Evidence has been put forward questioning China's successful coronavirus response and the effectiveness of its vaccines which are now being distributed around the world.
Believed to be ground zero of the global Covid pandemic, the Asian superpower crushed its initial outbreak with heavy-handed lockdowns. It has since produced vaccines and exported them to smaller and poorer nations.
But data from some of those countries appears to raise questions about how well the Chinese vaccines have quelled case numbers.
The country has donated more than 22 million vaccine doses to countries in South America, Africa, the Middle East and the Pacific, according to Bridge Beijing, a consultancy that tracks China’s impact on global health.
Many of those have been the state-made Sinopharm vaccine, considered the lynchpin of China's so-called vaccine diplomacy push. The other vaccine distributed from China is from Beijing-based private pharmaceutical company Sinovac.
However a new report by Wall Street bank JP Morgan highlights some potential shortcomings of the program as questions mount about the real world effectiveness of the jabs.
"Most countries have approved multiple vaccines, so it’s not easy to figure out actual field efficacy for individual vaccines," the report says.
"That said, there are a few countries we can identify that have been moderately or highly reliant on the Sinopharm vaccine, where vaccination levels are high, and where infection levels are still high as well."
Including China, there are 45 countries which approved the Sinopharm jab with the World Health Organisation saying the vaccine has a 79 per cent efficacy rate – higher than the AstraZeneca jab Australia initially sought to rely on.
"An advisory group to the WHO had a 'high level of confidence' that it prevents Covid-19 in adults. However, they did cite a 'low level' of confidence for people over 60 since Sinopharm enrolled few adults above 60 years old in its trials," Mike Cembalest, the bank's chairman of investment strategy wrote in the report.
Graphs show problems for nations relying on Chinese vaccines
Sharing graphs comparing countries with high vaccine rates using Chinese-produced vaccines with countries using Pfizer, Moderna, AstraZeneca, J&J jabs, shows cases numbers have not seen the same uniform decline in the former.
While other factors including lockdowns are at play, there is a "stark difference in infection levels between Sinopharm countries in the first chart, and countries using genetic RNA and vector vaccines in the second chart," the JP Morgan report said.
The comparison was posted online by Chinese science writer Fang Shimin before being shared by others including Singapore based hedge fund manager Alex Turnbull, son of former Australian prime minister Malcolm Turnbull, who is among many to suggest the Chinese vaccines don't work as advertised.
Lingering questions and variants plague China's vaccines
The small island nation of Seychelles last month held the mantle of the world's most vaccinated country, The New York Times reported. But it had a surge in coronavirus cases despite much of its population being inoculated with China’s Sinopharm vaccine.
Infectious disease expert from the University of New South Wales, Raina MacIntyre, described the Sinopharm jab as a "reasonable vaccine".
The situation in Seychelles could have resulted from a number of reasons including failures in the cold-chain logistics needed for transport, and storage of the vaccine rendering it ineffective, as well as dormant vaccine-resistant variants, she wrote recently.
The seeming failure of the Chinese vaccine to produce high levels of protection "is possibly due to variants of concern," she told Yahoo News Australia.
"The Delta variant is associated with some vaccine escape, and has been identified in Bahrain, as has Beta, which is extremely vaccine resistant," she said.
Bahrain is one of a number of countries which has moved away from its reliance on the Sinopharm vaccine after an ongoing surge in cases.
"We need to see good genomic surveillance data from these countries to determine if current epidemics are caused by variants of concern," Prof MacIntyre said.
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