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CoronaVac

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CoronaVac
CoronaVac.jpg
An empty vial of CoronaVac vaccine
Vaccine description
TargetSARS-CoV-2
Vaccine typeInactivated
Clinical data
Trade namesCoronaVac
Routes of
administration
Intramuscular
ATC code
  • None
Legal status
Legal status
Identifiers
DrugBank

CoronaVac, also known as the Sinovac COVID-19 vaccine,[1] is an inactivated virus COVID-19 vaccine developed by the Chinese company Sinovac Biotech.[2] It was Phase III clinical trialled in Brazil,[3] Chile,[4] Indonesia,[5] the Philippines,[6] and Turkey[7] and relies on traditional technology similar to BBIBP-CorV and Covaxin, other inactivated-virus COVID-19 vaccines.[8] CoronaVac does not need to be frozen and both the final product and the raw material for formulating CoronaVac can be transported refrigerated at 2–8 °C (36–46 °F), temperatures at which flu vaccines are kept.[9]

A real-world study of millions of Chileans who received CoronaVac found it 65% effective against symptomatic COVID-19, 87% against hospitalization, 90% against ICU admissions, and 86% against deaths.[10] In Indonesia, real world data from 128,290 healthcare workers showed 94% protection against symptomatic infection by the vaccine, beating results in clinical trials.[11] In Brazil, after 75% of the population in Serrana, São Paulo received CoronaVac, preliminary results show deaths fell by 95%, hospitalizations by 86%, and symptomatic cases by 80%.[12][13]

Phase III results from Brazil previously showed 50.7% efficacy at preventing symptomatic infections and 83.7% effective in preventing mild cases needing treatment. Efficacy against symptomatic infections increased to 62.3% with an interval of 21 days or more between the doses.[14] Final Phase III results from Turkey announced on 3 March 2021 showed an efficacy of 84%.[15]

Politicization, transparency issues and some incomplete trial data in Brazil contributed to a lack of trust in CoronaVac there.[16][17][18]

CoronaVac is being used in vaccination campaigns in various countries in Asia,[19][20][21] South America,[22][23][24] North America,[25][26][27] and Europe.[28][29][30] By April 2021, Sinovac had a production capacity of 2 billion doses a year[31] and had delivered 600 million total doses.[32] It is currently being manufactured at several facilities in China,[31] with planned overseas manufacture in Brazil in September 2021[33] and eventually in Egypt[34] and Hungary.[35]

On 1 June 2021, the World Health Organization (WHO) validated the vaccine for emergency use,[32][36][37] by which time over 430 million doses of CoronaVac had already been administered globally.[32]

Technology

As an inactivated vaccine like BBIBP-CorV and Covaxin, CoronaVac uses a more traditional technology[38][8] that is similar to the inactivated polio vaccine. Initially, a sample of SARS-CoV-2 from China was used to grow large quantities of the virus using vero cells. From then on, the viruses are soaked in beta-propiolactone, which deactivates them by binding to their genes, while leaving other viral particles intact. The resulting inactivated viruses are then mixed with an aluminium-based adjuvant.[39]

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.[9] 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.[40]

Efficacy

Real-world studies

In Brazil, a study was conducted in Serrana, population 45,000, where authorities attempted to vaccinate the entire adult population with CoronaVac.[41] After 75% of the adult population received the vaccine, preliminary results show deaths fell by 95%, hospitalizations by 86% and symptomatic cases by 80%. According to Ricardo Palacios, a director at Sao Paulo’s Instituto Butantan, “The most important result was understanding that we can control the pandemic even without vaccinating the entire population.”[42][43]

In May 2021, a real-world study of millions of Chileans who had received CoronaVac found the vaccine found to be 65% effective against symptomatic COVID-19, 87% against hospitalization, 90% against ICU admissions, and 86% against deaths. The finding is significant because the study was conducted when variants of concern found in Brazil have been known to be significantly circulating in the country. The study covered 10.2 million people.[10][44] The study is largely consistent with earlier results published by Chile in April.[15]

In May 2021, real-world data from Indonesia showed 94% of inoculated health care workers had been protected against symptomatic infection by the vaccine, besting results in clinical trials.[11] In this study of 128,290 health workers in Jakarta,[45] less than 1% of the vaccinated healthcare workers contracted symptomatic COVID-19, compared to more than 8% among the unvaccinated healthcare workers. The vaccine reduced the risk of hospitalization and death of the inoculated medical workers by 96% and 98% respectively.[46][47]

Uruguay released real-world data based on 795,684 people who have received both doses of CoronaVac for more than 14 days as of June 1 2021. In this group, 8,298 tested positive, 45 were admitted to the ICU, and 35 died of COVID-19. This indicated 64.52% and 61.47% efficacy in reducing COVID-19 cases for people aged 18-49 and 50 and older respectively. The vaccine was 94.95% and 92.18% effective in reducing ICU admissions, and 95.35% and 95.2% effective to prevent deaths. Among fully-vaccinated healthcare professionals, the vaccine was 66% effective in preventing cases, and 100% effective in preventing ICU admissions and deaths.[48]

Phase III clinical trials

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. Efficacy against symptomatic infections increased to 62.3% with an interval of 21 days or more between the doses. A total of 12,396 volunteers participated in the study between 21 July and 16 December 2020. All participants received at least one dose of the vaccine or placebo. Of this total, 9,823 participants received both doses.[14] Further detail published by Sinovac showed an efficacy 50.65% (95% CI, 35.6662.15%) against all symptomatic cases, 83.70% (57.9993.67%) against cases that require medical treatment, and 100.00% (56.37100.00%) 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.[49]

Phase III results from Turkey showed an efficacy of 84%. The final efficacy rate was based on 41 infections, 32 of which had received a placebo. The vaccine prevented hospitalization and severe illness in 100% of cases, with all six people who were hospitalized in the placebo group. The final results were based on 13,000 participants in the trials.[15]

On 1 April 2021, a preliminary report[50] from a phase III clinical trial in Chile[51] revealed that CoronaVac is safe and induces humoral and cell-mediated immunity in adults (18–59 years old) and the elderly (60 years or older) similar to previous phase II trials conducted in China with the same age groups and immunization schedule consisting of two doses with a 14-day interval. The side effects were mild and local, mainly limited to pain at the injection site, which was more common in adults. Seroconversion rates for adults 14–28 days after the second dose were 95.6% for the IgG specific against the S1-RBD (receptor binding domain of the S1 subunit of the spike protein) and 96% for neutralizing anti-S1-RBD IgG. For the elderly, seroconversion rates were 100% 14 days and 87.5% 28 days after the second dose for the S1-RBD specific IgG, 90% 14 days, and 100% 28 days after the second dose for neutralizing anti-S1-RBD IgG. As found in studies in animals, seroconversion rates for IgG specific against the N (nucleocapsid) protein were weak for both groups, although CoronaVac contains significant amounts of the N protein. A robust increase of T helper cells (CD4+) secreting interferon gamma was detected 14 days after both doses in response to stimulation with peptides of the S protein and of other viral particles, but the response to S protein peptides was reduced in the elderly due to a natural reduction of activated CD4+ T cells in this age group, as found in studies of other vaccines. The immune response of cytotoxic T cell (CD8+) was not as robust. The observed CD4+ T cell response is considered a balanced immune response capable of viral clearance and is similar to that observed in other COVID-19 vaccines, such as BNT162b1 and Convidecia.

Variability in results

Officials in Brazil said the lowered figure of 50.4% included "very mild" cases of COVID-19 among participants omitted in the earlier analysis.[52][53] 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 counted as an infection among trial participants.[54] The Institute splitted the cases in six categories: asymptomatic, very mild, mild, two levels of moderate, and severe; the first two didn't require medical assistance.[52][53] Possible explanations for lower efficacy rate included: trial was largely made up of frontline health care workers who were more exposed to the virus;[53] two vaccine doses were given at shorter intervals (2 weeks);[53][55] counting very mild cases;[53][56] and the Gamma variant (lineage P.1), more transmissible and perhaps evaded immunity better, was circulating.[56]

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.[57]

Variants

On 10 March, Instituto Butantan Director Dimas Covas said CoronaVac was efficient against three variants of COVID-19 in the country; Alpha (lineage B.1.1.7), Beta (lineage B.1.351), and lineage B.1.1.28 (identified in Brazil), from which Gamma and Zeta (lineages P.1 and P.2) descend.[58]

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.[58] 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 Gamma variant.[59]

Clinical trials

Phase I–II

In the Phase II trial completed in July 2020 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.[60]

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 and adolescents ages 3–17.[61] 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.[62]

Phase II–III

In April 2021, Sinovac began Phase II/III trials for the elderly aged 60-80 in the Philippines involving 352 volunteers.[63]

Phase II

In May 2021, Sinovac began Phase IIb trials in China with 500 participants for children and adolescents 3-17 years old.[64]

Phase III

Latin America

In July 2020, Sinovac began Phase III trials to evaluate efficacy and safety on 9,000 volunteer healthcare professionals in Brazil, collaborating with Butantan Institute.[65][66] 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.[67] On 23 October, São Paulo increased the number of volunteers in the trial to 13,000.[68]

Brazil briefly paused the trials on 10 November after the suicide of a volunteer before resuming them on 11 November. Instituto Butantan said the suicide had no relation to the vaccine trial.[69][70]

In August, a trial was started in Chile run by Pontifical Catholic University of Chile which was expected to include 3,000 volunteers between the ages of 18 and 65.[4]

Europe

In September, Turkey began trials with 13,000 volunteers on a two-dose 14-day interval.[71] The monitoring process took place at 25 centers in 12 cities across the country.[72]

The Governor of West Java Ridwan Kamil participating in phase 3 trial of the Sinovac COVID-19 vaccine in Indonesia.
Asia

In August, Sinovac began trials in Indonesia with Bio Farma in Bandung involving 1,620 volunteers.[5]

In October, Sinovac began trials in China involving 1,040 volunteers.[73]

In October, Saudi Arabia signed an agreement to distribute CoronaVac to 7,000 healthcare workers, after conducting Phase III trials with the Saudi Arabian National Guard.[74]

Manufacturing

Brazilian version of CoronaVac, filled and finished by Instituto Butantan

In April, Sinovac said its third manufacturing plant for Coronavac was ready and had started manufacturing bulk vaccine ingredients, doubling its annual capacity to 2 billion doses.[31]

In November, Brazil's Instituto Butantan began building a facility to manufacture 100 million doses of CoronaVac a year, with a target completion date in September 2021.[75] On 10 December, São Paulo Governor João Doria said that in the interim, prior to the local manufacture of CoronaVac, Instituto Butantan aimed to fill and finish 1 million doses of the vaccine per day.[33]

In Egypt, the government approved a manufacturing agreement to make 80 million doses a year for domestic use and export to African countries.[34]

In Indonesia, Bio Farma had by April 2021 filled and finished 35 million doses of CoronaVac, but was facing some production delays because of diminished supply of bulk delivered CoronaVac from China.[76]

Meanwhile in Malaysia, Pharmaniaga has obtained local approval for its fill and finish CoronaVac.[77]

In May 2021, Turkey was provided a license to produce CoronaVac.[78]

On 31 May 2021, Hungary announced an agreement to initially locally fill and finish CoronaVac, with the goal to eventually manufacture it locally in a new plant in Debrecen.[35]

Market and deployment

  Full authorization
  Emergency authorization
  Eligible COVAX recipient[79]
  EMA review in progress[80]

By May, 600 million doses of CoronaVac had been delivered to all countries and 430 million doses used. The World Health Organization validated the Sinovac-CoronaVac COVID-19 vaccine for emergency use on 1 June 2021.[32][37][36]

Asia

In January, Azerbaijan launched its vaccination campaign with CoronaVac.[81] It purchased 4 million doses from Turkey and 5 million doses from China.[82]

In May, Armenia received 100,000 doses from China.[83]

In June, Bangladesh approved Coronavac for emergency use.[84]

In February, Cambodia approved Coronavac for emergency use[85] and started vaccinations in March.[86] The country had received 4.5 million doses by June.[87]

In late August, China approved CoronaVac for emergency use to vaccinate high-risk groups such as medical staff.[88] In early February, China approved CoronaVac for general use.[21] On 5 June 2021, China approved CoronaVac for emergency use with children and adolescents for 3-17 years old.[89]

In December, Hong Kong ordered 7.5 million doses of CoronaVac.[90] The vaccination campaign with CoronaVac began on 26 February.[91]

By December 2020, Indonesia had signed agreements for 140 million doses of CoronaVac.[92] Indonesia approved emergency use authorization on 11 January[93] and President Joko Widodo received the first shot of the vaccine.[19] By May, Indonesia had received 92.9 million doses.[94]

In January, Malaysia ordered 12 million doses[95] which was approved for emergency use in March.[96] Science, Technology and Innovation Minister Khairy Jamaluddin received the first dose as part of the vaccination campaign.[97]

In March, Kazakhstan ordered 3 million doses,[98] of which 500,000 doses arrived in June and has been approved for use by the Ministry of Health.[99]

In May, Oman received its first batch of the vaccine.[100]

In April, Pakistan granted emergency use authorization for CoronaVac[101] and purchased 5 million doses.[102]

In January, the Philippines announced the country had secured 25 million doses.[103] 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,[104] and the country had received 7.5 million doses by June.[105]

Singapore signed advance purchase agreements for CoronaVac.[106] In February, the first doses arrived[107] and in June it was approved for use under the Special Access Route.[108]

In May, Tajikistan's Ministry of Health announced it would receive 150,000 doses.[109]

In February, Thailand approved emergency use[110] and started its vaccination program on 27 February.[20] As of May, Thailand had received 6 million doses with 3 million more outstanding.[111]

In May 2021, Turkmenistan received a delivery of CoronaVac.[112]

In May 2021, AKIPress reported Uzbekistan plans to use CoronaVac.[113]

Africa

In March, Benin received 203,000 doses of CoronaVac[114] and started vaccinations on 29 March prioritizing healthcare workers, people over 60, and those with co-morbidities.[115]

In April, Botswana received 200,000 doses of CoronaVac as a donation and purchased an additional 200,000 doses[116] to be used in the vaccination program.[117]

In March, Djibouti received 300,000 doses of CoronaVac.[118]

In April, Egypt approved emergency use of CoronaVac.[119]

In April, Guinea received 300,000 doses of CoronaVac which it had purchased.[120]

In April, Libya received 150,000 doses of CoronaVac from Turkey.[121]

In April, Somalia received 200,000 doses of CoronaVac.[122]

In March, South Africa's drug regulator began assessing CoronaVac for use in the country.[123] South African firm Numolux said it could supply 5 million doses once it secured regulatory clearances.[124]

In April, Togo received 200,000 doses of CoronaVac.[125]

In March, Tunisia's Ministry of Health approved marketing authorization for CoronaVac[126] and the first 200,000 doses arrived on 25 March.[127]

In March, Zimbabwe approved emergency use[128] and the first 1 million doses arrived on 30 March.[129]

Europe

In November, Turkey signed a contract to buy 50 million doses of CoronaVac.[130] Turkey approved emergency use on 13 January[131] and President Recep Tayyip Erdoğan received his first dose at Ankara City Hospital.[132] In February, Turkey signed a deal for another 50 million doses for a total of 100 million doses.[28] 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.[133]

In March, Albania launched its vaccination campaign using mainly CoronaVac,[30] a week after securing 1 million doses from Turkey.[134]

By June, Northern Cyprus received 190,000 doses donated by Turkey.[135]

In March, Bosnia received 30,000 doses donated by Turkey.[136]

In June, North Macedonia received 30,000 doses donated by Turkey.[135]

In April, Georgia received 100,000 doses from China[137] for which vaccinations started in May.[138]

In March, Ukraine granted approval for use of CoronaVac. Ukrainian Pharmaceutical Company Lekhim has an agreement to deliver 5 million doses.[139] 1.7 million doses had been delivered by June.[140]

In April, Moldova purchased 400,000 doses of CoronaVac.[141]

On the 4th of May, the EMA's human medicines committee (CHMP) started a rolling review of CoronaVac.[142]

South America

São Paulo State Secretary of Health Jean Gorinchteyn (left) and Instituto Butantan chairman Dimas Covas (right) holding single-dose prefilled syringes of CoronaVac, part of the fourth shipment of Sinovac-manufactured vaccine to arrive in Brazil

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.[143] The price for CoronaVac was announced to be US$10.3 (about R$59).[144] In January, Brazil announced it would obtain 100 million total doses.[145] On 17 January, Brazil's health regulatory agency Anvisa approved emergency use of CoronaVac.[146] In early February, Brazil said it intends to buy an additional 30 million doses on top of existing 100 million doses.[22] A total of 39.7 million doses had been delivered by early April.[147]

In January, Bolivia authorized use of CoronaVac.[148]

In October, Chile signed an agreement to purchase 20 million doses of CoronaVac[149] which was approved for emergency use on 20 January.[150] By early March, the country had received 10 million doses of CoronaVac and had vaccinated 4.1 million people.[151]

In February, Colombia had purchased 5 million doses and was in talks for an additional 5 million doses,[152] which had been approved for emergency use on 5 February.[153]

In February, Ecuador signed a deal for 2 million doses which was approved for emergency use,[154] with the first 1 million doses arrived in early April.[155][156]

In March, Paraguay received a donation of 20,000 doses from Chile.[157] Paraguay began vaccinations with CoronaVac on 10 March.[158]

In January, Uruguay purchased 1.75 million doses,[159] of which the first 192,000 doses arrived on 25 February and vaccinations started on 1 March.[24]

North America

By 8 March, Dominican Republic had vaccinated 400,000 people and had reserved delivery for 10 million additional doses of CoronaVac.[26]

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 30 March and 5 April.[27]

In February, Mexico approved emergency use of CoronaVac.[160] The country has ordered 20 million doses,[161] of which 7 million had been received by May.[162]

In April, Panama approved emergency use of Coronavac.[163]

Oceania

In March, Fiji said it would be receiving a donation of CoronaVac.[164]

Controversies

Politicization

CoronaVac has been championed by the governor of São Paulo, João Doria.[165] 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.[166] After Instituto Butantan announced CoronaVac's efficacy rate, Bolsonaro mocked the vaccine's effectiveness against COVID-19.[167]

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.[168] During the pandemic parliamentary inquiry in Brazil, senators have expressed that anti-China rhetoric has contributed to delaying access to vaccines in Brazil.[169]

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 about transparency as it was the third delay in releasing results from the trials.[18] Scientists said the lack of transparency risked damaging CoronaVac's credibility.[16]

Effectiveness

On 18 June 2021, Reuters reported that more than 350 Indonesian doctors and medical workers out of 5,000 in Kudus have contracted the SARS-CoV-2 Delta variant despite being vaccinated with the CoronaVac, an infection rate of 7 percent. In response to this development, Griffith University epidemiologist Dicky Budiman questioned the effectiveness of the CoronaVac vaccine against the Delta variant.[170]

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Further reading

External links