Chinese vaccines and strategy on the Delta variant

The numbers and phrases

“It’s been just over a month, and China has once again squelched Covid-19,” Bloomberg reported last week, under the title China Hits Zero Covid Cases With a Month of Draconian Curbs.

For the last three days, the Chinese government said there were zero COVID-19 cases as a result of local transmission. As the recent Delta variant break retreats, this newsletter looks at two key Chinese tools against it - the vaccines and the strategy.

The first part offers a translation of some remarks by Chinese officials at a recent press conference (Mandarin), focusing on the numbers.

The second part offers an overview of some high-frequency phrases that local leaders use in implementing and building on important instructions from President Xi Jinping on controlling this round of outbreaks.

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Zheng Zhongwei, Director of the Development Center for Medical Science and Technology of the National Health Commission who also heads the team coordinating the country's COVID-19 vaccine development projects, said

新冠疫苗在本轮疫情中肯定是起到了作用的。从南京、扬州、郑州这几个地方来看，截止到8月25日，共报告感染者1388例。刚才吴司长也把今天的数据报出来了，1395例。在这些感染者当中，也不同程度地有接种疫苗以后感染的人员。这些人群当中，也不同程度地出现了重症和危重症。在这里，我也可以给你几个数据。第一，在重症病例当中，完成了两剂新冠疫苗接种的，也就是完成了免疫程序14天以上的人员，占重症的比例小于5%。也就是说，95%以上的是没有接种或者没有完成免疫程序的人员。第二，在60岁以上重症人群当中，超过90%以上是没有接种疫苗，或者没有完成接种疫苗的。在扬州出现的危重症患者，都没有接种疫苗。所以说，新冠疫苗接种可以很明确地说，对整个这波疫情的控制是有好处的。……最近大家也注意到，德尔塔株，这次南京、扬州、郑州等地发生的疫情全是德尔塔株感染。前两天，钟南山院士的团队针对广东的疫情也做了研究，并且发表了相应的文章。广东感染毒株也主要是德尔塔株，通过钟院士他们的研究表明，两剂疫苗接种后，对中度新冠肺炎的保护效果达到了70%，对重症的保护效果达到了100%。广东省疾控中心还有一项研究，我在这里也可以和大家分享，就是他们研究发现，没有接种疫苗的或者只接种了一剂疫苗的人，它的病毒载量是接种完疫苗的人的3倍。也就是说，接种完疫苗的人群再传染给其他人的风险也是下降的。

The COVID-19 vaccine must have played a role in containing the current outbreak. Nanjing, Yangzhou and Zhengzhou have reported 1388 cases of HIV infection as of August 25. (Deputy) Director-General Wu also reported today's figures just now, so it’s now 1,395 cases.

Among these infected people, to varying degrees, there are people infected after vaccination. Among these people, severe and critical symptoms have also occurred to varying degrees.

Here, I can also give you some data. First, among the people with severe symptoms, those who have completed two doses of COVID-19 vaccine, that is, those who have completed the immunization program for more than 14 days, account for less than 5% of the serious cases.

That is to say, more than 95% of the people （infected in this round）are those who have not been vaccinated or have not completed the immunization program.

Second, among the severe cases over the age of 60, more than 90% have not received the vaccination or have not completed the vaccination. All the critically ill patients in Yangzhou were not vaccinated.

So, the COVID-19 vaccination is clearly benfitial for the epidemic control.

……

Recently, people have also noticed that the outbreaks in Nanjing, Yangzhou, and Zhengzhou were all caused by the Delta strain. Two days ago, Academician Zhong Nanshan's team also conducted research on the epidemic situation in Guangdong and published the research (on Emerging Microbes & Infections).

The strains in Guangdong in this round were mainly Delta strains. Academician Zhong Nanshan’s research shows after two doses of vaccine inoculation, the protection against moderate COVID-19 reached 70% and the protection against severe symptoms reached 100%.

There is another study by the Guangdong CDC, which I can share with you here. Their study found that the viral load of the people who did not get the vaccine or received only one dose of the vaccine was three times that of those who received the vaccine. That is to say, the risk of people passing the vaccine to others is also reduced (via vaccinations).

Then came a very provocative question

Q: 据报道，以色列是世界上疫苗接种水平最高的国家之一，78%的12岁及以上人口接种了疫苗。但是德尔塔株暴发导致疫情再次蔓延。据了解，以色列接种的主要是辉瑞疫苗和阿斯利康疫苗，请问应该如何看待这种现象？面对德尔塔株，mRNA和腺病毒载体这两种技术路线是否已经失效？

Q:According to reports, Israel is one of the countries with the highest vaccination level in the world, with 78% of the population aged 12 and above vaccinated. But the outbreak of Delta strain caused the epidemic to spread again. It is understood that Israel is mainly vaccinated with Pfizer vaccine and AstraZeneca vaccine. How should we treat this phenomenon? In the face of Delta strain, have mRNA and adenovirus vectors vaccines failed?

And the answer:

A: 据我们了解，近期在一些国家，特别是在我们统计当中大家看到的一些疫苗接种率比较高的国家，出现了不同程度的一些反弹。很多人就开始怀疑，疫苗还有没有效。实际上我刚才给大家报告的，在美国发布的一些数据看，不接种疫苗的风险是远远高于接种疫苗的。我们也研究了这样一些情况，比如刚才你谈到的某些国家，它的接种率已经达到了一定的水平，它也出现了疫情的反弹。我们在研究当中发现，当这个国家的接种率达到70%左右的时候，实际上它的疫情出现了有效的下降的。但是之后，在德尔塔株流行以后，特别是在这些国家流行以后，随着它的防控的放松，反而出现了一些反弹。最早的时候，反弹感染的人员主要是没有接种的人群。刚才王司长也提到了，学校为什么要开展接种？这些国家最早的时候也没有开展12岁到17岁人群的接种，最后他们发现，在这个人群当中，随着德尔塔株流行，反弹的时候，就发生了一些变化。 第二，当初这些国家在做疫苗接种覆盖率判断的时候，是基于当时它的原型株流行的情况。大家知道，德尔塔株的传播力较原型株是明显增高的。根据德尔塔株的流行率，我们还能不能继续按照以前的疫苗覆盖率去继续我们的防控策略？那就值得商榷了。所以为什么最近大家看到这些国家也在快速的提高疫苗接种率，同时也在进一步收紧防控策略。 但是从目前综合各方面情况来看，我们的疫苗，包括你刚才提到的国外的这些疫苗，在应对疫情当中，不管是防感染还是防重症，还是防死亡，都不是百分之百，但是都有明确的预防感染，都有显著的预防重症和死亡的能力，这一点我们不应该去怀疑它。在目前情况之下，正像刚才吴司长说的，我们还是必须强化严防严控手段。为什么？因为我们的疫苗接种覆盖率，针对现在的流行株，还需要进一步提高，只有当我们疫苗接种覆盖率提高到一定程度了，而且我也想特别强调一下，在覆盖率当中，“一老一小”大家真要关注，因为老人一旦感染，发生重症、危重症、死亡的风险，是年轻人的数倍，甚至十倍。小孩这个人群，大家也关注到，他现在的感染风险也在提高，不管是美国的报道也好，还是其他一些西方国家的报道也好，当德尔塔株流行起来以后，最开始出现的就是这些人群的感染。而大家也在关注这些人群接种疫苗究竟安不安全。刚才实际上大家也在讨论这个问题，在这里我也想补充一点，我们现在国内用的疫苗主要是灭活疫苗和重组蛋白疫苗，这两类疫苗的安全性，事实上已经经过了几代人持续接种的证明。像我们的灭活疫苗，用的最早的是2月龄的孩子，它的安全性是有保证的，大家可以放心。

A: As far as we know, some countries, especially those with higher vaccination rates in our statistics, have seen a rebound in COVID-19 transmission to varying degrees recently. Many people began to wonder if the vaccine was effective.

In fact, as I reported to you just now, according to some data released in the United States, the risk of not being vaccinated is much higher than that of being vaccinated.

We have also studied such situations. For example, in some country/countries you mentioned just now, the vaccination rate has reached a certain level, and there has also been a rebound in the transmission. In our research, we found that when the vaccination rate in this country reached about 70%, its epidemic situation actually improved effectively.

However, after the Delta strain became widespread, especially in the countries where the prevention and control had been relaxed, there was some rebound in transmission instead.

In the earliest period of the rebound, the people who were infected were mainly those who were not vaccinated. Just now, Director-General Wang (of the Ministry of Education) also mentioned why schools should carry out vaccination. Those countries didn't vaccinate people aged between 12 and 17 at the earliest period, and finally they found that some changes took place when Delta strain became widespread and saw a rebound.

Second, when planning on the vaccination coverage, the country/countries based their calculation on the prevalence of the original strain (not the Delta strain) at that time.

As we all know now, the Delta strain is obviously far more contagious than that of the original strain. Based on the (high) contagious rate of the Delta strain, can we continue our prevention and control strategy based on the previous vaccination plan? That is open to question.

So that's why you see that these countries are also rapidly increasing the vaccination rate and tightening the prevention and control strategies? However, comprehensively considering the current situation, our vaccines, including the foreign vaccines you mentioned just now, despite not being 100% in preventing infection, severe illness and death, all have significant effecacy against severe illness and death, which we should not doubt.

Under the current situation, as (Deputy) Director-General Wu said just now, we still have to strengthen the means of strict control. Why? Because our vaccination coverage rate needs to be further improved for the currently dominating COVID-19 strains (the Delta strain) - our vaccination coverage rate must be improved to a certain extent.

And I also want to emphasize that in the vaccination coverage rate, "one old and one young" should be paid attention to, because once the elderly are infected, the risk of serious illness, critical illness and death is several times or even ten times that of young people.

People have paid attention to the group of children, whose infection risk has increased now, according to reports in either the United States or other Western countries.

On another note, there was this Q&A from Dr. John MacArthur, CDC Southeast Asia Regional Director, hosted by the U.S. Department of State’s Asia Pacific Media Hub in Manila:

Question: …. And does the U.S. welcome other countries to donate vaccines to Vietnam to reduce the shortage, including China? Thank you.

Dr. MacArthur: …With regards to Vietnam, Vietnam did a fantastic job early on in containing COVID-19. I think with the entrance of the Delta variant, it’s a little bit more challenging. They are in the process now of introducing vaccines to their population and rolling that out. Where Vietnam or other countries source their vaccines is an individual country choice, so we don’t try to influence that. We only promote the use of safe and efficacious vaccines.

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Continuing with Zheng Zhongwei, Director of the Development Center for Medical Science and Technology of the National Health Commission who heads the team coordinating the country's COVID-19 vaccine development projects

从5月份以来，先后有秘鲁、泰国、智利、阿根廷、蒙古、巴林、乌拉圭、斯里兰卡等大规模接种我国新冠灭活疫苗的国家相继发布真实世界研究数据。但是在这里我要明确一下，由于各国的防控策略不一样，变异株流行的情况也有所不同，所发布的灭活疫苗预防感染、重症和死亡的数据也有所差异。总的来看，预防感染的保护率从57%到85%不等。预防重症的保护率均在90%左右。预防死亡的保护率在84%到97%之间。跟大家分享的同时，我也可以明确地告诉大家，大家要真正的科学认识疫苗，疫苗不光是预防感染不是百分之百的，预防重症也不是百分之百的，预防死亡也不是百分之百的，但是它确确实实能有效预防感染，能显著预防重症和死亡。跟大家分享一下具体的数据。

智利卫生部在《新英格兰医学杂志》上发表了科兴中维灭活疫苗真实世界的研究结果，这也是目前为止全世界在医学杂志上发表的最大样本量的真实世界数据，样本量达到1000万人以上。针对这1000万人，在接种两剂灭活疫苗14天后进行了研究，他的结论是，整体保护力为65.9%，就是防感染的保护率。防止住院保护率为87.5%，防重症的保护率是90.3%，防死亡的保护率是86.3%。

秘鲁卫生部报告，有60593名医生接种了国药集团灭活疫苗，其中完成2剂疫苗接种后，医务人员人群当中的死亡率下降了98%。大家都知道，医务人员是高风险人群。

阿根廷卫生部也发布了报告，这个报告也很有趣，他对接种2剂中国生物灭活疫苗60岁以上人群的死亡保护率作了一个分年龄阶段的研究，总体的保护率是84%，但是60-69岁是80.2%，70-79岁是88.3%，80岁以上是77.6%。

斯里兰卡也正式发布了国药集团灭活疫苗的一个研究报告，它的研究报告提示，疫苗接种者对德尔塔株的抗体滴度下降了1.38倍。对德尔塔株的结论是仍有较好的保护作用。此外，通过他的研究还证明，以前我们经常讲，灭活疫苗能不能刺激细胞免疫，是不是只能刺激体液免疫？他的研究结果表明，国药疫苗还能诱导T细胞和记忆B细胞的免疫反应。就是我们灭活疫苗的接种，同样可以刺激产生中和抗体、细胞免疫和免疫记忆。

以上就是真实世界的研究情况，而且这些国家都是有不同程度的疫情流行的。

Since May, Peru, Thailand, Chile, Argentina, Mongolia, Bahrain, Uruguay, Sri Lanka, and other countries that have received the two Chinese inactivated vaccines in COVID-19 have successively released real-world research data. However, I want to make it clear that due to different prevention and control strategies in different countries and the different epidemic situations in terms of mutant strains, the published data on the prevention against infection, severe illness, and death are also different.

Overall, the two Chinese vaccines’ - from Sinopharm and Sinovac respectively- protection against infection ranged from 57% to 85%. The protection rates against severe diseases are about 90%. The protection rate against death is between 84% and 97%.

While sharing with you, I can also clearly tell you that you should have a real scientific understanding of vaccines. Vaccines are not 100% effective for the prevention of infection, nor are they 100% effective for the prevention of serious illnesses, nor are they 100% effective for the prevention of death.

However, they can indeed effectively prevent infection and can significantly prevent serious illnesses and deaths. Let's share some specific data.

Chile's Ministry of Health published in the New England Journal of Medicine the results of a real-world study of the inactivated vaccine from Sinovac. This is also the real-world data with the largest sample size published in medical journals in the world so far, with the sample size reaching more than 10 million people. A study of these 10 million people was conducted 14 days after receiving two doses of inactivated vaccine and he concluded that the overall protection was 65.9%, that is, the protection against infection. The protection rate against hospitalization, severe illness, and death was 87.5%, 90.3%, and 86.3%, respectively.

Peru's Ministry of Health reported (Spanish) that 60,593 doctors received the Sinopharm inactivated vaccine. After two doses of vaccination, the mortality rate among the medical staff decreased by 98%. It is well known that medical personnel are a high-risk group.

Argentina's Ministry of Health also released a report (Spanish). This report is also very interesting. They conducted an age-specific study on the protection rate against death in people over 60 years old after receiving two doses of the Chinese inactivated vaccine from Sinopharm. The overall protection rate was 84%, but it was 80.2% at the age of 60-69, 88.3% at the age of 70-79, and 77.6% at the age of 80 and over.

Sri Lanka has also officially released a research report on the inactivated vaccine produced by Sinopharm. Its research report says that antibody levels in people receiving Sinopharm's BBIBP-CorV vaccine had a 1.38-fold reduction to the Delta variant versus an older version of the coronavirus first identified. The conclusion is Sinopharm/BBIBP-CorV still has relatively good protection against the Delta variant.

In addition, this research also showed something else. We used to ask can the inactivated vaccines stimulate cellular immunity? Or can inactivated vaccines ONLY stimulate humoral immunity? The Sri Lanka research results show that the Chinese Sinopharm vaccine could also induce the immune response of T cells and memory B cells. That means our inactivated vaccine can also stimulate the production of neutralizing antibodies, cellular immunity, and immune memory. That's the real-world researches, and all those countries have varying degrees of the pandemic.

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This part presents some high-frequency phrases used by local leaders at the provincial level in squelching the Delta variant, sourcing from local press reports describing 29 provincial-level meetings on COVID-19 control and prevention.

In each and every meeting, the provincial-level leaders respectively made clear that they were implementing and building on important instructions from President Xi Jinping.

1） 外防输入、内防反弹

To guard against imported cases, and to prevent a rebound in domestic cases

This is everywhere. In eastern Jiangsu Province, local leaders stressed: “strengthening the external defense line from imported cases, conducting closed-loop management over the whole process of entry personnel at airports, ports, and docks, and conducting closed-up management for personnel in high-risk positions.”

强化外防输入防线，对机场、口岸、港口、码头的入境人员全程闭环管理，对高风险岗位人员封闭管理。

A meeting in southeastern Fujian Province emphasized: “resolutely guarding all checkpoints for preventing from imported cases, seriously and strictly conducting the prevention and control of entering Fujian by land, by air, or by sea, strictly controlling the front-end of inbound goods, and preventing COVID from being imported through illegal channels.”

要坚决守住外防输入的各个关口，认真严把陆海空入闽途径的有关防控，严格入境货物前端管控，防范疫情经非法渠道输入。

At the provincial level, the prevention of imported cases doesn’t only mean COVID cases from outside the Chinese border, but also could include other provinces, municipalities, or autonomous regions as well.

For example, northeastern Heilongjiang Province focused on the screening of people entering the province.

“We will strictly and tightly carry out the current pandemic prevention and control, implement and refine various prevention and control measures, and take the screening of personnel entering our province as the emphasis in the current epidemic control and prevention of imported cases. We will adhere to accurate prevention and control and accurate implementation of policies, consolidate the hard-won achievements in COVID prevention and control, and ensure the safety and health of people.”

从严从紧做好当前疫情防控工作，做实做细各项防控措施，把进入我省人员排查工作作为当前外防输入疫情防控的重点，坚持精准防控、精准施策，巩固来之不易的疫情防控成果，保障人民群众生命安全和身体健康。

2) 压实“四方”责任

Tighten up on the “Four Parties” with responsibility.

The “Four Parties” refer to

1)属地 local region, under the leadership of local Party and govt

2)部门 govt department, in charge of certain sectors or industries

3)单位 units, or employers in plain English

4)个人 individuals

In northern Hubei Province, the local leaders highlighted that “no mistakes are allowed in the epidemic prevention and control and all the localities in the province must attach great importance to it, ensure the responsibilities of local governments，departments, units, and individuals are performed in earnest and fully implement the measures for preventing and controlling the epidemic.”

各项防控工作容不得丝毫闪失，各地务必高度重视，压紧压实“四方责任”，切实把疫情防控各项措施执行到位。

3) 坚持把疫情防控工作当作重中之重

Continue to make COVID prevention and control a top priority

A literal translation would be something like “continue to make COVID prevention and control the priority in priorities.”

In southwestern Fujian Province, local leaders emphasized that “we must earnestly study and implement the spirit of General Secretary Xi Jinping's important instructions on epidemic prevention and control, implementing the spirit of the National Conference on COVID-19 prevention and control, and soberly recognizing the serious and complicated situation of the current COVID-19 situation, taking the initiative to take targeted measures, resolutely curbing the pandemic, making COVID prevention and control as the top priority as well as the prerequisite and foundation for the economic and social development of the province.”

强调要认真学习贯彻习近平总书记关于疫情防控工作的重要批示精神，落实全国疫情防控电视电话会议精神，清醒认识当前疫情严峻复杂的形势，主动采取有针对性的措施，坚决遏制疫情苗头，把疫情防控工作当作重中之重和确保全省经济社会发展的前提与基础。

4) 落实“四早”要求

Achieve the "four early" measures, namely early detection, early reporting, early isolation, and early treatment

In a mobilization meeting on epidemic prevention and control, local leaders of northwestern Shaanxi province underlined the quick response to COVID-19 cases, emphasizing that we should “resolutely achieve the ‘four early’ measures to ensure the rapid screening, epidemiologic study, isolation, and control and make every effort to block the transmission route and chain of the epidemic.”

要从快启动疫情响应，坚决落实“四早”要求，做到落地查找快、流调跟进快、隔离管控快，全力阻断疫情传播途径和链条。

In a meeting in Fujian Province, local leaders emphasized the necessity to expeditiously find loopholes in COVID-19 prevention and control work, deeply analyze the problems and identify the crux of them, so as to achieve the "four early" measures, adhere to the simultaneous prevention of SARS-CoV-2 transmission via both people and goods, and shore up the weakness in epidemic prevention and control.

会议强调，要抓紧梳理排查疫情防控工作漏洞，深入分析问题，找准问题症结，落实“四早”要求，坚持“人”“物”同防，加快补齐疫情防控各环节短板。

That goods are in the same category as people in the prevention and control of COVID-19 in China is unique. The U.S., EU, and several other governments disputed Beijing’s assessment of the evidence, as did many experts outside China, the Wall Street Journal reported in January.

Chinese scientists have paid much attention to the role of cold chains in the transmission of the virus, said Wang Chen in February, President of the Chinese Academy of Medical Sciences and Peking Union Medical College.

Wang has said that a close connection between some patients' infections and their exposure to cold chain goods has been found in China, where on the surfaces of these goods live viruses were detected.

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5）坚决克服麻痹思想、厌战情绪、侥幸心理、松劲心态

Not let the guard down, get rid of any “war-weary” attitude, weariness, or fluke mind

As this friggin’ pandemic drags on, China has been warning against a lapse in judgment or action.

For instance, in a meeting in eastern Zhejiang Province, local leaders stressed that “we should raise our political awareness and establish the correct understanding, not let the guard down, and get rid of any ‘war-weary’ attitude, weariness or fluke mind, earnestly strengthening the awareness of epidemic prevention and control in both thinking and action.”

提高政治站位、树立正确观念，坚决克服麻痹思想、厌战情绪、侥幸心理、松劲心态，切实增强疫情防控的思想自觉和行动自觉。

In southwestern Sichuan Province, leaders used the same language against “letting the guard down, ‘war-weary’ attitude, weariness or fluke mind” and ask for “more tenacious will, more powerful measures.”

全省各级各部门和广大党员干部要…… 坚决防止麻痹思想、厌战情绪、侥幸心理、松劲心态，以更加顽强的意志、更加有力的举措抓实抓细疫情防控各项工作，坚决打赢这场疫情防控遭遇战、阻击战。

6) 常态化疫情防控

Normalized/Routine pandemic prevention and control

As the phrase shows, the prevention and control measures in general - they do vary depending on exact local situations - are here to stay.

In central Jiangxi Province, local leaders stressed the importance of normalized pandemic prevention and control to “create a decent environment for sustained and healthy economic and social development.”

The leaders of eastern Shandong Province noted, “the current round of epidemic situation is very fierce, and the situation is grim.”

“Normalized pandemic prevention and control cannot be relaxed, not even for a moment. Departments at all levels should attach great importance to the pandemic, stay highly vigilant, tighten the string of COVID prevention and control, and resolutely avoid lowering the guard and overcome laxity.”

刘家义指出,当前这轮疫情来势很猛,形势严峻,常态化疫情防控须臾不可放松。各级各部门要高度重视,始终保持高度警醒,绷紧疫情防控这根弦,坚决克服麻痹松懈思想。

7) 切实巩固/坚决守住来之不易的疫情防控成果 

Earnestly consolidate / firmly hold the hard-won achievements in epidemic prevention and control

For example, a meeting held by Guangzhou Province’s party committee underlined that “implementing the experience and practices summarized in the practice of (previous) COVID prevention and control, being stricter than strict on the prevention and control work, with extreme conscientiousness and close attention to detail, and earnestly maintaining the hard-won achievements of COVID prevention and control”.

落实好在疫情防控实践中总结形成的经验做法，严而又严、细之又细抓好防控工作，切实维护来之不易的疫情防控成果。

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Thanks to Zhixin Wan and Alexander Wang, two contributors to Pekingnology, for going through 29 readouts of provincial-level meetings and picking out the high-frequency phrases.