Brief on China: COVID-19 Testing and the Production, Distribution, and Export of Vaccines

By Lantian Li

China has successfully contained the spread of the pandemic within its territory. Despite the initial chaos, life in China has come back to normal. Data shows that for most of the days since last spring, the total number of new infection cases in China was below 100. The core idea of pandemic control is “dynamic elimination” (dongtai qingling).10 That is, whenever a new case was diagnosed, the local health agency would quickly follow up with strict quarantine and travel restrictions, large-scale testing and aggressive contact tracing until the case number in the locality returned to zero.

In this context, China has enforced one of the most thorough and strict COVID-19 testing policies in the world. This is best exemplified by its rather rigorous flight test requirement. For instance, given the sharp increase of imported cases from the U.S. last winter, since December 23, 2020, China required all passengers travelling to China from the U.S. to show negative results of not only nucleic acid rt-PCR test but also IgM serum antibody test.11 More recently, believing that anal swab is more effective than oral or nasal swab in tests, China began to apply anal swab in certain domestic quarantine zones and foreign visitor testing. This aggressive move triggered controversies among both foreign visitors and the Chinese public, including those who have been very cooperative in pandemic-related restrictions since day one. Some netizens mocked this arguably overreaction as “not very harmful, but very offensive,” (shanghaixing buda, wuruxing jiqiang) which soon became a catchphrase online.12

The success of the aggressive pandemic control, on the other hand, seemed to have partly contributed to the slow progress of the country’s mass vaccination program. China is among one of the few countries that have developed their own COVID-19 vaccines (approved 5 in total so far). The two leading vaccines were made through conventional inactivated technologies by Sinopharm and Sinovac. By the end of March, over 100 million Chinese vaccines have been administered domestically.13 Yet this number is far from enough for herd immunity given the huge population size of 1.4 billion (about 7%). According to Yanzhong Huang, a global health expert, the challenge is daunting since the herd immunity in China would require at least 66% of the total population to receive vaccines of over 91% efficacy.14 Huang also cited Ipsos-World Economic Forum survey data and showed that one reason for the vaccine hesitancy is that many people thought “the risk of infection in China is not that big,” though 80% of the surveyed Chinese said they would be willing to receive vaccines if they were available. Others were more worried about the side effects. Notably, although the Chinese vaccines reported lower overall efficacy than m-RNA vaccines marketed by Pfizer-BioNTech and Moderna, only around 16% of surveyed Chinese expressed suspicions over their effectiveness.

The Chinese state probably also predicted low risk of local outbreaks, and thus prioritized the vaccine export to other Southern countries over domestic mass vaccination. By early March, China had exported its vaccines to 28 countries and provided vaccine aid for 69 countries and 2 international organizations. The clinical data collected from other Southern countries reported different efficacy rates, e.g., 50.4% in Brazil (Sinovac), 86% in United Arab Emirates (Sinopharm with localized production plan), 83.5% in Turkey (Sinovac), and 67% against symptoms and 80% against death in Chile based on a real-world study of millions (Sinovac).15 Recently on April 12, China’s CDC director Gao Fu publicly acknowledged that Chinese vaccines “don’t have very high protection rates,” whereas China has not approved any foreign vaccines for use.16 Despite the effectiveness controversies and anti-China sentiments, China has been pushing the “vaccine diplomacy” to boost its global influence. This seemed to have garnered support from some Southern countries that were hit hard by the pandemic but struggled to access Western-produced vaccines, which were predominantly procured by rich countries. 17

Looking forward, China seems to have become a new safe haven with close to zero new infection rate, as well as a critical export site of COVID-19 vaccines for the Global South. As it ramps up production capacity, it is likely that the dual promise of mass inoculation and export acceleration could be met in the near future. However, if the global pandemic lingers on and other countries try to resume a certain level of openness after mass vaccination, China might find it hard to maintain the aggressive “dynamic elimination” pandemic control measures, unless it continues to enforce strictest border closing policies.

Lantian Li is a PhD Candidate in the Department of Sociology at Northwestern University.


10 Huang, Yanzhong, “Has China Done Too Well Against Covid-19?” New York Times, Jan 24, 2021.

11 Embassy of the People’s Republic of China in the United States, “Notice on the Requirement Adjustment of the Nucleic Acid rt-PCR and IgM Serum Antibody Tests” Dec 19, 2020.

12 Zhang, Ping and Sha Hong, “China Applying Anal Swab in Nucleic Acid Test Unsettled Netizens.” Deutsche Welle, Jan 27, 2021.

13 Meng, Yaxu, “Over 100 Million COVID Vaccines Have Been Administered Nationwide.” Xinhuanet, Mar 29, 2021.

14 Huang, Yanzhong, “Has China Done Too Well Against Covid-19?” New York Times, Jan 24, 2021.

15 Barrington, Lisa, “UAE Firm to Manufacture Chinese Sinopharm Vaccine from April.” Reuters, Mar 27, 2021. Kucukgocmen, Ali, “Turkish Study Revises down Sinovac COVID-19 Vaccine Efficacy to 83.5%.” Reuters, Mar 3, 2021. Simões, Eduardo, “New Brazil Data Shows Disappointing 50.4% Efficacy for China’s CoronaVac Vaccine.” Reuters, Jan 12, 2021. Vergara, Eva, “Big Chile Study Finds Chinese Vaccine Slashes COVID Deaths.” Associated Press, April 16, 2021.

16 McDonald, Joe and Huizhong Wu, “Top Chinese Official Admits Vaccines Have Low Effectiveness.” Associated Press, April 10, 2021.

17 Huang, Yanzhong, “Vaccine Diplomacy Is Paying Off for China.” Foreign Affairs, Mar 11, 2021.