China's 'Two Sessions': Vaccines, Drugs Seen Key To Easing Restrictions Amid New Spike
Boosters Needed But mRNA Options Lag
Executive Summary
The latest policies from Beijing show that the Chinese government is readying its own new vaccines and drugs for COVID-19 in a bid to gradually ease some of the strictest pandemic restrictions globally, but progress is mixed and domestic reported infections are surging to their highest level since March 2020.
March marks the beginning of a week-long meeting of China's National People's Congress in Beijing, where delegates from the country's 31 provinces gather to discuss macro economic policy direction for the coming year.
The government also released its "scorecard" for 2021, suggesting that the emphasis around COVID-19 will be on domestically-developed vaccines and effective new drugs as China prepares for a gradual easing of its strict "COVID Zero" policies, some of the toughest worldwide.
Over the last two years, the country has severely restricted outside visitors and effectively closed its borders, but this approach has met mounting challenges amid the rapid spread of highly transmissible virus variants, underscored by a recent surge in cases in Hong Kong to more than 30,000. (Also see "Hong Kong Issues Vaccine Mandate Amid Local Surge" - Scrip, 22 Feb, 2022.)
On 5 March, Chinese Premier Li Keqiang presented his annual report to the Congress, in which he outlined policy priorities to accelerate R&D of effective vaccines and drugs and to continue increasing the rate of inoculation, mostly among the younger and elderly populations.
With a high two-dose vaccination rate of nearly 80% nationwide, Beijing is expected to continue its restrictions for the time being while also progressing its own home-grown mRNA vaccines as booster shots to open the way to gradual policy easing, some observers have predicted, although various factors mean this may take some time.
New Vaccine Approved
On 1 March, Chinese regulators conditionally approved Chongqing Zhifei Biological Products Co. Ltd.'s recombinant protein COVID-19 vaccine for emergency use, marking a step forward to offering differentiated jabs other than those based on inactivated virus and adenovirus platforms. (Also see "China OKs Heterologous Booster Shots Amid Heated COVID Vaccine Race" - Scrip, 24 Feb, 2022.)
Outside China, the European Medicines Agency has already approved a similar recombinant protein vaccine from Novavax, Inc., Nuvaxovid (NVX-CoV2373). (Also see "Nuvaxovid COVID-19 Vaccine Wins EU Approval" - Pink Sheet, 20 Dec, 2021.)
Zeng Guang, former chief scientist at the China Centers for Disease Control and Prevention (CDC), said that China needs to implement more targeted control and prevention measures to replace existing general cookie cutter restrictions. Such more precise measures would mean increasing initial and booster vaccination rates among vulnerable populations and using antivirals to quickly treat infected people and prevent development of severe symptoms.
However, the booster program has been stagnating amid delays for imported mRNA vaccines, including that from Pfizer Inc./BioNTech SE, while efforts to accelerate domestic mRNA candidates have also been delayed without a clear time frame. The lead contender, ArCoV, being developed by Walvax Biotechnology Co., Ltd., ABOGEN INC and the Academy of Military Medical Sciences, is now in Phase III trials but there have been no recent updates.
In the antiviral arena, Pfizer's oral antiviral Paxlovid (nirmatrelvir/ritonavir) was approved in China this February, providing another option (Also see "How Paxlovid Approval May Influence China's Pandemic Policies" - Pink Sheet, 15 Feb, 2022.), while Brii Biosciences’s antibody combination of amubarvimab and romlusevimab for moderate to severe COVID-19 patients was cleared for use late last year. (Also see "China Touts First COVID Antibody Approval But Border Opening Eludes" - Scrip, 10 Dec, 2021.)
Additional antivirals and vaccines are expected to bolster official confidence for a limited and stepped easing, but this is likely to start only from summer after the highly infectious spring season. “We don’t need to open the borders at the peak of a global pandemic and relax restrictions amid early spring’s high seasonal flu time," Zeng declared in a blog post.
Until then, while the restrictions had seen the number of daily reported cases drop to double-digits, these are now surging again to their highest level in two years - although still low on a reported basis by international levels. On 7 March, the government reported a total of 325 cases, 175 domestically transmitted and the rest from abroad.
Booster Challenges
Wu Ke, CEO of Wuhan-based vaccine firm BravoVax Co Ltd, told the Pink Sheet that, despite the delays, highly effective vaccines such as mRNA shots will remain front and center to China’s COVID strategy. “Antivirals can’t replace vaccines because the target population is different,” he noted.
The strict controls have also given little opportunity for China's population to develop antibodies and any herd immunity, thus necessitating a reliance on vaccines. Many epidemiologists including Zeng think the protection provided by inactivated virus-based vaccines wears off over time, requiring boosters.
Wu's view is that the newly approved recombinant protein vaccine from Zhifei won’t necessarily help increase booster shots, with domestically-developed mRNA vaccines expected to shoulder most of this burden, if and when approved.
On 19 February, the China CDC announced it would allow heterologous immunization, in which people can choose either an adenovirus or recombinant protein vaccine for their booster, which may help the program in the meantime.