This video was made possible by CuriosityStream. If you’ve already signed up for the CuriosityStream/Nebula
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both CuriosityStream and Nebula bundled together for just $15 a year with the current sale
at CuriosityStream.com/Wendover. China has backed itself into a corner. About a year ago, in Spring 2020, it emerged
triumphant—after months of devastation, it became the first country to coax life back
to near-normal after a widespread COVID epidemic. Just as it emerged from lockdown, the rest
of the world was entering into it, so China started to focus its attention on not only
recovering from COVID, but also from the hit it took to its global image as a result of
perceived mismanagement in the virus’ early days. As the US and Europe struggled from far larger,
far more devastating outbreaks, China sat on the sidelines, working on ways to be viewed
not only as the country that crushed COVID within its borders, but also led the fight
against it around the world. They wanted to be seen doing what the US and
Europe couldn’t while they were focused on their problems at home. As hospital ships docked and intensive care
units ballooned in size throughout April in New York, planes were landing at JFK carrying
thousands of desperately-needed ventilators from China. As hospitals around the world ran out of supplies
and required healthcare workers to reuse masks for days or weeks on end, national airlines
were making special, dedicated trips to pick up medical supplies donated by China. As every corner in the world worked to ramp
up testing to get a more accurate picture of their problems, Chinese-made test kits
were streaming through their borders. China was at the center of the fight against
the virus, but the center can be the riskiest place to be. As donations turned into purchases, it emerged
that there was a major quality problem. Some 90% of mask certifications from China,
according to one measure, were fake; tests that were supposed to have 80% sensitivity
actually had 30%; and stories emerged globally of Chinese officials demanding public displays
of thanks in exchange for donations. What was supposed to be a diplomacy coup rekindled
an old narrative of Chinese-made as inferior. At best, this effort did little to rewrite
China’s role in the pandemic, but at worst, it seems very possible that it actually further
damaged their global image. However, while the start and the middle of
the pandemic did not entirely go China’s way, in terms of global image, there was still
the end. China still had the chance to recover what
they’d lost and, more specifically, they had the chance to display their home-grown
scientific skill and manufacturing might. China could be the country that supplies the
shots that would end the world’s misery and put the pandemic in the history books. They could make the world’s vaccine, but,
of course, first, they needed a vaccine. Luckily, they had a head-start. As soon as the outbreak begun in China, a
number of private companies, state-owned enterprises, and government-run institutes started work
on developing a vaccine. By Spring, there were some strong, viable
candidates, so the next step was testing. Just as most of the western world entered
their lockdowns, the first Chinese vaccine—Ad5-nCoV by CanSino Biologics—entered a Phase I clinical
trial on March 17th, 2020, with 108 adults in Wuhan receiving the shot. After positive data, this same vaccine became
the first in the world to enter Phase II trials on April 11th, with 508 participants. When the results from that trial were published
on July 20th, they revealed that not only was the vaccine acceptably safe, but that
it was also generating the desired immune response—in short, it was seemingly both
safe and effective. However, the next phase of clinical testing
presented a problem for CanSino. You see, Phase I vaccine trials are about
seeing if they're safe, and then phase II trials are about seeing if they generate the
desired immune response in the body. Phase III, however, that’s about seeing
if a vaccine works in the real world—to see if it actually protects humans. To do so, researchers divide the study participants
into two equal-sized groups. One receives the actual candidate vaccine,
the other receives a placebo shot—typically just a saline solution. Then, the two groups are tracked to see if
one is less likely to contract the virus than the other. The problem for CanSino, the other Chinese
vaccine makers, and the country at a whole was that, by late-summer, when the first Chinese
vaccines were moving into Phase III trials, daily COVID cases in the country had been
reduced to double-digit levels in a country of well over a billion. Most Phase III vaccine trials have below 50,000
participants, so it would take years, if not decades, at those case loads to get to the
hundreds of infections needed in a trial to prove a vaccine’s efficacy. Essentially, it was impossible for Chinese
companies to complete their COVID vaccines in China exactly because the country had done
so well at surprising the virus. Therefore, they had to move abroad. The CanSino Ad5-nCoV vaccine started Phase
III trials in Russia, Pakistan, Saudi Arabia, Mexico, Argentina, and Chile, while the other
leading candidates moved to dozens of other countries with more severe COVID epidemics. However, with many of these, China and its
pharmaceutical companies had to curry favor with each government. Typically, that took the form of offering
priority access to the very vaccines that they were testing, which was fine… for the
moment. As of now, five Chinese-made vaccines have
been approved in the country. In general, there has been widespread criticism
of the country’s vaccine development practices—they’ve started vaccinating the general public before
their Phase III trials reached their endpoints, they haven't been forthcoming with clinical
trial data, they’ve misrepresented efficacy ratings from trials, and more—however, despite
that, there is evidence that these vaccines are acceptably safe and effective—even if
potentially less so than other approved vaccines. On December 30th, the BBIBP-CorV vaccine manufactured
by Sinopharm—a Chinese state-owned enterprise—was approved in the country, making it one of
the first COVID vaccines in the world to be deployed in the general population. Despite the fact that this vaccine was developed
and manufactured by a company owned by the Chinese government, and despite the fact that
the country had some 1.4 billion people to inoculate, many of the first doses of the
Sinopharm vaccine were sent beyond their borders. Chinese state-owned media reports that the
company has orders for its vaccine from over 100 countries, although the details of such
orders are not publicly known, leading to some skepticism over the numbers. We do know details for certain orders, though,
and in some cases, we might know more than China wants us to. In general, though, China’s goal with its
global vaccine distribution is essentially to do what it failed to do with masks, ventilators,
and tests in 2020—China wants to be the country that ended other country’s epidemics. Now, even though Western vaccines from Moderna
and Pfizer have a 95% efficacy rating compared to 50% to 83% in Chinese vaccines, those Western
vaccines have order obligations taking up their inventory until well into 2022. However, that's not the case with certain
Chinese vaccines, so some countries are making the calculation that it's better to have less-effective
vaccines sooner than the alternative. Of course, for China, this is a major diplomacy
coup—countries historically allied with the West, such as Hungary and Mexico, are
turning to China. In their narrative, China is doing what the
West cannot. Of course they want this to continue, and
even ramp up. That’s why they’ve been sending their
vaccines all around the world, for free. Mongolia and Sri Lanka received 300,000 doses
of the Sinopharm vaccine; Algeria, Sierra Leone, and Zimbabwe—200,000; and Belarus,
Equatorial Guinea, Gabon, Mozambique, Namibia, and Bolivia—100,000. Now, a couple hundred thousand doses isn’t
going to end any of these country’s epidemics, but it’s enough for clips of healthcare
workers receiving Chinese-made and donated vaccinations to make the evening news. It’s also enough for each of these countries
to see that these vaccines are acceptably safe and effective, giving them little reason
to not order more when China is offering them months or years before the big Western manufacturers. However, the fact that many of China’s vaccines
are made and distributed by state-owned enterprises has led many to wonder whether the country
is choosing who gets these life-saving inoculations based on diplomatic intentions. It’s leading many to wonder whether who
lives and who dies in this pandemic is starting to be based on how friendly the country on
a given person’s passport is to the People’s Republic of China. The answer to this question is not hard to
find. On the read-out of the call between Chinese
State Councilor and Foreign Minister Wang Yi and Algerian Foreign Minister Sabri Boukadoum,
the Chinese official brought up Algeria’s vote 50 years ago to switch Chinese representation
at the UN from the Republic of China government, now known as Taiwan, to the People’s Republic
of China, which most now refer to as China. In addition, the Chinese official noted Algeria’s
participation in China’s Belt and Road infrastructure development initiative, before announcing
the country’s intention to donate 200,000 Sinopharm vaccine doses to Algeria. Elsewhere, in South America, ten of its twelve
countries have vaccinated their populations with either purchased or donated Chinese vaccines. The only two exceptions are Suriname—the
lowest population country on the continent—and Paraguay. Now, Paraguay’s absence on the list of countries
to have received Chinese vaccines is not tough to figure out—it’s because of another
list that they are on. Paraguay is one of just 15 countries worldwide
that recognizes Taiwan as an independent nation—something that undermines China’s claims of the island. In fact, there is zero overlap between the
list of countries that recognize Taiwan and those that have received Chinese COVID vaccines. However, the cases of Algeria and Paraguay
simply show China rewarding its allies, and ignoring its foes. This is not at all different from how the
US, for example, has operated so far regarding COVID vaccine donations—it’s sent them
to strong allies like Mexico and Canada—although, it’s quite possible that China is going
beyond rewarding its key existing allies, and using vaccines to try and form new ones. Brazil and the US have gotten along rather
well in recent years, especially over most of the past four as Brazilian president Jair
Bolsonaro is an open admirer of former US president Donald Trump. That meant that Brazil followed the US’
lead in banning the Chinese telecom giant Huawei from playing a part in building out
their 5G cell network infrastructure—purportedly out of security concerns. Therefore, it was a bit of a surprise when
Brazilian communications minister Fábio Faria took a trip to Beijing in February and met
with Huawei executives. According to Faria, he “took advantage of
the trip to ask for vaccines, which is what everyone is clamoring for.” Soon after, he posted a letter on Twitter
from the Chinese ambassador to Brazil which noted the request, reading “during your
visit to China, you expressed the desire to continue to strengthen cooperation between
our two countries regarding COVID-19 vaccines. I give this matter great importance.” A few weeks later, the Brazilian government
announced the rules and structure for its 5G auction and, in a change of course, Huawei
was now allowed to participate. The company, in response to questions about
this, didn’t even directly deny that a tit-for-tat deal took place. In a statement, they said that while they
could not directly provide vaccines, they could facilitate, “communication in an open
and transparent manner in a topic involving the two governments.” While there’s no direct evidence of China
trading vaccines for its foreign policy goals, people are starting to pay more attention
to situations like this, where countries are opening the door for such an action, and China’s
certainly not closing that door. While its exact details might still be murky,
it is clear that China is engaging in some form of vaccine diplomacy. This, however, presents a problem. You see, one of the main advantages of mRNA
vaccine technology—the kind used in Moderna and Pfizer’s COVID vaccines—is that its
relatively easy to manufacture. Most other types of vaccines include an attenuated
or dead version of the virus itself, or a portion of it, but growing and then processing
the virus itself is a time-consuming process that is harder to scale. Meanwhile, mRNA vaccines simply include the
genetic instructions for the body to create a harmless version of the Coronavirus’ spike
protein which can train the immune system to respond to it. Done right, that means that mRNA vaccine production
can be faster than that of attenuated or inactivated virus, protein-based, or viral vector vaccines—the
technologies that China's vaccines are based on. That means that, after a slow-to-scale manufacturing
processes, priority order obligations to trial-hosting countries, a robust program of vaccine diplomacy,
and an insistence to only use Chinese-made vaccines, that doesn’t leave a whole lot
of Chinese COVID vaccines for China to use for itself. As of March, 2021, China has administered
about 5 doses for every 100 citizens. That’s compared to between 10 and 15 for
every 100 in most EU countries, 35 for 100 in the US, and 42 for 100 in the UK. Of course, with very few COVID cases within
its borders, there is less of a pressing need for vaccination in China, but the country’s
entire foreign image goal during the pandemic has been to be viewed as better than Europe
or the US—it's to be viewed as the country that, thanks to its remarkable economic transformation
over the past decades, has caught up to Europe or the US’ superpower status. At present, estimates believe that China will
attain widespread vaccination towards the end of 2022—roughly the same time period
as India, Iran, Egypt, Ethiopia, or Columbia. By that time, assuming all goes to plan, most
of the Western World will have been back to normal for at least a year, as the era of
border restrictions, snap lockdowns, and economic uncertainty drags on in the People’s Republic. That’s not the look the country wants both
at home and abroad. Now, none of this is to say that China’s
vaccination practices necessarily are or are not immoral or harmful or any other value
judgement, but it is to say that the practices are problematic for China itself. People, both within the country’s borders
are beyond, are going to wonder why doses are going to foreign arms first, when Chinese
citizens are still vulnerable; they're going to wonder why China didn't use its newfound
wealth to purchase more effective and faster-delivering vaccines from foreign manufacturers; they're
going to wonder why, when life is back to normal in the West, the country that flouts
itself as the conqueror of the Coronavirus is still far from herd immunity. This wonder will lead to conclusions, and
without the narrative control that they so desperately work to maintain, China’s foreign
and domestic image might, once again, suffer in what is, hopefully, COVID-19’s third
and final act. So, $15 is about what it costs to get a fancy
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