Vaccines Are a Tough Sell. Their Chinese Origin Doesn’t Help.

BULAWAYO, ZIMBABWE — As a nurse at a private clinic, Jubilee Ngwenya had a front-row seat to the fear the coronavirus pandemic wrought. Yet when vaccine doses from China arrived here in February, the 27-year-old hesitated. Could she trust a vaccine from the country where the pandemic started? One that, at the time, hadn’t earned the World Health Organization’s approval? No, she decided.

“Since there are now other alternative vaccines, I might reconsider,” she says.

As Zimbabwe rolls out its inoculation campaign, the country faces a significant hurdle: a deep distrust of Beijing. Although Zimbabwe has added Russian and Indian vaccines to its stockpile, China’s Sinovac and Sinopharm still constitute more than 90% of its doses. That’s made many people — health care workers included — wary of inoculation.

A recent survey of Zimbabweans showed that half were either unsure they would get vaccinated or had decided not to, according to an article in Vaccines, a journal affiliated with the American Society for Virology.

Their fears are not entirely unfounded. Some research has shown that Sinovac’s efficacy rate is as low as 50%, according to The BMJ, a journal published by the British Medical Association. That means the vaccine prevented symptoms of COVID-19, the disease caused by the coronavirus, in half the people who received it in clinical trials. (The efficacy rate for both the Pfizer-BioNTech and Moderna vaccines distributed in the United States is more than 90%.)

In April, George Gao, head of the Chinese Center for Disease Control and Prevention, said publicly that it’s “under consideration whether we should use different vaccines,” The BMJ reported. After his comments spread across social media, he said they were misinterpreted.

Dr. Wilson Mpariwa, a medical practitioner at Midlands State University’s Zvishavane campus, just east of Bulawayo, would prefer an efficacy rate closer to 70% in the Chinese vaccine. But he says efficacy can differ from region to region, depending on which coronavirus variant is circulating. In Zimbabwe, the so-called South African variant is dominant.

“We are hopeful that Sinovac will have high efficacy rates here,” he says.

Vimbai Chinembiri, GPJ Zimbabwe

Nurse Lovemore Mahohoma administers a second dose of China’s Sinopharm vaccine to Dr. Wilson Mpariwa in Zvishavane, Zimbabwe.

A representative from the Chinese Embassy in Zimbabwe referred questions about the vaccines to Zimbabwean health officials. Dr. Agnes Mahomva, chief coordinator of the country’s COVID-19 response, says officials have “no concerns whatsoever” about their efficacy, particularly with the WHO’s recent approval of Sinopharm for emergency use.

China and Zimbabwe grew particularly close in the early 2000s. China’s economy was thriving, allowing it to wield economic influence in Africa. Zimbabwe’s was sputtering, in part because the U.S. and the European Union had imposed sanctions due to what the U.S. State Department called “widespread, government-sponsored violence.”

In 2003, Zimbabwe adopted its “Look East” policy, and over the next decade, according to a report from the South African Institute of International Affairs, “hardly any aspect of Zimbabwean life did not feel the Chinese impact.” Road construction, telecommunications, electricity generation — China was involved.

To many Zimbabweans, Beijing became synonymous with exploitation. When China invested heavily in iron and diamond mining, people accused the country of plundering resources and mistreating workers. Stores derided as “China shops” popped up, selling footwear, kitchenware and electric appliances that sometimes fell apart. These days, people grumble that China is essentially recolonizing the country.

“It is the trust factor that remains a challenge when it comes to China,” says Dr. David Mukwekwezeke, an HIV clinician in Harare, Zimbabwe’s capital.

China’s Sinopharm and Sinovac each require two doses, 14 to 28 days apart. Mukwekwezeke says they appear safe because they work the same way many vaccines do: a weakened version of the virus essentially trains the body’s immune system to fight it. One benefit of the Chinese vaccines is that they don’t require extremely cold storage, as the Pfizer and Moderna vaccines do. With Zimbabwe’s frequent power outages, Mukwekwezeke says, it would be difficult to keep those vaccines from spoiling.

“I believe that it is safe, despite people’s skepticism about it,” says a Chinese national born in Zimbabwe who recently got the Sinopharm shot. The man asked for anonymity because of the stigma China has carried since the pandemic began. “Since COVID was first detected in China … I would suppose that the Chinese vaccine would be safer than other vaccines later made in other countries.”

Zimbabwe doesn’t have many other options. Wealthier nations snapped up a disproportionate amount of the world’s vaccines. As of January, the U.S. had ordered enough doses to inoculate its population twice, according to the Duke Global Health Institute in North Carolina, while Canada could vaccinate its population five times. That has made Africa more reliant on donations or direct purchases from China and Russia.

In March, the Chinese state-run outlet People’s Daily framed the dynamic this way: “While China makes selfless contributions to the global anti-pandemic effort, some wealthy countries are busy hoarding vaccines and hyping up their claims of so-called ‘vaccine diplomacy’ to smear China.”

At the public hospital in Zvishavane, Kudzai Kazi is in charge of convincing front-line workers to get vaccinated. It has been tough. The vaccines’ Chinese origins made some people skittish. Others distrusted shots developed in less than a year — in their minds, too short a time. So hospital management got their Sinopharm shots first.

“This helped in building confidence among the rest of the health workers,” Kazi says. “Even those who had initially refused came back to volunteer to be vaccinated.” Now almost all of the hospital’s 300 workers are inoculated.

Vimbai Chinembiri, GPJ Zimbabwe

Abigirl Mupakaviri displays her vaccination card at a clinic in Harare, Zimbabwe, after getting a dose of China’s Sinovac vaccine.

Officials have tried to reassure the public, running radio and TV ads promoting vaccination. President Emmerson Mnangagwa even got jabbed on TV. But China isn’t the only government about which Zimbabweans are wary. In a recent survey, nearly half of respondents said they were suspicious of the vaccines because they didn’t trust Zimbabwe and China working together, says Dr. Norman Matara of the Zimbabwe Association of Doctors for Human Rights.

The campaign is also unfolding amid what the WHO has termed an “infodemic” of social media falsehoods. In Zimbabwe, the conspiracy theories include that citizens are unwitting guinea pigs in an experiment to test vaccines; that vaccines actually infect people with the coronavirus; and that inoculations are an effort by the West to sterilize or kill Africans. Those televised injections of government officials? According to messages circulating on WhatsApp, the syringes were filled with water.

“People generally have a fear of new things,” says Mpariwa, the Midlands State University doctor. “When antiretroviral therapy came to treat HIV, there was a similar problem of people fearing death and not trusting the new medication.”

When Zimbabweans heard a coronavirus vaccine might come from America, they panicked that it would alter their DNA, he says. “China is just an outlet. People need a reason to avoid vaccination.”

Roy Dube, 33, is a pharmacist in Bulawayo. When he told friends he planned to get vaccinated, some tried to talk him out of it, citing conspiracy theories. But Dube wanted to do his part to halt the spread of the virus, and got the Sinovac shot.

“It was clear that it was not a cure, but reduced one’s chances of contracting COVID-19,” he says. That felt safer than leaving his health to chance.