I was asked the other day for my thoughts on the local approval and use of Sinovac, so just sharing my general take on this. Sinovac was given an emergency use license (EUL) by our Sri Lanka NMRA on 16 July 2021,  six weeks after WHO had given its EUL (1 Jun 2021). We have not since purchased it as far as I know and certainly not used it, so why?

Should Sinovac be approved for emergency use during this ongoing COVID pandemic?

The answer to that is fairly simply – YES. This basically boils down to two considerations: (1) Does it work? and (2) Is it safe enough for emergency use, given the limited evidence that any vaccine will have in an emergency scenario. This is the decision that WHO came to (and they are really slow when it comes to non-US/UK/EU vaccines), and the same decision that robust regulatory authorities in places like Hong Kong, Chile came to months before WHO. GIven that and given the reality that we faced of tight global supplies of COVID vaccines, our local NMRA approval was in fact if anything rather slow.

The second question is whether we should use or purchase it.

Should Sinovac be used in our Sri Lankan COVID vaccination strategy?

The question of whether Sinovac should be used in our national COVID vaccination strategy is a completely separate one, and not one that NMRA should or could decide. This separate decision needs to be based on the overall public health strategy, plus COST and AVAILABILITY considerations.

The bottom line here is that the answer depends on what our alternatives are, and how desperate we are to boost population immunity.

There are three things to know about Sinovac. First, it is not as effective in stopping severe illness and also in stopping transmission as Sinopharm or Astra-Zeneca, and much less effective than the mRNA vaccines, like Pfizer and Moderna. Second, it is much more available to developing countries than Astra-Zeneca, Pfizer and Moderna, because Sinovac is being produced in the billions of doses and most Western countries aren’t buying it. Third, although Sinopharm is a better vaccine, Sinovac was available in bulk outside China much earlier, because Sinovac, a commercial firm, was much faster in getting approvals than the more lethargic, state-run Sinopharm.

So Sinovac has been put to use in many countries, including in Europe and also some OECD countries, such as Chile and Mexico. GAVI has also signed agreements to purchase Sinovac for global distribution through the COVAX program. For practical reasons. Sinovac and also Sinopharm are the only vaccines that are available in sufficient bulk to allow COVAX to deliver on its commitments to developing countries, so COVAX desperately needs both Sinovac and Sinopharm. So there is a rational case for purchasing Sinovac in bulk in many countries, and even Western-dominated entities like GAVI have come to this conclusion.

However, for us in Sri Lanka, where we appear to now have substantial supplies of mostly Sinopharm vaccines, Sinovac is not a good choice any longer, since Sinopharm is much better in terms of immune protection. This means that with continuing widespread transmission (since contrary to HE President’s Official COVID Strategy, our real strategy has been for months to live and die! with the virus), Sinovac will require boosters earlier, and it will thus end up being more costly.

Here it should be said that if we had actually stuck to HE President Gotabaya’s official strategy of preventing and stopping outbreaks, then Sinovac might have had a role, since even a partially effective vaccine can help in reducing the cost of maintaining a COVID- free country. That’s essentially what China is doing right now. It doesn’t need the best vaccines, just vaccines good enough to slow transmission enough to allow other control measures to defeat the virus, without putting the whole country in lockdown….

But we are not China. We have followed the failed playbook that the UK and USA adopted. So we have widespread transmission in the community and literally thousands of deaths each month. So for us, buying and deploying Sinopharm, topped up with Moderna, Pfizer and Sputnik seems to be best strategy for now, with the exact mix depending on what is available quickly in quantity. Moreover, given that thousands are dying and will continue to die until the virus slows down by infecting enough people, speed and quantity are the biggest considerations, and no longer cost, since we have already made the decision to go for broke…and I mean that literally!