TAIPEI, Taiwan -- China's vaccine diplomacy campaign has been a surprising success: It has pledged roughly half a billion doses of its vaccine to more than 45 countries, according to a country-by-country tally by The Associated Press.
With just four of China's many vaccine makers able to produce at least 2.6 billion doses this year, a large part of the world's population will end up inoculated not with the Western vaccines but with China's shots.
Amid a dearth of public data on China's vaccines, fears over their efficacy and safety are pervasive in the countries depending on them, along with concerns about what China might want in return. Nonetheless, inoculations with Chinese vaccines have begun in more than 25 countries, and the shots have been delivered to another 11, according to The Associated Press' tally, based on independent reporting in those countries along with government and company announcements.
It's a potential face-saving coup for China, which has been criticized over its initial mishandling of the covid-19 outbreak.
"We're seeing certainly real-time vaccine diplomacy start to play out, with China in the lead in terms of being able to manufacture vaccines within China and make them available to others," said Krishna Udayakumar, founding director of the Duke Global Health Innovation Center at Duke University.
China has said it is supplying "vaccine aid" to 53 countries and exports to 27, but it rejected a request for the list. Beijing has denied vaccine diplomacy. Chinese experts reject any connection between the export of its vaccines and the revamping of its image.
China has targeted the low- and middle-income countries largely left behind as rich nations scooped up most of the pricey vaccines produced by the likes of Pfizer and Moderna.
China's vaccines, which can be stored in standard refrigerators, are attractive to many countries that may struggle to accommodate the ultracold storage needs of vaccines like Pfizer's. Sinovac and Sinopharm rely on a traditional technology in which a live virus is killed and then purified, triggering an immune response.
In Europe, China is providing the vaccine to countries such as Serbia and Hungary -- a significant geopolitical victory in Central Europe and the Balkans, where the West, China and Russia are competing for influence.
But China's vaccine diplomacy will be only as good as the vaccines it is offering, and it still faces hurdles.
Chinese vaccine companies have been "slow and spotty" in releasing their trial data, compared with companies like Pfizer and Moderna, said Yanzhong Huang, a global health expert at the U.S. think tank Council for Foreign Relations. None of China's three vaccine candidates used globally have publicly released their late-stage clinical trial data.
Sinopharm, which said its vaccine was 79% effective based on interim data from clinical trials, did not respond to interview requests. CanSino, another Chinese company with a one-shot vaccine that it says is 65% effective, also declined to be interviewed.
There is also confusion around Sinovac's efficacy. In Turkey, where Sinovac conducted part of its efficacy trials, officials have said the vaccine was 91% effective. However, in Brazil, officials revised the efficacy rate in late-stage clinical trials from 78% to just over 50% after including mild infections.
An expert panel in Hong Kong published data submitted by Sinovac to health regulators that showed the vaccine was just over 50% effective.
Globally, public health officials have said any vaccine that is at least 50% effective is useful.
Information for this article was contributed by Chen Si, Patricia Luna, Sam Magdy, Jim Gomez, Niniek Karmini, Justin Spike, Dusan Stojanovic and Allen G. Breed of The Associated Press.