China's success at controlling the coronavirus outbreak has resulted in a population that has seemed almost reluctant to get vaccinated.
The country is accelerating its inoculation campaign by offering incentives — free eggs, shop coupons and discounts on groceries and merchandise — to those getting a jab.
After a slow start, China is now giving millions of vaccines a day. A top government doctor, Zhong Nanshan, announced a June goal of vaccinating 560 million of the country’s 1.4 billion people.
The challenge lies partly in the sheer scale of the effort and the need to convince a population that currently feels safe from infections.
When patients first showed up at hospitals in Wuhan in late 2019 with fevers, coughs and breathing difficulties, the government locked down the city and others in Hubei province for more than two months starting in January 2020. Wuhan later became known as the epicentre of the outbreak.
Since then, China has controlled the virus through stringent border controls and quick lockdowns whenever new outbreaks crop up.
People can dine out in restaurants and the risk of infection is low, so many don't seem to be in a hurry to get the vaccine.
But China also wants to open up as the world seeks to return to pre-pandemic normalcy and Beijing readies to welcome tens of thousands of visitors as host of the Winter Olympics in February 2022.
For now, in major cities like Shanghai and Beijing, the government has relied mostly on sustained messaging and freebies to convince people to get vaccinated.
Shopping malls have offered points at stores or coupons. A temple in Beijing offered free entry to anyone showing proof of vaccination. Shanghai is using buses in its campaign to set up mobile vaccination points.
And then there are the free eggs. “Good news. Starting from today, residents 60-years-old and above who have got their first shot are eligible for five ‘jin’ (2.5 kilograms or 5 1/2 pounds) of eggs. First come, first served,” said a poster by a city-run health centre in Beijing.
Some people have expressed doubts about how good the existing vaccines are given how quickly they were developed.
The five vaccines currently being used in China have an efficacy range of 50.7% to 79.3%, based on what the companies that developed them have said.
But 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. The Pfizer-BioNTech vaccine has been found to be 97% effective.
`The threshold needed for regulatory approval by the World Health Organization (WHO) is also 50%.
Herd immunity only occurs when enough of the population has immunity, either from vaccinations or past infection, to stop the uncontrolled spread of an infectious disease.
China may need to vaccinate at least 1 billion people to achieve that, said Wang Huaqing, a top immunology official with China’s Center for Disease Control, in an interview with state media this week.
As of early April, roughly 34 million people had received two shots and about 65 million got one dose.
Gao Fu, the head of the CDC, said last weekend that China is considering various strategies such as mixing different vaccines to try to increase effectiveness. Outside experts say China could eventually deploy other, more effective vaccines, such as the Pfizer or Moderna shots.
Chinese drugmaker Fosun Pharmaceutical Group has partnered with Germany's BioNTech to sell the Pfizer vaccine in China. However, it has only been approved in Hong Kong and Macao, special territories in China with their own regulatory agencies. A clinical trial for mainland approval is underway.
Vaccination is supposed to be voluntary, but overzealous efforts by some local governments and companies prompted health officials to issue a warning this week against forced vaccinations.
A hospital in Danzhou on the southern island province of Hainan issued an apology after it issued a notice to staff saying: “Those who are not vaccinated could be fired.”
In Zhejiang province, an April 2 announcement said all government departments, Communist Party cadres and people working in universities would be required to take the lead in getting shots.
The national government also required vaccination for all residents in Ruili, a border town with Myanmar, because of a recent outbreak.