the population has obtained some immunity from the preceding wave.

Beijing will begin distributing Pfizer's Covid-19 drug Paxlovid to the city's community health centers in the coming days, state media reported Monday. The report comes as the city grapples with an unprecedented wave of infections that has severely strained its hospitals and emptied pharmacy shelves. The state-run China News Service reported Monday that after receiving training, community doctors will administer the medicine to Covid-19 patients and give instructions on how to use them. “We have received the notice from officials, but it is not clear when the drugs will arrive,” it cited a worker at a local community health center in Beijing’s Xicheng district as saying. Paxlovid remains the only foreign medicine to treat Covid that has been approved by China’s regulator for nationwide use, but access is extremely difficult to come by. When a Chinese healthcare platform offered the antiviral drug earlier this month, it sold out within hours. Azvudine, an oral medicine developed by China’s Genuine Biotech, has also been approved. After nearly three years of lockdowns, quarantines and mass testing, China abruptly abandoned its zero-Covid policy this month following nationwide protests over its heavy economic and social toll. The abrupt change in policy has sparked panic buying of fever and cold medicines, leading to widespread shortages, both at pharmacies and on online shopping platforms. Long lines have become routine outside fever clinics and hospital wards overflowing with patients in the capital Beijing and elsewhere in the country.

On Monday, Chinese state media CCTV quoted President Xi Jinping as saying the country needed a more targeted health strategy to protect people’s lives as the Covid situation in China changes. “Xi Jinping emphasized that our country is currently facing a new Covid outbreak situation and new responsibilities, we need to conduct our patriotic health movement in a more targeted manner,” the CCTV report said. It was one of the first public statements made by Xi about China’s Covid situation since the government’s decision to ease its strict restrictions. An emergency room doctor in Beijing told the state-run People’s Daily on Thursday that four doctors on his shift did not have time to eat or drink. “We have been seeing patients nonstop,” he said. Another emergency room doctor told the newspaper he had been working despite having developed fever symptoms. “The number of patients is high, and with fewer medical staff, the pressure is multiplied,” said the doctor. In a sign of the strain on Beijing’s medical system, hundreds of health professionals from across China have traveled to the city to assist medical centers.

As the capital, Beijing has some of the best medical resources in the country. However, the abrupt zero-Covid u-turn has left people and health facilities ill-prepared to deal with a surge in infections. China’s official Covid case count has become meaningless after it rolled back mass testing and allowed residents to use antigen tests and isolate at home. It has stopped reporting asymptomatic cases, conceding it was no longer possible to track the actual number of infections. According to an internal estimate from the National Health Commission, almost 250 million people in China have caught Covid in the first 20 days of December – accounting for roughly 18% of the country’s population. Experts have warned that as people in big cities return to their hometowns for the Lunar New Year next month, the virus could sweep through China’s vast rural areas, where vaccination rates are lower and medical resources are severely lacking.

Nearly 37 million people in China may have been infected with Covid-19 on a single day this week, according to estimates from the government’s top health authority, making the country’s outbreak by far the world’s largest. As many as 248 million people, or nearly 18% of the population, likely contracted the virus in the first 20 days of December, according to minutes from an internal meeting of China’s National Health Commission held on Wednesday, confirmed with people involved in the discussions. If accurate, the infection rate would dwarf the previous daily record of about 4 million, set in January 2022...

Scientists hope the immunizations, delivered through the nose or mouth, will prevent even mild cases of illness.  Two needle-free COVID-19 vaccines that are delivered through the nose or mouth have been approved for use in China and India. China’s new vaccine, announced on Sunday, is inhaled through the nose and mouth as an aerosolized mist, and India’s, announced on Tuesday, is administered as drops in the nose. These mucosal vaccines target thin mucous membranes that line the nose, mouth and lungs. By prompting immune responses where SARS-CoV-2 first enters the body, mucosal vaccines could, in theory, prevent even mild cases of illness and block transmission to other people — something COVID-19 shots have been unable to do. Vaccines that produce sterilizing immunity would be game changing for the pandemic.  “These approvals validate the need for mucosal vaccines,” says Marty Moore, co-founder of Meissa Vaccines in Redwood City, California, which is developing a COVID-19 immunization that is delivered through the nose. “That’s the direction we need to go globally, and the United States needs to catch up.” The regulatory nods from China and India bring the number of approved COVID-19 mucosal vaccines in the world to four, including one already approved in Iran and another in Russia. More than 100 mucosal vaccines against the disease are in development globally, and about 20 have reached clinical trials in humans, according to Airfinity, a health-analytics company in London. Delivery methods include sprays, drops, aerosols and pills.

New arrivals

China’s inhaled vaccine, developed by CanSino Biologics in Tianjin, contains the same ingredients as the company’s COVID-19 shot that is already available in the country. A device called a nebulizer turns the liquid vaccine into an aerosol spray that is inhaled. China’s health department and National Medical Products Administration approved the vaccine to be used as a booster dose. India’s vaccine, developed by Bharat Biotech in Hyderabad, is approved as a two-dose primary inoculation, rather than a booster. Both companies have produced ‘viral vector’ vaccines that use a harmless adenovirus to deliver SARS-CoV-2 genetic material into host cells. Neither company has published phase III clinical-trial data, but both say they have completed those studies. Data from a phase II trial of CanSino’s inhaled vaccine found that, when given as a booster, the vaccine raised blood-serum antibody levels significantly more than did a boost from an injection. This suggests that the inhaled vaccine will offer protection that is as good as, or better than, that provided by the shot. Similarly, Bharat compared its intranasal vaccine to Covaxin, a COVID-19 jab available in India, by measuring antibody levels in the blood. The company did not release results of this study, but deemed the trial “successful”. Exactly how successful these vaccines will be is unclear. Expecting a vaccine to stop transmission of a virus or prevent even mild illness — achieving what is called sterilizing immunity — is a high bar. Bharat and CanSino won’t know whether their vaccines can achieve this until they have conducted further efficacy studies. Scant data are available on the efficacy of the two other mucosal COVID-19 vaccines. Iran approved a COVID-19 vaccine administered as a nasal spray and made by Razi Vaccine and Serum Research Institute in Karaj in October 2021. More than 5,000 doses have been delivered to the public. And Russia’s health ministry is reported to have approved an intranasal-spray version of Sputnik V, the country’s injected COVID-19 vaccine. Mucosal vaccines have been developed for other diseases, including polio, influenza and cholera. Most of these vaccines are taken orally, and one, against flu, is administered through the nose.

SHANGHAI, March 27 (Reuters) - China's financial hub of Shanghai said on Sunday it would lock down the city in two stages to carry out COVID-19 testing over a nine-day period, after it reported a new daily record for asymptomatic infections. Authorities said they would divide Shanghai into two for the exercise, using the Huangpu River that passes through the city as a guide. Districts to the east of the river, and some to its west, will be locked down and tested between March 28 and April 1. The remaining areas will be locked down and tested between April 1 and 5. Public transport, including ride-hailing services, in these areas will be suspended when they are locked down, the city government said on its official WeChat account, adding that unapproved vehicles will not be allowed on the roads. It also said that all firms and factories will suspend manufacturing or work remotely during the lockdown, apart from those involved in offering public services or supplying food.

"The public is asked to support, understand and cooperate with the city's epidemic prevention and control work, and participate in nucleic acid testing in an orderly manner," the government added. Shanghai has battled a new COVID-19 surge for nearly a month and for Saturday it reported its highest daily number of cases since the initial outbreak in China receded. The city recorded 2,631 new asymptomatic cases, which accounted for nearly 60% of China's total new asymptomatic cases that day, plus 47 new cases with symptoms. While the number of cases in Shanghai remains modest by global standards, the city of 26 million people has become a testing ground for China's "zero-COVID" strategy as it tries to bring the highly infectious Omicron variant under control. Shanghai authorities have previously resisted a broad lockdown of the city to avoid destabilising its economy and opted for a more bespoke "slicing and gridding" approach, which involves screening neighbourhoods one by one.

Different choices that were available and plausible could have been made at several crucial turning points.  Zeynep Tufekci's Latest:  Dive deep into the internet, technology, politics and society with Zeynep Tufekci's latest column as soon as it’s published. This article is part of Times Opinion’s reflection on the two-year mark of the Covid pandemic. Read more in a note from Alexandra Sifferlin, Opinion’s health and science editor, in our Opinion Today newsletter.

Four-fifths of symptomatic cases develop fevers, more than in earlier outbreaks. The findings match trends in other countries where the Delta variant is spreading.  As the Delta variant of the coronavirus spreads in southeastern China, doctors say they are finding that the symptoms are different and more dangerous than those they saw when the initial version of the virus started spreading in late 2019 in the central city of Wuhan. Patients are becoming sicker and their conditions are worsening much more quickly, doctors told state-run television on Thursday and Friday. Four-fifths of symptomatic cases developed fevers, they said, although it was not clear how that compared with earlier cases. The virus concentrations that are detected in their bodies climb to levels higher than previously seen, and then decline only slowly, the doctors said. Up to 12 percent of patients become severely or critically ill within three to four days of the onset of symptoms, said Guan Xiangdong, director of critical care medicine at Sun Yat-sen University in the city of Guangzhou, where the outbreak has been centered. In the past, the proportion had been 2 percent or 3 percent, although occasionally up to 10 percent, he said. Doctors in Britain and Brazil have reported similar trends with the variants that circulated in those countries, but the severity of those variants has not yet been confirmed.

The testimonies from China are the latest indication of the dangers posed by Delta, which the World Health Organization last month labeled a “variant of concern.” First identified this spring in India, where it was blamed for widespread suffering and death, Delta has since become the dominant variant in Britain, where doctors suggest that it is more contagious and may infect some people who have received only one of two doses of a Covid-19 vaccine. China has uniquely detailed data, however, because it has essentially universal testing in the vicinity of outbreaks, allowing officials to gather detailed information on the extent of cases. Delta’s spread in southeastern China focuses more attention on the effectiveness of China’s self-made vaccines. The Chinese authorities have not indicated how many of the new infections have occurred in people who had been vaccinated. In some other countries where Chinese-made vaccines are in wide use, including the Seychelles and Mongolia, infections among vaccinated people are rising, although few patients have reportedly developed serious illness. Nearby Shenzhen had a handful of cases last week of the Alpha variant, which first emerged in Britain.

As some other parts of the world still struggle to acquire and administer large numbers of coronavirus tests, southeastern China has used its local production of scarce chemicals to conduct testing on a remarkable scale. The authorities said that they had conducted 32 million tests in Guangzhou, which has 18 million people, and 10 million in the adjacent city of Foshan, which has seven million.

Guangzhou has also isolated and quarantined tens of thousands of residents who had been anywhere near those infected. The testing and quarantine appear to have slowed but not stopped the outbreak. China’s National Health Commission announced on Friday that nine new cases had been found in Guangzhou the previous day. “The epidemic is not over yet, and the risk of virus transmission still exists,” said Chen Bin, deputy director of the Guangzhou Municipal Health Commission.

By Tuvan Gumrukcu and Ali Kucukgocmen ANKARA (Reuters) -A COVID-19 vaccine developed by China's Sinovac Biotech is 91.25% effective, according to interim data from a late-stage trial in Turkey, a potentially much better result than reported from a separate trial of the vaccine in Brazil.  Researchers in Brazil, which is also running a final Phase III trial of the vaccine, said on Wednesday the shot was more than 50% effective, but withheld full results at the company's request, raising questions about transparency. Turkish researchers said on Thursday no major side-effects were seen during their trial, apart from one person who had an allergic reaction. Common adverse effects caused by the vaccine were fever, mild pain and slight fatigue, they said.  The Turkish trials began on Sept. 14 and have included more than 7,000 volunteers, the researchers said, adding the results announced on Thursday were based on data from 1,322 people. 

Sinovac is the first Chinese vaccine maker to release details from late-stage clinical trials, following positive results from rival products developed by Pfizer, Moderna and AstraZeneca last month. The Turkish researchers, speaking alongside Health Minister Fahrettin Koca, said 26 of the 29 people who were infected during the trial were given placebos, adding the trial would continue until 40 people become infected. "We are now certain that the vaccine is effective and safe (to use) on Turkish people," Koca said, adding Ankara would use the data for licensing the vaccine.  He also said that researchers initially planned to announce the results after 40 people were infected, but that the findings showed the volunteers had minimal adverse effects after the shot and that it was therefore deemed safe. "Despite it being risky, we saw a very light picture where three people's PCR (COVID test) were positive, with no fever or respiratory problems... We can easily say that despite it being risky, those three people went through it very lightly," he said.

SHIPMENTS ARRIVE MONDAY

Turkey had agreed to buy 50 million doses of Sinovac's shot and receive delivery by Dec. 11 but the shipment was delayed. Koca said three million doses would arrive on Monday, adding that Turkey would vaccinate some nine million people in the first group, starting with health workers. Sinovac has also signed supply deals for its vaccine, called CoronaVac, with countries including Indonesia, Brazil, Chile and Singapore, and is negotiating with the Philippines and Malaysia. CoronaVac has been given to tens of thousands of people under an emergency use programme China launched in July targeting specific groups of high-infection risks. CoronaVac is based on traditional vaccine technology that uses inactivated coronavirus that cannot replicate in human cells to trigger an immune response. Vaccines developed by Pfizer/BioNTech and Moderna use a new technology called synthetic messenger RNA (mRNA) to activate the immune system against the virus and require far colder storage. Pfizer's treatment is the first fully tested COVID-19 shot to be administered, with rollout already under way in Britain and the United States Koca said Turkey would sign a deal with Pfizer/BioNTech for 4.5 million doses of their vaccine to be delivered by the end of March, with an option to buy a further 30 million doses later. On Thursday, Turkey's death toll from the coronavirus rose by 254 to 19,115, according to Health Ministry data, while the total number of COVID-19 infections rose by 18,102.

A Chinese virologist and whistleblower on Monday (Sept. 14) followed through on her pledge to release a paper explaining how the genome of the Wuhan coronavirus (COVID-19) indicates that it was constructed in a Chinese lab rather than naturally occurring. For the past few months, Yan Li-Meng (閻麗夢), a virologist employed as a researcher at the University of Hong Kong's School of Public Health when the coronavirus pandemic began, has been alleging that the coronavirus came from a Chinese lab and that it is a chimera based on the "Zhoushan bat coronavirus." According to Yan, an examination of the genome sequences released by the Chinese government on Jan. 14 also shows that the Zhoushan ZC45 and ZXC21 strains are the closest to SARS-CoV-2 and that they are the "backbone" upon which COVID-19 was constructed. In August, Yan claimed that she and her team had produced a scientific report that shows the origin of COVID-19 is the "PLA-owned Zhoushan bat coronavirus." She stated that she planned to release the report in the near future, and accused the World Health Organization (WHO) of "covering up numerous lies for the CCP."

On Monday, Yan released the report on the data platform Zenodo with the title "Unusual Features of the SARS-CoV-2 Genome Suggesting Sophisticated Laboratory Modification Rather Than Natural Evolution and Delineation of Its Probable Synthetic Route." Zenodo is a general open access repository developed under the European OpenAIRE project and operated by the European Organization for Nuclear Research (CERN), allowing researchers to store data, software, reports, and any research-related tools. In the abstract, Yan's team pointed out that despite the fact that COVID-19 (SARS-CoV-2) has claimed the lives of over 900,000 people and devastated the global economy, the origin of the virus remains a mystery and highly controversial. The theory that the virus originated in nature is widely accepted, despite the lack of solid evidence, while suggestions that the disease may have come from a laboratory have been strictly censored from scientific journals, according to the report. The paper pointed out that the biological characteristics of SARS-CoV-2 are not consistent with a naturally occurring zoonotic virus. The researchers assert that the genomic, structural, medical, and literaty evidence presented in the paper strongly contradicts the natural origin theory.

As previously mentioned by Yan, the researchers claim that evidence provided in the report point to the ZC45 and ZXC21 bat coronaviruses as the model or base for the chimera that became SARS-CoV-2. Furthermore, the authors postulate that the steps needed to produce the virus synthetically in a laboratory can be achieved in "approximately six months." The scientists then call for an independent investigation into China's virology laboratories, particularly gain-of-function research carried out at the Wuhan Institue of Virology (WIV). In Part 1 of the paper, the scientists provide evidence that the SARS-CoV-2 was subjected to in vitro manipulation. First, it states that the genomic sequence of the virus is strikingly similar to that of a bat coronavirus found by People's Liberation Army (PLA) labs in the Third Military Medical University in Chongqing, China, and the Research Institute for Medicine of Nanjing Command in Nanjing, China. Second, it shows that the receptor-binding motif (RBM) found in the virus's notorious spike protein is "suspiciously" similar to SARS-CoV from the 2003 SARS outbreak, indicating it was genetically modified. Third, the spike protein of the virus contains a unique furin cleavage site that is "completely absent in this particular class of coronaviruses found in nature," while the rare codons seen in this sequence suggest that it could have been inserted into the genome artificially.

Regarding the "Zhoushan bat virus," the team wrote that ZC45 and ZXC2 have the highest sequence identity with SARS-CoV-2. In terms of similarity between ZC45/ZXC2 and SARS-CoV-2, the genome is 97 percent identical, the nucleocapsid protein is 94 percent identical, the membrane protein is 98.6 percent identical, and the S2 portion (2nd half) of the spike protein is 95 percent identical. The paper emphasized that the Orf8 protein is 94.2 percent identical, while the E protein is 100 percent identical. The Orf8 is highly unusual in coronaviruses, while no other known coronaviruses share 100 percent of the E protein with SARS-CoV-2 besides ZC45/ZXC2. The study excludes the RaTG13 virus submitted by WIV scientist Shi Zhengli, also known as "Bat Woman," because recent research has shown that its spike protein cannot bind to the angiotensin-converting enzyme 2 (ACE2) of two types of horseshoe bats, the alleged natural host, indicating that it may be "fabricated to shift the attention away from m ZC45/ZXC2.

In Part 2 of the paper, the researches describe how SARS-CoV-2 could be designed and "created conveniently" in laboratories using the ZC45/ZXC2 viruses as the backbone. The scientists postulate that Step 1 consisted of replacing the RBM with a "designed and possibly optimized RBM" using that of SARS-CoV as a guide to enable it to bind with the human angiotensin-converting enzyme 2 (hACE2). The authors pointed out that Shi, along with long-term partner and structural biology specialist Fang Li, had successfully modified the RBM in this way. The report estimates that this first phase would take about one and a half months. Step 2 would consist of engineering a furin cleavage site at the S1/S2 junction of the spike protein. According to the researchers, this short stretch of gene sequence can be "conveniently inserted" using a number of standard cloning techniques, such as "QuikChange Site-Directed PCR60, overlap PCR followed by restriction enzyme digestion and ligation91, or Gibson assembly." The authors stated that none of these methods would leave any trace in the sequence. This further modification of the spike, including the furin-cleavage site, could be completed in "no more than two weeks," according to the report.

Step 3 could be carried out simultaneously with the previous steps and would consist of acquiring an ORF1b gene that holds the RdRpgene segment from RaBtCoV/4991, a bat coronavirus discovered in 2013. The authors believe that that the Chinese virologists wanted the RdRp protein either to ensure that the resulting chimera would be classified in different groups/sub-lineages than ZC45/ZXC2 in phylogenetic studies or to test antiviral drugs. Step 4 would involve using reverse genetics to produce the chimera and recover live viruses within the course of two weeks. The authors cited an example of how a Swiss team was able to reconstruct the entire SARS-CoV-2 genome using transformation-assisted recombination in yeast within a single week. Significantly, this method has been available since 2017 and "would not leave any trace of artificial manipulation in the created viral genome." The paper also mentioned that the WIV has used alternative methods of reverse genetics in the past.

Step 5, and the final step in the process, is to optimize the virus for its hACE2 binding affinity (ability to infect humans) with experiments on live animals. This normally consists of infecting rodents, such as hACE2 transgenic mice (hACE2-mice), with the virus and extracting the highest viral load from 10 to 15 rounds of passage to obtain the strain with the optimal hACE2-binding affinity. However, the authors of this report postulate that the Chinese scientists failed to use a "proper animal model" when testing the transmissibility of the virus. If they had, the scientists say the highly contentious nature of SARS-CoV-2 would have been obvious and the early claims of "not causing human-to-human transmission" would have not been made at the start of the pandemic. The researchers suggest that "extensive laboratory-adaption" geared toward augmented transmissibility and lethality "may have driven the virus too far." The scientists believe that the virus might have lost the "capacity to [attenuate] both transmissibility and lethality during its current adaptation in the human population," as evidenced by the lack of attenuation by the virus despite its extensive spread globally and the emergence of a variant with "improved transmissibility."

Manuscript uploaded to Zenodo (Sept. 14, 2020):

https://zenodo.org/record/4028830#.X2D30dNKht8

China on Wednesday approved the first phase of human testing for a nasal spray vaccine, the first trial vaccine for the coronavirus that does not require a needle injection. The spray vaccine was co-developed by researchers at Xiamen University and Hong Kong University with the aid of vaccine maker Beijing Wantai Biological Pharmacy Enterprise, Bloomberg reported.  Previously, the intranasal spray method has been used to administer flu vaccines for people seeking an alternative to injections.  The latest vaccine marks the 10th candidate from China to enter human trials.

The announcement comes as the U.K.-headquartered company AstraZeneca was forced to pause late-stage human trials of a potential coronavirus vaccine after a spinal cord illness was detected in a patient who received the shot. Advanced Chinese vaccine developers such as CanSino Biologics and state-operated China National Biotec Group have reassured their product's efficacy amid setbacks experienced by AstraZeneca. CanSino said its shot has been safe in trials and has not caused severe side effects. An obstacle CanSino faces, however, is getting other nations to allow trials abroad. Critics are skeptical about the Chinese-made vaccine because it allegedly triggers fewer antibodies than other products currently under trial analysis, Reuters reported. Zhu Tao, CanSino's co-founder and chief scientific officer, defended the company's vaccine against criticism, saying last week that the variation in antibody readings was due to different measuring methods.

One-third of passengers aboard a bus were infected by a fellow passenger, scientists reported. In late January, as the new coronavirus was beginning to spread from China’s Hubei Province, a group of lay Buddhists traveled by bus to a temple ceremony in the city of Ningbo — hundreds of miles from Wuhan, center of the epidemic. It was a sunny day with a gentle breeze, and the morning service was held al fresco, followed by a brief luncheon indoors. A passenger on one of the buses had recently dined with friends from Hubei. She apparently did not know she carried the coronavirus. Within days, 24 fellow passengers on her bus were also found to be infected. It did not matter how far a passenger sat from the infected individual on the bus, according to a study published in JAMA Internal Medicine on Tuesday. Even passengers in the very last row of the bus, seven rows behind the infected woman, caught the virus. The only factor that may have mitigated the risk of infection was sitting near a window that could be opened, or near the door.

The incident adds to a large body of evidence indicating that the coronavirus can be transmitted by tiny particles that linger in the air, and not just through large respiratory droplets that fall quickly to the ground. The World Health Organization acknowledged the virus may be airborne in July and that these particles may seed superspreader events in closed spaces like restaurants and workplaces. The new study “adds strong epidemiological evidence that the virus is transmitted through the air, because if it were not, we would only see cases close to the index patient — but we see it spread throughout the bus,” said Linsey Marr, a professor of civil and environmental engineering at Virginia Tech and a leading expert on airborne viruses.  The two buses carrying passengers to the event had cooling units that were recirculating air inside the vehicles. “That would facilitate the virus in the air and spread it around the bus,” Dr. Marr said. None of the 60 passengers on the second bus was infected.

Dr. Muge Cevik, an expert on infectious diseases and virology at the University of St. Andrews School of Medicine in Scotland, said that the outbreak was likely caused by a combination of factors: a long trip, a confined environment, a crowded bus and an individual who was probably extremely contagious because she was in the early stages of the infection. “There isn’t really a dichotomy between aerosol and droplet transmission,” Dr. Cevik said. “There have to be multiple things happening at the same time for this type of high risk transmission to occur. This was the wrong place, the wrong time, the wrong person.” The study’s authors, who are physicians with the Chinese Center for Disease Control and Prevention, concluded that “future efforts at prevention and control should consider the potential for airborne spread of Covid-19.” The study was published previously online as a preprint. The outing to the Buddhist temple was what scientists refer to as a natural experiment. It took place on Jan. 19, when there were still no confirmed Covid-19 cases reported in Ningbo. The circumstances conveniently allowed for a comparison between similar passengers on two different buses. Some 300 people attended the temple ceremony, but only 128 made the 50-minute trip by bus. One bus carried 68 passengers, including the individual who was infected, while the second bus carried 60 people. None of the worshipers wore masks. The paper in JAMA Internal Medicine does not describe the infected individual and says the person did not have symptoms until the after returning from the temple. But a version of the study published in China says the individual was a 64-year-old woman and that she developed symptoms on Jan. 18, a day after dining with guests from Hubei and a day before going to the temple. She took medicine but did not see a doctor...

Study published in JAMA (Sept. 1, 2020):

https://doi.org/10.1001/jamainternmed.2020.5225 

A U.S. House of Representatives panel yesterday released evidence that a Chinese research team submitted a SARS-CoV-2 genome to a U.S. database on 28 December 2019, nearly 2 weeks before a sequence from another group became public and kick-started the race to develop vaccines and drugs for COVID-19. The revelation, first reported by The Wall Street Journal, renewed allegations that Chinese officials tried to cover up early sequences of the new coronavirus. Lawmakers said the new information also raises the question of whether the U.S. National Institutes of Health’s (NIH’s) GenBank database should somehow flag submissions of pathogen sequences with urgent public health importance. The agency had marked the researcher’s submission as incomplete and deleted the sequence before it became public. The never-completed GenBank submission was “a huge missed opportunity” to start developing drugs, diagnostics, and vaccines earlier, agrees virologist Jeremy Kamil of Louisiana State University Health Shreveport.

CHENGDU, China, June 8, 2023 /PRNewswire/ -- On June 8th, 2023, Coviccine® Trivalent XBB.1.5-Recombinant COVID-19 Trivalent (XBB.1.5+BA.5+Delta) Protein Vaccine (Sf9 cell) developed by WestVac Biopharma/ West China Medical Center, Sichuan University was approved for EUA by relevant authorities in China. This is the first COVID-19 vaccine in the world approved for EUA against XBB descendent lineages of SARS-CoV-2. It demonstrates that China is leading the world in the development of COVID-19 vaccines. WestVac Biopharma and its subsidiary company WestVac Biopharma (Guangzhou) leveraged the rapid response of the insect cell expression platform on constructing the vector for Coviccine® Trivalent XBB.1.5-Recombinant COVID-19 Trivalent (XBB.1.5+BA.5+Delta) Protein Vaccine (Sf9 Cell), which is of high purity and high quality for human use. The subunit vaccine antigen is precisely designed based on the structure of the targeting S-RBD and HR proteins of the COVID-19 subvariants XBB.1.5 and BA.5 and self-assembled into stable trimeric protein particles with squalene-based oil-in-water emulsion adjuvant added after purification and mixing. This novel adjuvant significantly raises the titer of neutralizing antibodies, which enables the trimeric protein vaccine to induce a higher level T-cell immune response. Studies have shown that Coviccine® Trivalent XBB.1.5 induced a high titer of neutralizing antibodies against multiple subvariants, including Omicron subvariants XBB.1.5, XBB1.16, XBB1.9.1, XBB.2.3, BA.5, BF.7, BQ.1, BA.2.75. 14 days after injection of this product, the protective efficacy against XBB.1, XBB.1.5, XBB1.9 is 93.28% with an excellent safety profile, demonstrating that it is a broad-spectrum COVID-19 vaccine against multiple prevalent subvariants locally and internationally.

The XBB.1.5 variant had gradually become the major circulating variant in various parts of the world by the beginning of 2023. With the professional guidance and support from the State Council's Joint Prevention and Control Mechanism's vaccine R&D team, the scientific team of WestVac Biopharma/West China Medical Center, Sichuan University overcame all hurdles and successfully developed a vaccine covering XBB family of variants. Early May, China CDC expert noticed that the transmission and immune escape capability of XBB variants is much stronger than that of the early circulating Omicron variants. The XBB.1 descendent lineages currently predominate SARS-CoV-2 circulation globally. As of the end of May, XBB family of variants accounted for 98.1% of all variants in the United States. In China, newly detected XBB variants have increased gradually and now exceed 90%. The WHO Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC) advised on May 18 that new formulations of COVID-19 vaccines should aim to induce antibody responses that neutralize XBB descendent lineages. The rate of "second infection" is rising. Experts urge prompt prevention, immunization against COVID-19, particularly for people with high-risk infection, the elderly, people with underlying diseases and those who are immunocompromised to get a vaccine covering SARS-CoV-2 variants. WestVac Biopharma uses the international advanced insect cell recombinant protein vaccine platform to develop Coviccine® Trivalent XBB.1.5 which has been approved for EUA in China. WestVac's COVID-19 vaccine offers a unique option for COVID-19 prevention, is crucial for the prevention of the current XBB descendent lineages and contributes significantly to the ongoing management of the COVID-19 epidemic.

About WestVac Biopharma

WestVac Biopharma Co., Ltd. is an innovative biopharmaceutical company, capable of doing the full spectrum of research, manufacturing, and commercialization of products. WestVac Biopharma has been selected successfully on the list of unicorn companies from 2021 to 2023. WestVac Biopharma Co., Ltd. is located in Chengdu of West China while WestVac Biopharma (Guangzhou), a wholly-owned subsidiary company of WestVac Biopharma., is located in Guangzhou Economic Development Zone. WestVac Biopharma Co., Ltd. has completed construction of 5,000-litre and 3,000-litre insect cell recombinant protein vaccine production lines with an annual production capacity of 100 million doses. The GMP production lines were well established with the "Drug Production License" in place. WestVac Biopharma (Guangzhou) has completed scale-up construction of insect cell recombinant protein vaccine production lines with an annual production capacity of 100 million doses. In December 2022, Coviccine®-Recombinant COVID-19 Vaccine (Sf9 cell) developed by WestVac Biopharma was approved by relevant authorities for EUA in China.

Genetic samples from the market were recently uploaded to an international database and then removed after scientists asked China about them. An international team of virus experts said on Thursday that they had found genetic data from a market in Wuhan, China, linking the coronavirus with raccoon dogs for sale there, adding evidence to the case that the worst pandemic in a century could have been ignited by an infected animal that was being dealt through the illegal wildlife trade. The genetic data was drawn from swabs taken from in and around the Huanan Seafood Wholesale Market starting in January 2020, shortly after the Chinese authorities had shut down the market because of suspicions that it was linked to the outbreak of a new virus. By then, the animals had been cleared out, but researchers swabbed walls, floors, metal cages and carts often used for transporting animal cages. In samples that came back positive for the coronavirus, the international research team found genetic material belonging to animals, including large amounts that were a match for the raccoon dog, three scientists involved in the analysis said. The jumbling together of genetic material from the virus and the animal does not prove that a raccoon dog itself was infected. And even if a raccoon dog had been infected, it would not be clear that the animal had spread the virus to people. Another animal could have passed the virus to people, or someone infected with the virus could have spread the virus to a raccoon dog. But the analysis did establish that raccoon dogs — fluffy animals that are related to foxes and are known to be able to transmit the coronavirus — deposited genetic signatures in the same place where genetic material from the virus was left, the three scientists said. That evidence, they said, was consistent with a scenario in which the virus had spilled into humans from a wild animal.

China’s murky statistics are fueling widespread public distrust. Its narrow definition of Covid deaths “will very much underestimate the true death toll,” the W.H.O. says. The hearses bearing black and yellow funeral paper flowers crept in a steady stream toward the Dongjiao crematory in eastern Beijing. Several dozen people crowded around the closed gate waiting to be let in. A man unable to get a spot in line could only watch, wondering what to do with the body of a relative who had just died of Covid. The hospital could not keep the body — there were already too many in its morgue. When he called the crematory, an employee told him he had to wait a week. When he called again, nobody answered. A country trying to mourn its dead from an explosive Covid outbreak is grappling with a system unprepared for the surge in fatalities. Two weeks after China abruptly abandoned its “zero Covid” policy, cases have soared in cities like Beijing, along with reports of people dying. Funeral home directors and sellers of funeral supplies describe a flood of phone calls from families needing help handling the bodies of relatives. On Chinese social media, people are sharing videos and photos of morgues crowded with bodies, as well as their own personal accounts of losing loved ones to the outbreak. But China’s government is painting a less dire picture. In its official statistics and propaganda reports, China has acknowledged only seven deaths from Covid in the past two weeks, and only in Beijing. The National Health Commission even reduced the country’s cumulative Covid death toll on Wednesday by one, to 5,241. Officials have explained that China counts Covid deaths only if the virus was the direct cause of a respiratory failure — a definition the World Health Organization said would lead to a vast underestimate. The ruling Communist Party may have a political incentive to downplay the toll of an epidemic it has suddenly stopped trying to control. Xi Jinping, China’s top leader, has portrayed his country’s earlier success in limiting Covid deaths as evidence of China’s superiority over the West, a claim that would be hard to maintain with numerous deaths.

What is already known about this topic?

Severe   acute   respiratory   syndrome   coronavirus   2(SARS-CoV-2)  Omicron  subvariant  has  a  stronger transmission  capacity  and  faster  transmission  speed than the previous strain.

What is added by this report?

The first coronavirus  disease  2019  (COVID-19)  case infected  with  the  SARS-CoV-2  Omicron  subvariant BA.2.76 who caused local transmission was reported in Chongqing  Municipality  on  August  16,  2022.  For 35minutes, the Patient Zero jogged along a lake at a local park without wearing a mask. Among the 2,836 people potentially exposed  at  the  time,  39  tested  positive. Overall, 38 out of 39 cases did not wear a mask on the morning of August 16. All 39 cases lacked any previous exposure to the variant before testing positive on their nucleic acid test.

What are the implications for public health practice?

It is essential to  maintain  personal  wellbeing  by ensuring one maintains personal protection and follows regulated  guidelines  such  as  maintaining  safe  distances from others both indoors and outdoors.

The first coronavirus disease 2019 (COVID-19) case infected with the  severe  acute  respiratory  syndrome coronavirus   2   (SARS-CoV-2)   Omicron   subvariant BA.2.76  causing  local  transmission  was  reported  in Chongqing Municipality on August 16, 2022. For 35 minutes, Patient Zero jogged along  a  lake  in  a  park without wearing mask. Of the 2,836 people potentially exposed in the park,  39  tested  SARS-CoV-2  positive. Gene   analysis   from   the   39   cases   showed   highly homologous   when   compared   to   Patient   Zero. Epidemiological  investigations  supported  Patient  Zero transmitted  to  the  following  33  visitors  and  2  park cleaners and the 2 cleaners transmitted to 4 colleagues. This outbreak indicated  that  the  Omicron  subvariant BA.2.76 could be easily transmitted to others outdoors if  they  are  not  equipped  with  effective  protection equipment.  The public  should  be  encouraged  to  use good  protection  measures  and  retaining  safe  distances amongst others both indoors and outdoors....

Preprint available in China CDC Weekly (Nov. 18, 2022)

https://doi.org/10.46234/ccdcw2022.209 

The country’s drug regulator has granted conditional authorization for an HIV drug to be used to treat COVID-19.  China’s drug regulator granted conditional approval on Monday for an HIV drug to be used to treat COVID-19. The drug, Azvudine, developed by Chinese drugmaker Genuine Biotech, is the first oral antiviral for the disease made in China. Genuine Biotech, headquartered in Pingdingshan, applied for regulatory approval earlier this month. In an announcement, the company said that 40% of people with COVID-19 who were given Azvudine for a week in a phase III clinical trial showed “improved clinical symptoms”, compared with 11% of those given a placebo. However, detailed data from the trial, including whether the treatment reduced the risk of hospitalization or death, have not been released. Although drug-efficacy data are lacking, Jun Wang, a pharmacologist at Rutgers University in New Brunswick, New Jersey, says because Azvudine is already approved in China as an HIV treatment, it should have abundant safety data, which would have fast-tracked its application. Genuine Biotech will need to submit more post-marketing data in order for the drug to receive full approval. Most antivirals target two SARS-CoV-2 proteins that are essential for replication, a polymerase and a protease. Azvudine tricks the virus’s polymerase into incorporating the drug into its RNA, which stops the virus from replicating1. In China and globally, the demand for COVID-19 therapies is enormous, says Sheng Ding, a pharmaceutical chemist at Tsinghua University in Beijing. Until the Azvudine authorization, China had approved only one oral antiviral to treat the disease, Paxlovid, developed by Pfizer in New York City. It is highly effective — it reduces the risk of hospitalization and death by nearly 89% — but supplies in China are limited. “The market will have room for several more drugs that may not outperform Paxlovid, but allow more people to access effective therapies,” adds Ding. Another Chinese-made oral antiviral, VV116, is in the final stages of development, and another dozen are in various stages of development.

Published in Nature  (July 26, 2022):

https://doi.org/10.1038/d41586-022-02050-x

China reported thousands of new local Covid-19 cases Sunday as the Omicron variant drove the worst outbreak in the country since Wuhan in early 2020, according to the National Health Commission (NHC).  Health officials said 2,125 cases were reported across 58 cities in 19 of 31 mainland provinces, marking the fourth consecutive day China reported more than 1,000 daily local cases. More than 10,000 cases have been reported since the latest outbreak began in early March, the NHC said. Saturday, the commission reported 3,122 local cases -- the highest number of daily infections since the Wuhan outbreak and the first time new cases have exceeded 3,000 in a day, NHC data showed. Throughout the pandemic, China has adhered to a strict zero-Covid policy that aims to stamp out all outbreaks and chains of transmission using a combination of border controls, mass testing, quarantine procedures and lockdowns.  Nearly half of the total infections in the latest outbreak have been reported in northeastern Jilin province, with 4,605 cases since March 1, when the first clusters of cases in Jilin's border city Yanbian were identified, according to the provincial government. The bulk of cases on Sunday, 1,026, were also reported in Jilin province, according to the NHC. Jilin province's city of Jilin has locked down 504 neighborhoods and launched eight rounds of mass testing, the municipal government said.

Two new studies say the virus was present in animals at the Huanan seafood market in 2019. Scientists released a pair of extensive studies on Saturday that point to a market in Wuhan, China, as the origin of the coronavirus pandemic. Analyzing data from a variety of sources, they concluded that the coronavirus was very likely present in live mammals sold in the Huanan Seafood Wholesale Market in late 2019 and suggested that the virus twice spilled over into people working or shopping there. They said they found no support for an alternate theory that the coronavirus escaped from a laboratory in Wuhan.  “When you look at all of the evidence together, it’s an extraordinarily clear picture that the pandemic started at the Huanan market,” said Michael Worobey, an evolutionary biologist at the University of Arizona and a co-author of both studies.

The two reports have not yet been published in a scientific journal that would require undergoing peer review. Together, they represent a significant salvo in the debate over the beginnings of a pandemic that has killed nearly 6 million people globally and sickened more than 400 million. The question of whether the coronavirus outbreak began with a spillover from wildlife sold at the market, a leak from a Wuhan virology lab or some other way has given rise to pitched geopolitical battles and debates over how best to stop the next pandemic. But some outside scientists who have been hesitant to endorse the market origin hypothesis said they remained unconvinced. Jesse Bloom, a virologist at the Fred Hutchinson Cancer Research Center, said in an interview that there remained a glaring absence of direct evidence that animals at the market had themselves been infected with the coronavirus. “I think what they’re arguing could be true,” Dr. Bloom said of the new studies. “But I don’t think the quality of the data is sufficient to say that any of these scenarios are true with confidence.” In their new study, Dr. Worobey and his colleagues present evidence that wild mammals that might have harbored the coronavirus were being sold in December 2019. But no wildlife was left at the market by the time Chinese researchers arrived in early 2020 to collect genetic samples...

Preprints cited available at (Feb.25, 2022)

https://zenodo.org/record/6299600#.YhsH6e7MKLH

https://www.researchsquare.com/article/rs-1370392/v1

BEIJING (AP) — In a rare admission of the weakness of Chinese coronavirus vaccines, the country's top disease control official says their effectiveness is low and the government is considering mixing them to get a boost.  Chinese vaccines “don’t have very high protection rates,” said the director of the China Centers for Disease Control, Gao Fu, at a conference Saturday in the southwestern city of Chengdu. Beijing has distributed hundreds of millions of doses abroad while trying to promote doubt about the effectiveness of the Pfizer-BioNTech vaccine made using the previously experimental messenger RNA, or mRNA, process. “It’s now under formal consideration whether we should use different vaccines from different technical lines for the immunization process,” Gao said.  Officials at a news conference Sunday didn’t respond directly to questions about Gao’s comment or possible changes in official plans. But another CDC official said developers are working on mRNA-based vaccines. Gao did not respond to a phone call requesting further comment. “The mRNA vaccines developed in our country have also entered the clinical trial stage,” said the official, Wang Huaqing. He gave no timeline for possible use.

Experts say mixing vaccines, or sequential immunization, might boost effectiveness. Researchers in Britain are studying a possible combination of Pfizer-BioNTech and the traditional AstraZeneca vaccine. The coronavirus pandemic, which began in central China in late 2019, marks the first time the Chinese drug industry has played a role in responding to a global health emergency. Vaccines made by Sinovac, a private company, and Sinopharm, a state-owned firm, have made up the majority of Chinese vaccines distributed to several dozen countries including Mexico, Turkey, Indonesia, Hungary, Brazil and Turkey. The effectiveness of a Sinovac vaccine at preventing symptomatic infections was found to be as low as 50.4% by researchers in Brazil, near the 50% threshold at which health experts say a vaccine is useful. By comparison, the Pfizer-BioNTech vaccine has been found to be 97% effective. Health experts say Chinese vaccines are unlikely to be sold to the United States, Western Europe and Japan due to the complexity of the approval process.

A Sinovac spokesman, Liu Peicheng, acknowledged varying levels of effectiveness have been found but said that can be due to the age of people in a study, the strain of virus and other factors. Beijing has yet to approve any foreign vaccines for use in China.

Gao gave no details of possible changes in strategy but cited mRNA as a possibility. “Everyone should consider the benefits mRNA vaccines can bring for humanity,” Gao said. “We must follow it carefully and not ignore it just because we already have several types of vaccines already.” Gao previously questioned the safety of mRNA vaccines. He was quoted by the official Xinhua News Agency as saying in December he couldn’t rule out negative side effects because they were being used for the first time on healthy people. Chinese state media and popular health and science blogs also have questioned the safety and effectiveness of the Pfizer-BioNTech vaccine. As of April 2, some 34 million people in China have received both of the two doses required for Chinese vaccines and about 65 million received one, according to Gao. The Sinovac spokesman, Liu, said studies find protection “may be better” if time between vaccinations is longer than the current 14 days but gave no indication that might be made standard practice.

UAE health ministry reports 86% protection against infections in trial, but offers little data.  A COVID-19 vaccine made in China has outstanding efficacy data, according to a press release issued today by the United Arab Emirates (UAE), which has been testing the candidate in a study involving 31,000 people. UAE said that based on an interim analysis of data from that trial, it would formally “register,” or approve, the vaccine for widespread use. This is the fifth COVID-19 vaccine to show signs of working, and this one uses an entirely different technology from the others. UAE’s Ministry of Health and Prevention said the vaccine, which contains a chemically inactivated version of the pandemic coronavirus and is given in two doses, had 86% efficacy “against COVID-19 infection”—a phrase that puzzled outsiders, as other vaccines have mainly been assessed for their ability to prevent symptoms. The press release further states that the vaccine completely prevented moderate and severe cases of the disease and raised “no serious safety concerns.” Yet it offers no details beyond the efficacy claims. China National Biotec Group (CNBG), which makes the vaccine, did not reply to an email from Science and has not released its own statement. The UAE ministry and a lead investigator of the trial also did not reply to emails. “The interim results for CNBG’s vaccine are very positive. … I just hope the results are based on rigorous analysis of the clinical trial data, and the number of infections meets the cutoff requirements as shown in the trials conducted by Western vaccinemakers,” says Yanzhong Huang, a global health specialist at both Seton Hall University and the Council on Foreign Relations.

In contrast to CNBG’s inactivated virus candidate, the four other COVID-19 vaccines that have reported efficacy data rely on the surface protein of SARS-CoV-2, the cause of the disease, to trigger immune responses. Those vaccines—none made in China—use messenger RNA that codes for the surface protein or stitch the gene for it into putatively harmless adenoviral vectors. Their developers have reported efficacies of 62% to 95% for protection against symptomatic disease. All four vaccines showed remarkable efficacy against severe disease. If CNBG’s vaccine indeed prevented 86% of infections and 100% of symptomatic disease, it would stand out as the best efficacy data yet. But the few details of the trial’s protocol available indicate it primarily aimed to evaluate the vaccine’s ability to prevent cases of disease, not infection. CNBG, a division of state-owned Sinopharm, has two, competitive divisions that produce vaccines using inactivated SARS-CoV-2, one based in Beijing and the other in Wuhan, China. The trial in UAE is part of a 45,000-person study that includes participants from Bahrain, Jordan, and Egypt and compares both vaccines against a placebo shot. According to the UAE press release, the efficacy claim and planned approval only refer to the vaccine made by CNBG’s Beijing Institute of Biological Products.

UAE began to use the CNBG vaccines in September outside of the clinical trial under what’s known as emergency use authorization for front-line health workers. Some government officials, including the prime minister, received it, too. CNBG efficacy trials are also underway in Peru, Argentina, and Morocco. Because China has contained SARS-CoV-2 with its aggressive use of traditional public health measures, CNBG and other Chinese COVID-19 vaccinemakers had to go abroad to test the efficacy of their candidates. Sinovac, a Beijing-based company that also has an inactivated SARS-CoV-2 vaccine in efficacy trials in several countries, may report results from its Brazilian arm soon, Science has learned. The independent board that monitors the trial met yesterday in Brazil to review the data.

A coronavirus vaccine being developed in China could be ready as early as November, according to a senior Chinese scientist. The Chinese Centre for Disease Control and Prevention's chief biosafety expert, Wu Guizhen, said on Monday that one of the four vaccines being developed in the country could be ready for use as early as the winter months, according to a Reuters report. Guizhen, told the state broadcaster CCTV on Monday: "It will be very soon. The progress is currently very smooth." China has been giving key workers shots of an experimental coronavirus vaccine since July. Zheny Zhongei, the head of the National Health Commission (NHC) science and technology center, indicated that health workers and border officials were among those on whom the vaccine was being tested. Guizhen said that she had taken an experimental vaccine herself in April and had experienced no adverse reaction to it.

It comes amid a global race for a vaccine which has already seen Vladimir Putin, the Russian president, announce that scientists in Moscow had developed one which is safe and effective. Putin's announcement was widely criticised, however, amid suggestions the vaccine had not been tested fully. Germany's health minister Jens Spahn said he was "very sceptical" that Russia's vaccine had been proven to be fully safe, while Dr. Anthony Fauci, the top US infectious-disease expert, said he "seriously doubts" whether Moscow had yet developed a safe and effective vaccine that was ready for use. There are 176 coronavirus vaccines being developed across the world, and there are likely to be at least fifty undergoing human trials by the end of 2020, according to a Business Insider review. A total of 32 vaccine candidates are now being tried on humans in clinical trials, one of which could be proven as safe as effective by the end of 2020.

Public health experts warn that the wide-reaching emergency use program poses risks.  China has taken a shortcut in the global sprint to develop and deliver vaccines for the novel coronavirus. Sinopharm, the state-owned company developing two of China’s leading vaccine candidates, told China National Radio on Monday that it has already vaccinated hundreds of thousands of Chinese citizens — even though the company’s phase 3 clinical trials have not yet concluded. Individuals received one of two Sinopharm vaccines in development in an emergency use program launched by the Chinese government in late July, which also authorized a third vaccine, CoronaVac, developed by the privately owned drugmaker Sinovac Biotech. Under Chinese vaccine law, such authorization is allowed within a certain scope and time frame during a health emergency. China’s top vaccine official mentioned front-line medical workers and customs officials when he first announced the program, implying these high-risk groups had been prioritized to receive the still-experimental vaccines.

Phase 3 clinical trials, which look at the efficacy of a vaccine candidate at preventing a virus from spreading in a community, for the three Chinese vaccines had just begun overseas when they were approved for emergency use domestically. In July, Sinopharm initiated phase 3 trials for its two vaccine candidates in the United Arab Emirates; one of the vaccines also began trials in Morocco and Peru in August, according to the New York Times vaccine tracker. Sinovac launched CoronaVac’s phase 3 trials in July in Brazil, followed by Indonesia the following month. (The trials are being conducted outside of China because the vaccines’ protectiveness can be better evaluated in regions where Covid-19 transmission is high.) China and Russia are the only countries that have provisionally greenlit vaccines that have yet to be deemed safe and effective through phase 3 trials. In the US, the Centers for Disease Control and Prevention has told states to prepare to distribute vaccines to high-risk groups by the end of October or early November, stirring concerns that the vaccine approval process may be politicized ahead of the 2020 election. However, nine leading vaccine developers pledged to not submit their vaccines for approval until data from phase 3 trials shows that they meet predetermined safety and efficacy thresholds. No Chinese companies signed the pledge. 

So far, China has not reported any serious issues with its emergency vaccine program. But vaccine experts told Vox that skipping or shortening phase 3 trials is risky and could subject citizens to an ineffective or unsafe vaccine. The risks are even higher in China, where vaccine producers have a history of scandals and the media is largely unable to play a watchdog role because of state control. Although transmission has reportedly been very low in China since February, controlling local hot spots is still a priority for the government, said Yanzhong Huang, a professor of global health at Seton Hall and author of Toxic Politics, an examination of China’s environmental health crisis. “They have this strong incentive to develop vaccines to show Chinese high-tech capacity, and also [to] give people the sense of national pride,” Huang added.

Here’s what we know about how China’s emergency vaccine program is playing out so far. In the crowd of pharmaceutical companies that have jumped into the vaccine effort, Chinese companies got a swift and aggressive start. Of the 211 vaccines in development worldwide as of September 11, nine vaccines are in phase 3 trials, and four of the nine are from Chinese companies. These trials allow scientists to determine the vaccines’ efficacy and identify side effects that may not have appeared in phase 1 or phase 2 trials. But rather than waiting for trial results, the Chinese government started allowing certain workers to be vaccinated on a separate track...