CoronaVac, also known as the Sinovac COVID-19 vaccine, is an inactivated virus COVID-19 vaccine developed by the Chinese company Sinovac Biotech. It has been in Phase III clinical trials in Brazil, Chile, Indonesia, the Philippines, and Turkey.
It relies on traditional technology similar to BBIBP-CorV and BBV152, other inactivated-virus COVID-19 vaccines in Phase III trials. CoronaVac does not need to be frozen, and both the vaccine and raw material for formulating the new doses could be transported and refrigerated at 2–8 °C (36–46 °F), temperatures at which flu vaccines are kept.
Phase III results from Brazil submitted to Lancet showed 50.7% efficacy at preventing symptomatic infections, 83.7% effective in preventing mild cases needing treatment. The efficacy against symptomatic infections is increased to 62.3% with an interval of 21 days or more between the two doses. Final Phase III results from Turkey announced on 3 March 2021 showed an efficacy of 83.5%. Interim results in Indonesia were announced on 11 January 2021 with an efficacy of 65.3%.
CoronaVac is being used in vaccination campaigns by certain countries in Asia, South America, North America, and Europe. In April, Sinovac had a production capacity of 2 billion doses a year of which 200 million doses had been delivered and an estimated 100 million doses administered globally. It is being produced separately in China, Brazil, Indonesia, and Egypt.
CoronaVac is an inactivated vaccine. It uses a similar, more traditional technology as in BBIBP-CorV and BBV152, other inactivated-virus vaccines for COVID-19 in Phase III trials. CoronaVac does not need to be frozen, and both the vaccine and raw material for formulating the new doses could be transported and refrigerated at 2–8 °C (36–46 °F), temperatures at which flu vaccines are kept. CoronaVac could remain stable for up to three years in storage, which might offer some advantage in vaccine distribution to regions where cold chains are not developed.
Phase III results from Brazil submitted to Lancet showed 50.7% efficacy at preventing symptomatic infections, 83.7% effective in preventing mild cases needing treatment. The efficacy against symptomatic infections is increased to 62.3% with an interval of 21 days or more between the two doses. A total of 12,396 volunteers participated in the study between July 21 and December 16, 2020. All participants received at least one dose of the vaccine or placebo. Of this total, 9,823 participants received both doses. Further detail published by Sinovac on the Brazil trials showed an efficacy 50.65% (95% CI, 35.66–62.15%) against all symptomatic cases, 83.70% (57.99–93.67%) against cases that require medical treatment, and 100.00% (56.37–100.00%) against severe, hospitalized and fatal cases. In the placebo group (N=4870), there were 168 COVID cases, 30 cases requiring medical attention, and 10 severe cases including one death. In the vaccine group (N=4953), there were 85 COVID cases, 5 cases requiring medical attention, and no severe cases or deaths.
On 3 March 2021, final Phase III results from Turkey showed an efficacy of 83.5%. The final efficacy rate was based on 41 infections, 32 of which had received a placebo, said Murat Akova, head of the Phase III trials in Turkey. He added the vaccine prevented hospitalization and severe illness in 100% of cases, saying six people who were hospitalized were all in the placebo group. The final results were based on a 10,216 participants, 6,648 of whom received the vaccine as part of the Phase III study that began mid-September. Turkey had announced an interim result with 29 infections in December, which placed the efficacy at 91.25%.
On 11 January, Indonesia released Phase III results from an interim analysis of 25 cases which showed an efficacy rate of 65.3% based on data of 1,600 participants in the trial. The trial was conducted in the city of Bandung, and it was not clear how Indonesian scientists made their calculations. On 6 April, a study conducted by University of Chile found efficacy against infections is 56.5% two weeks after the second dose and only 27.7% within the first two weeks, while a single dose has no relevant effects after 4 weeks.
Variability in results
Officials said the lowered figure of 50.4% included "very light" cases of COVID-19 among participants omitted in the earlier analysis. Ricardo Palácios, Medical Director of Brazil's Instituto Butantan said Sinovac's relatively low efficacy rate of 50% was due to more rigorous standards for what counts as an infection among trial participants. The Institute included six types of cases in its results: asymptomatic, very mild, mild, two levels of moderate, and severe, while western vaccine makers generally included only mild, moderate, and severe categories. Brazil's trial was also largely made up of frontline health care workers. "They are more exposed to the virus and may explain the relatively low efficacy rate," said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.
The release of more definitive data on CoronaVac's efficacy was delayed because Sinovac needed to reconcile results from different trials using varying protocols. According to Instituto Butantan director Dimas Covas, the Brazilian group was considered more vulnerable to infection and exposure to higher viral loads. In Turkish and Indonesian Phase III trials, the composition of volunteers was similar to that of the general population.
On March 10, Instituto Butantan Director Dimas Covas said CoronaVac was efficient against three variants of COVID-19 in the country; British B.1.1.7, South African 501.V2, and Brazil's P.1, of which are derived variants P.1 from Manaus state, and P.2 from Rio de Janeiro.
CoronaVac and other inactivated virus vaccines have all parts of the virus. Butantan said this may generate a more comprehensive immune response compared to other vaccines using only a part of the spike protein used by COVID-19 to infect cells. Preliminary results from a large study of health care workers suggest one dose of CoronaVac is still about 50% effective against symptomatic COVID-19 in Manaus where over 75% of new cases are caused by the highly transmissible P.1 variant.
In a Phase II clinical trial completed in July 2020 and published in The Lancet, CoronaVac showed seroconversion of neutralising antibodies for 109 (92%) of 118 participants in the 3 μg group, 117 (98%) of 119 in the 6 μg group, after the days 0 and 14 schedule; whereas at day 28 after the days 0 and 28 schedule, seroconversion was seen in 114 (97%) of 117 in the 3 μg group, 118 (100%) of 118 in the 6 μg group.
In May, CoronaVac began Phase I–II trials in China on adults over the age 60, and in September CoronaVac began Phase I–II trials in China on children ages 3–17. Phase II results for older adults published in The Lancet showed CoronaVac was safe and well tolerated in older adults, with neutralising antibody induced by a 3 μg dose similar to those of a 6 μg dose.
In late July 2020, Sinovac began conducting a Phase III vaccine trial to evaluate efficacy and safety on 9,000 volunteer healthcare professionals in Brazil, collaborating with Butantan Institute. On 19 October, São Paulo Governor João Doria said the first results of the clinical study conducted in Brazil proved that among the vaccines being tested in the country, CoronaVac is the safest, the one with the best and most promising immunization rates. On 23 October, São Paulo announced the creation of six new centers for trials of CoronaVac, increasing the number of volunteers in the trials to 13,000.
Brazil briefly paused Phase III trials on 10 November after the suicide of a volunteer before resuming on 11 November. Instituto Butantan said the suicide had no relation to the vaccine trial.
In September, Turkey began Phase III trials with 13,000 volunteers on a two-dose 14-day interval. The monitoring process for CoronaVac took place at 25 centers in 12 cities across the country.
In August, Sinovac began Phase III trials in Indonesia with Bio Farma in Bandung involving 1,620 volunteers. In November, Padjadjaran University Medical School provided an update that the trials were running smoothly and that "at most, they found a slight body fever which disappeared within two days".
In April, Sinovac said its third production plant for Coronavac was ready and had started manufacturing bulk vaccine ingredients, doubling its annual capacity to 2 billion doses.
In November, Brazil began building a facility to produce 100 million doses a year. On 10 December, São Paulo Governor João Doria said Butantan aimed to fill and finish 1 million doses per day.
Market and deployment
As of April, 200 million doses of CoronaVac have been delivered and an estimated over 100 million doses had been administered worldwide.
In Brazil, São Paulo governor João Doria signed a $90 million contract with Sinovac in September to receive the initial 46 million doses of CoronaVac. The price for CoronaVac was announced to be US$10.3 (about R$59). In January, Brazil announced it would obtain 100 million total doses. On 17 January, Brazil's health regulatory agency Anvisa approved emergency use of CoronaVac. In early February, Brazil said it intends to buy an additional 30 million doses on top of existing 100 million doses.
In January, Bolivia authorized use of CoronaVac.
In October, Chile signed an agreement to purchase 20 million doses of CoronaVac which was approved for emergency use on 20 January. By early March, the country had received 10 million doses of CoronaVac and had vaccinated 4.1 million people.
In March, Bosnia received a donation of 30,000 doses from Turkey.
In April, Moldova purchased 400,000 doses of CoronaVac.
In November, Turkey signed a contract to buy 50 million doses of CoronaVac. Turkey approved emergency use on 13 January and President Recep Tayyip Erdoğan received his first dose at Ankara City Hospital. In February, Turkey signed a deal for another 50 million doses for a total of 100 million doses. By March 10.7 million doses had been administered, and 852 of the 1.3 million people who had received both doses were later diagnosed with the disease. 53 were hospitalized, but none of those hospitalized were intubated or died.
In March, Ukraine granted approval for use of CoronaVac. Ukrainian Pharmaceutical Company Lekhim has an agreement to deliver 5 million doses to Ukraine, of which the first arrived on March 25.
On 19 January, Azerbaijan launched its vaccination campaign with CoronaVac. Azerbaijan plans to receive 4 million doses and aims to vaccinate 40% of the population.
In February, Cambodia approved Coronavac for emergency use and started vaccinations on March 31 with the first 1.5 million doses it received with plans to purchase another 4 million doses.
In August, Indonesia signed an agreement for 50 million doses, which later increased to 140 million doses. Indonesia approved emergency use authorization on 11 January and President Joko Widodo received the first shot of the vaccine, which would be free for all Indonesian citizens. By March, Indonesia had received 53.5 million doses of CoronaVac.
On 26 January, Malaysia ordered 12 million doses. CoronaVac was approved for emergency use on 2 March. Malaysian Science, Technology and Innovation Minister Khairy Jamaluddin received the first dose with CoronaVac on 18 March as part of the vaccination campaign.
In April, Pakistan granted emergency use authorization for CoronaVac.
In January, the Philippines announced the country had secured 25 million doses. The vaccine was approved on 22 February but not for all health workers as it had lower efficacy when used with health workers compared to healthy individuals aged 18–59. The first 600,000 doses of CoronaVac arrived on 28 February and the country began its vaccination campaign.
Thailand's Ministry of Public Health ordered 2 million doses of CoronaVac, which was approved for emergency use on 22 February. Thailand started its vaccination program on 27 February. In April, the 2 million doses had arrived and a public-private joint committee was set up to buy about 10 million more doses.
By March 8, Dominican Republic had vaccinated 400,000 people and had reserved delivery for 10 million additional doses of CoronaVac.
In March, El Salvador received 1 million doses of a total 2 million dose order for CoronaVac. Public sector teachers would receive the first dose between March 30 and April 5.
In February, Mexico approved emergency use of CoronaVac. The country has ordered 20 million doses, of which the first 200,000 doses arrived on 20 February and are being used as part of the national vaccination campaign.
In April, Panama approved emergency use of Coronavac.
In March, Djibouti received 300,000 doses of CoronaVac.
In March, South Africa's drug regulator began assessing CoronaVac for use in the country. South African firm Numolux said it could supply 5 million doses once it secured regulatory clearances.
In April, Somalia received 200,000 doses of CoronaVac.
In March, Fiji said it would be receiving a donation of CoronaVac.
CoronaVac has been championed by the governor of São Paulo, João Doria, who many believe will challenge Jair Bolsonaro for the presidency in 2022. A political showdown began in October 2020, when Bolsonaro vetoed a deal between the Brazilian health ministry and the São Paulo government for the purchase of 46 million doses of the vaccine. After Instituto Butantan announced CoronaVac's efficacy rate, Bolsonaro mocked the vaccine's effectiveness against COVID-19. Critics against the politicization of vaccines have warned that failure to follow international testing and safety protocols risks undermining public trust and can increase people's hesitancy to inoculation. Doctors in São Paulo said they were struggling to convince patients that CoronaVac would be safe.
In March 2021, the Paraná Pesquisas opinion polling institute found that the vaccines preferred by Brazilians are CoronaVac and the Oxford–AstraZeneca vaccine, chosen by 23.6% and 21.2% of Brazilians interviewed, respectively, against 11.3% of those who would prefer the Pfizer–BioNTech vaccine.
Delays in releasing results
On 23 December 2020, researchers in Brazil said the vaccine was more than 50% effective, but withheld full results at Sinovac's request, raising questions again about transparency as it was the third delay in releasing results from the trials. São Paulo Health Secretary Jean Gorinchteyn later said the vaccine didn't reach 90% efficacy. Turkey said its trial showed an estimated efficacy rate of 91.25%, though that was based on only 29 infected cases. When São Paulo state officials announced the protection rate, they declined to provide a more detailed breakdown of the trial, such as information about age groups and side effects of the vaccine. Scientists said the lack of transparency about the data ran the risk of damaging CoronaVac's credibility, with Brazilians and others world-wide already reluctant to take it. Nikolai Petrovsky, a professor at the College of Medicine and Public Health at Flinders University said, "There is enormous financial and prestige pressure for these trials to massively overstate their results."
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