The inoculation challenge

The inoculation challenge

The government is being scrutinised for buying a Chinese vaccine with low efficacy rates and ties to CP Group, while the most of the population is being supplied by a firm with little experience with vaccines

The cabinet approved plans to procure several million doses of Covid-19 vaccines during 2021.  Apichart Jinakul
The cabinet approved plans to procure several million doses of Covid-19 vaccines during 2021.  Apichart Jinakul

The country is eagerly awaiting the administration process in February of CoronaVac, a Covid-19 vaccine developed by a Chinese biopharmaceutical company, which recently received a hefty investment from a Thai conglomerate.

As the race to develop effective Covid-19 vaccines heats up among several pharmaceutical companies, in an effort to counter the surge of infections worldwide, the Thai government is also in a race against time to secure much-needed vaccines, hoping inoculations will provide a beacon of hope for the masses.

The cabinet approved plans to procure 35 million more doses of Covid-19 vaccines, adding to the 28 million scheduled to be shipped in the first half of the year, as part of its plan to inoculate at least half of the population.

Under current plans, Beijing-based Sinovac Biotech will supply 2 million doses under a budget of 1.2 billion baht, according to the Centre for Covid-19 Situation Administration.

The vaccine must be approved by both the Thai Food and Drug Administration (FDA) and China's equivalent body, the National Medical Products Administration (NMPA).

The Government Pharmaceutical Organization is expected to import the vaccine doses, and the Disease Control Department to purchase and distribute them.

Sinovac Biotech made headlines in early December 2020 when it secured US$515 million in funding for production of the vaccine from China-based Sino Biopharmaceutical Ltd, a subsidiary of the Charoen Pokphand (CP) Group.

The investment gave Sino Biopharmaceutical a 15% stake in Sinovac Life Sciences, the unit in charge of CoronaVac production under Sinovac Biotech.

But a recent news report raised some eyebrows regarding the efficacy of the China-made vaccine.

The BBC reported on Jan 13 the CoronaVac vaccine was found to be 50.4% effective in Brazilian clinical trials, according to the latest results released by researchers from the Butantan Institute. The ratio is barely above the 50% needed for regulatory approval.

Despite the recent news report, the Thai government insists it still plans to receive and administer the Chinese vaccine.

"There is no impact to our plan right now," said Supakit Sirilak, director-general of the Medical Science Department.

China's NMPA has not yet approved the Sinovac vaccine because it is also awaiting the company's efficacy and safety data.

CoronaVac has been undergoing phase three trials in various countries.

Interim data from late-stage trials in Turkey and Indonesia showed the vaccine was 91.25% and 65.3% effective, respectively, according to the BBC report.

TRIAL RESULTS

The CoronaVac vaccine works by using killed viral particles to expose the body's immune system to the virus without risking a serious disease response, the BBC reports. This contrasts with the method utilised in vaccines developed by Moderna and Pfizer.

Messenger RNA (mRNA) vaccines involve part of the coronavirus's genetic code being injected into the recipient, triggering the body to begin making viral proteins but not the whole virus, which is sufficient to train the immune system to attack, according to the report.

"Factually speaking, the CoronaVac vaccine [made by Sinovac] is the safest as it is produced from killed viral particles," said Thiravat Hemachudha, professor of neurology and director of the Thai Red Cross Emerging Infectious Disease Health Science Centre.

The trial results of Covid-19 vaccines produced by pharmaceutical companies in the West show 90% efficacy in results derived from an initial assessment, said Dr Thiravat.

These results are based on a 14-day period after the first inoculation followed by another 14-day period after the second shot, he said.

Trial results mainly come from inoculations of the most at-risk groups such as public health officials and the elderly, with the latter group sub-divided into healthy and fragile groups, said Dr Thiravat.

Referring to Sinovac's trial results in Brazil, it appears the efficacy of the inoculations was assessed based on the general population, he said.

"We have to step back and look at the efficacy of the influenza vaccine. The efficacy ratio is around 30% for this vaccine. Vaccines also work differently on different people," said Dr Thiravat.

Viroj NaRanong, research director of health economics and agriculture at the Thailand Development Research Institute (TDRI), said the Sinovac vaccine appears to be an alternative inoculation for Thais, with the government emphasis on the more than 20 million doses of vaccine jointly developed by the UK-based company AstraZeneca and Oxford University (Oxford-AstraZeneca).

The government's agreement with Sinovac Biotech is for the company to ship the first 200,000 shots of CoronaVac by the end of next month, another 800,000 shots in March and 1 million shots in April.

The 2 million shots are thought to be sufficient for 1 million high-priority people, including frontline officials, those living in the most high-risk areas of the country, and the elderly.

The government's goal is to provide coronavirus vaccines to 70% of the population to curb the pandemic and create herd immunity.

Another 26 million doses of the Oxford-AstraZeneca vaccine are expected to arrive in Thailand by the middle of the year.

Only Oxford-AstraZeneca and Sinovac Biotech have applied for their vaccines to be registered in Thailand, and the FDA is trying to speed up the approval process, said Surachok Tangwiwat, the FDA's deputy secretary-general.

Prime Minister Prayut Chan-o-cha signed a deal with UK-based biopharmaceutical firm AstraZeneca for Covid-19 vaccine supplies at Government House on Nov 27, 2020.

'TOM YUM KUNG' RECIPE

Thailand signed an agreement on Nov 27, 2020 with Oxford-AstraZeneca securing the country access to the company's Covid-19 vaccine and authorising the right for a local manufacturer to produce it.

In addition to supplying the vaccine to Thailand, Oxford-AstraZeneca is supporting local mass production of the vaccine by Siam Bioscience.

Siam Bioscience was selected by the UK-based pharmaceutical firm as its regional partner to produce the vaccine for the Southeast Asian region.

Siam Bioscience, a company affiliated with Crown Property Bureau, plans to produce the Oxford-AstraZeneca vaccine at its manufacturing plant in Pathum Thani province.

But lab-scale production and the mass production of millions of doses of the vaccine are very different, according to Dr Thiravat.

Although vaccine development can be done using textbook intuition, the bioequivalence of the original product and a replica could diverge, he said.

"It is like when a Tom Yum Kung recipe is distributed, but each cook makes it differently," said Dr Thiravat.

Siam Bioscience is known for its production of biotech drugs rather than vaccine development, said Mr Viroj of the TDRI.

"It seems like Thailand is putting all its eggs in one basket by relying mostly on the Oxford-AstraZeneca vaccine," he said.

A biomedical scientist, speaking on the condition of anonymity, said the government should have provided more opportunities for local firms with vaccine development expertise to partner with Oxford-AstraZeneca.

"The prime minister himself should get the first shot if any vaccine arrives, just as many other world leaders did," said the scientist.

HIGH RISK, HIGH RETURN

As one of Thailand's largest and most influential conglomerates, business ventures involving CP Group never fail to make news headlines both domestically and internationally.

The 15% share acquisition in Sinovac Life Sciences by Sino Biopharmaceutical, CP Group's pharmaceutical arm which has a large presence in China, generated both cheers and jeers from the public.

While some view this venture as being beneficial for Thailand because Sinovac is a vaccine producer, others are concerned it could create a conflict of interest because the Thai government agreed to purchase 2 million doses of Sinovac's vaccine.

A source from CP Group, speaking on the condition of anonymity, said the share acquisition via Sino Biopharmaceutical is likely to be solely for investment purposes.

A company holding a 15% stake is deemed to be a minority shareholder, said the source.

The source also brushed aside speculation that the deal may lead to CoronaVac controlling the Thai market in the future, pointing out that Sinovac sends vaccines to many counties at a much higher volume.

CP Group has a long history of business ventures in China. The issue is Thailand's antitrust regulatory system prevents a conglomerate from becoming a monopolistic entity, said Mr Viroj of the TDRI.

Sakon Varunyuwatana, chairperson of the Office of the Trade Competition Commission (OTCC), said there is a lack of details about CP Group's investment because the venture was routed through its affiliated company listed on the Hong Kong Stock Exchange.

However, he vowed the OTCC is monitoring this deal and any possible impact it may have on Thailand, such as trade activities that could be associated with the Trade Competition Act.

"No clear details of the deal have been publicised, such as the vaccine price and distribution channels in Thailand, nor import data. The OTCC is waiting for these facts," said Mr Sakon.

Researchers display samples of an mRNA Covid-19 vaccine. Nutthawat Wicheanbut

"However, it depends on the Public Health Ministry and the government in terms of how to manage the vaccine purchase and distribution because the Covid-19 vaccine management policy is a national agenda item."

A local pharmaceutical startup that is also developing Covid-19 vaccines said the healthcare industry is different from other businesses because it requires entrepreneurs to think more about the impact their products and services may have on society.

"Developers of new medicines and vaccines cannot only aim to maximise profit," said Suthira Taychakhoonavudh, chief executive and co-founder of Baiya Phytopharm Co, stressing she was referring to good business principles and not any specific companies.

She said medical firms also need to consider non-business issues such as whether their developments will bring benefits to the country.

The Covid-19 pandemic is a "wake-up call" and businesses should pay attention to ventures related to medicines, vaccines as well as laboratories, said Ms Suthira.

"This is a trend worldwide, not just in Thailand," she said.

"Large companies with a huge amount of capital are increasingly interested in the medical sector."

One incentive for this trend is innovative healthcare is among the targeted S-curve industries promoted by the government.

However, Ms Suthira warned that entrepreneurs who want to venture into medical and healthcare businesses, notably the development of Covid-19 vaccines and medicines, must possess in-depth scientific knowledge as well as a sharp business vision.

These businesses are full of challenges with "high risk, high return," she said.

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