China should make full use of all available COVID-19 vaccines to combat its current Omicron surge, according to the World Health Organization (WHO) – including mRNA vaccines that are more effective than China’s Sinovac and Sinopharm vaccines.

“Vaccination is the exit strategy from the impact [of Omicron],” Dr Mike Ryan, WHO head of health emergencies, told the last WHO global press conference for 2022 on Wednesday.

However, given that the Chinese vaccines are less effective than mRNA vaccines, the WHO advises that its citizens need three doses to have the same protection as two mRNA doses – which means that China’s population is under-vaccinated.

While 87% of Chinese people are vaccinated with two shots of the local homologous vaccines, Sinopharm and Sinovac-Coronavac, only 55% have had a third vaccination, according to WHO statistics.

Ryan said that full vaccination would mean three doses of the “available Chinese vaccines as a primary course, not two plus a booster”.

With protective efficacy “hovering a 50% or less” in people over the age of 60, “that’s just not adequate protection in a population as large as China,” stressed Ryan.

“We’ve learned that repeated vaccination with effective vaccines and the appropriate number of doses provides a very high level of protection, especially against severe disease and death,” said Ryan.

A 600% increase in vaccinations

However, he credited China with having made “massive progress over the last number of weeks in rolling vaccines”, saying that there had been a “600% increase or more and vaccination rates over the last week or two weeks”.

Meanwhile, WHO official Dr Rogerio Gaspar told the media briefing that, following a recent meeting with the Chinese authorities, science community and manufacturers, “we are aware of an extensive pipeline of different [vaccine] platforms that are being developed by the science community and manufacturers in China”.

At present, the BioNTech-Pfizer mRNA vaccine has only been approved in China for use by German nationals in China, Chinese Ministry of Foreign Affairs spokesperson Mao Ning told a media briefing earlier this month. In exchange, Chinese nationals in Germany have been authorised to take the Chinese vaccines.

“We believe there are discussions going on between the Chinese authorities and some, or at least one, of the mRNA manufacturers around registration of vaccines, and also around the production within China itself, but we’re not privy to those discussions,” said Ryan.

“We would certainly encourage that kind of work both to import vaccines, but also to find arrangements where vaccines can be produced in as many places as possible,” he added. “I do believe the Chinese authorities are pursuing this and it will be better to ask them and the mRNA manufacturers directly.”

China’s information lag

WHO Director-General Dr Tedros Adhanom Gebreyesus told the briefing that the global body was “very concerned over the evolving situation in China with increasing reports of severe disease”.

“In order to make a comprehensive risk assessment of the situation on the ground, WHO needs more detailed information on the severity of hospital admissions and requirements for ICU support,” said a somewhat hoarse and tired Tedros.

However, the WHO stressed that it did not believe that China was under-reporting COVID cases and their impact – but simply that their hospital data was lagging behind reality, as had happened in most of the world.

“I think they’re behind the curve about what’s actually happening as everyone is in a situation like this,” said Ryan.

“We need to get better ways of getting that data quickly so we can monitor the situation together because it’s in the interest of the Chinese health system to know where the pressure is in the system at any one time. That allows you to move resources, move PPE, move health workers, move oxygen, move patients,” Ryan stressed.

“We’re very good at detection and doing epidemiological surveillance. We’re not so good around the world at dynamically managing the health system stress during a pandemic.”

However, Ryan indicated that the definition of a COVID death  “is quite narrow” and  “focused on respiratory failure”.

“People who die of COVID die from many different systems failures, given the severity of the infection, so limiting a diagnosis of death from COVID to someone with a COVID-positive test, and respiratory failure will very much underestimate the true death toll,” said Ryan.

“We don’t want the definitions to get in the way of actually getting the right data so we will continue to work with our WHO colleagues in China who work on a daily basis with the National Health Commission in the Ministry of Health and the China CDC, and we will do our best ensure that they can learn lessons about how best to collect dynamic data on health impact during events like this.”

Appeal to China to share data

But both Tedros and Ryan appealed to China to share their data so that the WHO could offer more support – implicitly acknowledging that the global body was not being kept abreast with what was happening.

According to modelling by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, China can “expect 323,000 total deaths from COVID-19 by 1 April 2023”, and one million Chinese people could die from COVID-19 next year.

Dr Maria van Kerkhove, the WHO’s lead on COVID-19, said that “by far the dominant sub-lineages of Omicron that are circulating in China are the BA.5 sub-lineages”. These include Omicron BA.5 sub-lineages BQ1, BF7, BA. 2.75 and XBB.

“One of the critical things we have seen with Omicron is that each of these sub-lineages have a growth advantage. They’re highly transmissible, each of these has some level of immune escape, and we do see a similar level of severity of Omicron sub lineages across all of the Omicron sublinear,” said Van Kerkhove.

China may face over a million cases a day, says Airfinity

China is predicted to see two peaks in cases as COVID-19 spreads throughout the country, the first peak in mid-January and the second in early March, according to new modelling by Airfinity based on data from China’s regional provinces.

The Airfinity model, released late Wednesday, estimates case rates could reach 3.7 million a day in a January peak and 4.2 million a day in March 2023.

“Today, our model suggests that there are likely to be over one million cases a day in China and over 5,000 deaths a day. This is in stark contrast to the official data which is reporting 1,800 cases and only 7 official deaths over the past week,” according to the independent health data analysis body.

Airfinity’s Head of Vaccines and Epidemiology Dr Louise Blair says, “China has stopped mass testing and is not longer reporting asymptomatic cases. The combination means the official data is unlikely to be a true reflection of the outbreak being experienced across the country.

“China has also changed the way it records COVID-19 deaths to only include those who die from respiratory failure or pneumonia after testing positive. This is different to other countries that record deaths within a time frame of a positive test or where COVID-19 is recorded to have attributed to the cause of death. This change could downplay the extent of deaths seen in China.”

Image Credits: Flickr.