China’s new crown vaccination: voluntary or mandatory universal vaccination?

Vaccination against the new coronavirus in China has started one after another, and the latest data show that by the end of February, China had reported 52 million doses of the new coronavirus vaccine, ranking second in the world after the United States in terms of absolute number of doses. However, it is understood that the willingness of Chinese grassroots to receive the vaccine is generally low, with some companies requiring “leaders to demonstrate, employees to follow” vaccination efforts.

China has repeatedly stressed that it will not force people to be vaccinated, and Wu Zunyou, chief epidemiologist at the Chinese Center for Disease Control and Prevention, said that all people should be vaccinated with the new vaccine after the opening, but that universal vaccination will not be mandatory.

The World health Organization has spoken out against mandatory universal vaccination with the new crown vaccine. Kate O’Brien, a WHO vaccine expert, said in Geneva, “I don’t think people should be forced, especially not on the issue of vaccines.”

O’Brien added: “The better way to do it should be to encourage people, to give people the facility to get vaccinated, and WHO does not expect to see any country forcing people to get vaccinated.”

But there are indications that some Chinese state-owned central enterprises have linked vaccinations to attendance and performance, forcing employees to get vaccinated in disguise, and even some foreign-related departments have implemented mandatory universal vaccination in their own departments.

State-owned enterprises: “should be vaccinated as much as possible” and “should be received as much as possible”

The Beijing CDC issued an article on March 1 reminding people between the ages of 18 and 59 with no contraindications should be vaccinated with the new crown vaccine. The recommendation reads that vaccination against New Crown has been launched throughout Beijing and that vaccination is the most powerful weapon to prevent disease.

As of March 2, Beijing has received 7.65 million doses of inactivated New Crown vaccine, with a total of more than 5 million people vaccinated, of which 2.64 million have completed two doses.

Beijing resident Ms. Hu, an employee of a state-owned enterprise, told Voice of America about her unit’s vaccination policy. She said, “At the moment, our unit has only issued a notice on the implementation of vaccination, which requires that the vaccination of the unit’s new crown vaccine be implemented as soon as possible in accordance with the requirements of Beijing’s Epidemic prevention and control work, and that ‘as many doses as possible’ be given.”

In addition to the “should hit” policy, Mr. He, who is also an employee of a state-owned enterprise in Beijing, said that the policy of his unit is “should receive as much as possible”, and the policies of all Beijing’s state-owned central enterprises are more or less the same.

According to him, the inoculation policy of their company is “as much as possible”, which is in line with the national call. The so-called “as much as possible” means that if a person meets the age range of 18 to 60 and does not have chronic diseases, such as If a person is between the ages of 18 and 60 and does not have chronic diseases such as hypertension, hyperlipidemia or hyperglycemia, and if he or she is not vaccinated or taking anti-inflammatory drugs, or if he or she has no intention of being vaccinated or of having children, such a person is eligible for the vaccination policy and should be vaccinated.

He added: “At the same Time, the company issued a notice of vaccination, which is to ask people eligible for vaccination to respond positively to the national call (to help) control the spread of the epidemic and go for vaccination.”

Ms. Hu has long agreed that vaccines are not compulsory, but the office building where she works has issued requirements regarding vaccination rates, and departments have begun to conduct statistics on non-vaccination, fearing that they will settle scores in the fall.

“And then as far as I know, the property in our building requires tenants to have a vaccination rate of as much as possible over 90 percent.” Miss Hu said, “Now our unit issued a notice of vaccination, from the content of the notice itself, there is not much mandatory meaning, nor excessive constraints, but from the actual work, the group requires us to report the vaccination status and statistics on the willingness to vaccinate on a weekly basis, if you do not vaccinate or temporarily do not vaccinate, there is a possibility that in the future you will receive to inquiries from company leaders or investigations from relevant departments.”

Compulsory universal vaccination Leaders are called upon to “lead by example”

A senior executive of a state-owned enterprise who did not want to reveal his name said that most departments in his unit are responsible for external projects, and employees under 58 years old must receive mandatory universal vaccination for no special reason, otherwise they cannot arrange for business trips, and they can only be temporarily suspended pending treatment if they insist on not being vaccinated.

The official media Global Times has also published an article confirming that some state-owned enterprises with overseas business projects need to vaccinate their staff abroad. However, it was reported that more than 400 employees who had been vaccinated with the national vaccine by Tianjin Electric Power Construction Company to Pančevo, the capital of South Banat state in Serbia, had more than 300 people who were still diagnosed with the new crown. Tianjin Electric Power Construction Company refused to respond to the report and also removed the information about the Serbian project from its official website.

For the low vaccination rate, Professor Zhang Wenhong, director of the Infection Department at Huashan Hospital of Fudan University in Shanghai, has also repeatedly stressed that although the vaccine is voluntary, the leaders of the companies are still encouraged to “take the lead” in order to encourage people to get vaccinated and to prove the safety of the vaccine to the public. In an interview with Chinese media, he said, “I have said on many occasions that leaders should be vaccinated first, so that people will feel more comfortable when they see that they are fine. Sooner or later, they all have to be vaccinated, and the leaders can also serve as a demonstration by vaccinating earlier.”

In an interview with the Voice of America, Ms. Hu confessed to reporters that most members of the leadership team of state-owned central enterprises have been vaccinated, management staff are required to be vaccinated, in order to give ordinary employees an exemplary role. She said, “As far as I know, now on the unit’s statistics sheet, those who have been vaccinated are basically employees above the departmental leadership level, and most ordinary employees still choose not to be vaccinated for the time being, and everyone has various reasons for not being vaccinated.”

Various reasons for low voluntary vaccination rate

Although each unit has issued a notice on vaccination and arranged for leaders to take the lead, there are policies at the top and countermeasures at the bottom, and people like Mr. He and Ms. Hu still account for the majority of those who choose to wait and see.

Mr. He told the Voice of America, “I’m not getting vaccinated because I’m planning to have a baby and this (vaccine) may affect the development of the fetus, so I haven’t chosen to get vaccinated yet.”

Ms. Hu, on the other hand, said, “Because I just had other vaccinations some time ago, I am now worried about some rejection in my body with the new crown vaccine.”

In mid-February, the Chinese Journal of Vaccines and Immunization conducted a survey titled “New Coronavirus Vaccination Intentions and Influencing Factors among Health Care Workers in Zhejiang Province”.

The results showed that nearly 1,000 frontline health care workers in Zhejiang province participated in the survey, with 42.46 percent of the respondents saying they were willing to receive the new coronavirus vaccine, which has been approved for emergency use.

Previous surveys of the general public’s willingness to be vaccinated have also reported that 90% of the population would choose voluntary vaccination, but compared to the large difference between the two survey results, the journal explained that this was because the survey respondents in Zhejiang province were a highly educated younger group, receiving more social network information and professional information, and having more concerns about the effectiveness and side effects of the New Crown vaccine.

Dr. Yanzhong Huang, senior fellow for global health at the Institute for Foreign Relations, told VOA that the low rate of vaccination against the new strains of Coronavirus in China is related to the population’s willingness to get vaccinated and the vaccine’s production capacity.

He said, “I think the main reason is actually because people feel that there are very few cases in China itself, almost none, and then [the population] feels very safe and they don’t feel a very strong urgency to get vaccinated, so I think that’s a very important reason.”

He added: “Of course there are other reasons that the government is not showing a great urgency to push vaccination probably because the current (vaccine) capacity may not be fully up yet, and that may also have something to do with it.”

Safety: a long-standing topic

The safety of China’s self-developed vaccines has been a long-standing topic, and the domestic vaccine market is known as a big mess, with vaccine accidents commonplace, with unfavorable medical supervision, lax laws and regulations, and untimely penalties in place perhaps the main culprits.

The 2005 Anhui hepatitis A vaccine incident resulted in one death, 20 serious injuries and 121 abnormal reactions.

The 2007 Shanxi vaccine incident resulted in the poisoning or death of nearly 100 children.

Multiple cases of injury and death of infants injected with hepatitis B vaccine in southern China in 2013.

In the 2018 Changsheng Biologicals’ Bai Baiyao vaccine incident, 250,000 doses of inferior vaccines reached the market.

Nonetheless, Yang Xiaoming, chairman of China National Pharmaceutical Group’s China Bio, is very confident in the safety of the New Crown vaccine, saying repeatedly that the overall use of the New Crown vaccine is very safe and no serious adverse reactions have been detected.

Liu Jingzhen, secretary of the Party Committee of Sinopharm, said in an interview in January this year that no serious adverse reactions had been reported. He said, “At present, the reactions to the vaccination of New Crown vaccine that we have monitored are mainly local reactions, mainly pain at the vaccination site. Systemic reactions mainly include headache, myalgia and fever.”

The two independently developed vaccines in China are from Kexing Biologicals and Sinopharm, both inactivated vaccines, and the vaccines currently administered to the domestic population are mainly from Sinopharm.

According to Professor Zhang Wenhong, director of the Department of Infection at Huashan Hospital affiliated with Fudan University in Shanghai, the inactivated vaccine is safe overall, and it has only short-term risks, such as the possibility of causing allergies or local pain.

In response, Dr. Huang Yanzhong, senior fellow for global health at the American Institute for Foreign Relations, said that the nature of vaccines in China and the United States are completely different, but there should be little difference in safety issues, only that there may be a gap in efficiency.

He said, “China is Kexing and the national drug is inactivated vaccine, they are really different from the messenger RNA mRNA vaccine used in many places in the U.S. In terms of safety I reckon it should be about the same, but there may be a certain gap in terms of efficiency.”

Dr. Huang Yanzhong added: “Only the top of safety can be tracked, and the data in this regard we now …… can’t say there isn’t any, the official word seems to be safe, at least I haven’t heard reports of death by injection.”

China’s vaccination progresses fast and slow

In a March 1 article in the Financial Times, “China’s domestic vaccination progresses slowly,” the article stated that there are currently fewer cases of the new coronavirus in China, which has also led to a lower willingness of the nation to vaccinate, with current vaccination rates below the levels needed to form herd immunity.

This was countered by an article in the official media Global Times, in which a Chinese immunization health expert said that China’s vaccination rate is very fast and second only to that of the United States.

Dr. Huang Yanzhong told VOA that the country’s vaccination rate is indeed second only to the U.S. in terms of total number of vaccinations, but that the number of doses and rates cannot be compared to China’s large population base.

If you look at the absolute numbers, that is, how many doses of vaccine have been administered, this is the absolute figure, but it is still very high compared to other countries, (China) has more than 50 million doses of vaccine administered, which is probably second only to the United States,” he said. But if we talk about the vaccination rate, because China’s population is very large, we say 1.4 billion people, then this proportion is less than 4%, I think. This percentage is actually very low compared to developed countries, for example, now the United States has more than a quarter of the population vaccinated, that 4% is still a big difference compared to 25%.”