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Why did the efficacy of China’s top vaccine drop from 78% to 50%?

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Why did the efficacy of China’s top vaccine drop from 78% to 50%?


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Nearly one week ago, Brazilian officials sounded triumphant in announcing that the vaccine from Chinese drugmaker Sinovac was 78% effective in preventing COVID-19 infections.

“Today is the day of hope, the day of life,” João Doria, governor of Brazil’s São Paulo state, said at a press conference on Jan. 7.

But at a press conference on Tuesday, officials delivered a more sobering follow-up: Sinovac’s vaccine was, in fact, only 50.4% effective in preventing COVID-19 infections. The officials said that the lowered figure accounted for “very light” cases of COVID-19 among participants in the country’s phase III trial of the vaccine that had been omitted in the earlier analysis.

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Sinovac’s 50.4% efficacy rate in preventing COVID-19 infections is significantly lower than the 95% and 94% efficacy rates for Pfizer’s and Moderna’s vaccines, respectively. The lower figure reportedly came after Brazilian scientists pressured Sinovac’s Brazilian partner, the Butantan Institute, to release a fuller picture of its trial results.

Ricardo Palácios, medical director of the Butantan Institute, argued that the lower efficacy rate was evidence that Sinovac’s Brazil trials focused on higher risk groups than the Pfizer and Moderna trials and that the institute used more stringent standards. “We added all possible difficulties [to our trials],” he said. 

Neither Sinovac nor the Butantan Institute, however, has released full details of its trial data to the public, and Sinovac did not respond to Fortune’s request for comment on the vaccine’s new efficacy figure.

Experts tell Fortune that Sinovac’s lowered efficacy rate may not be as big a blow as it might appear, and that the vaccine may still prove a useful tool in helping bring an end to the global pandemic. At the same time, Tuesday’s announcement marks the latest in a series of inconsistent conclusions about the potency of Sinovac’s vaccine, which has now produced four different efficacy results across three continents. The discordant figures, combined with the dearth of publicly available data, may make it more difficult for the company to build public confidence in its doses.

Why did the rate drop?

A vaccine efficacy’s rate is calculated by comparing the number of COVID-19 infections among trial volunteers who received the vaccine versus the cases among volunteers in the placebo group. In the Brazil trial, 85 participants injected with Sinovac’s vaccine developed COVID-19 infections compared to 167 who developed infections in the placebo group, creating an efficacy rate of just above 50%.

At Tuesday’s press conference, Palácios said Sinovac’s relatively low efficacy rate of 50% was due to its more rigorous standard for what counts as an infection among trial volunteers. The Butantan Institute said it included six types of cases in its results: asymptomatic, very mild, mild, two levels of moderate, and severe. (The Brazilian authorities stressed that the public should focus on the vaccine’s 100% efficacy in protecting against severe cases of COVID-19.) Western vaccine makers generally included only mild, moderate, and severe categories, and companies like Pfizer are doing additional studies to see if the vaccine will prevent asymptomatic cases.

“People want to compare other studies, but that’s like comparing a person that runs a 1 kilometer race on a flat stretch and another doing it on a steep and obstacle-filled stretch,” Palácios said.

There is some evidence to back up Palácios claim that Brazil’s trial standards are more likely to catch mild cases of COVID-19 than trials conducted elsewhere, which would results in a lower efficacy rate.

In the U.S.’s Food and Drug Administration’s evaluation of Pfizer’s vaccine trials, the agency found that there were up to 1,594 suspected but unconfirmed cases of COVID-19. Because the infections were unconfirmed, they didn’t factor into the Pfizer vaccine’s efficacy rate.

“It’s true that other vaccine trials have not been able to confirm as many mild infections [as Sinovac],” says Ben Cowling, an epidemiologist at the University of Hong Kong. “The [vaccine efficacy] against mild disease could be lower than 90%-95% for Moderna and Pfizer.”

Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations, noted that Brazil’s trial was also largely made up of frontline health care workers. “They are more exposed to the virus and may explain the relatively low efficacy rate,” Huang said. Sinovac’s CEO Yin Weidong made that same argument when he addressed the lower efficacy rate at a press conference on Wednesday.

Transparency

Cowling cautioned that Sinovac’s efficacy figure is still based on limited public data, and that a fuller data release is needed to fully assess the efficacy of Sinovac’s vaccine.

“I think we really need to see more comprehensive documentation before making any assessment of the vaccine performance” says Cowling. “What we have seen so far is pretty limited information.”

It’s not just the new efficacy figure in Brazil and the lack of public data that’s stirring confusion about how well Sinovac’s vaccine works.

Turkey has claimed that Sinovac’s vaccine is 91.25% effective in preventing COVID-19 infections, and Indonesia has said it’s 65% effective. (Both figures are based on interim trial data from the respective countries.)

The questions that remain about Sinovac’s vaccine hasn’t stopped the company from rolling it out. It’s distributed jabs of the vaccine outside of clinical in China for months, and Indonesia used Sinovac’s vaccine to launch a massive campaign to vaccinate 181 million people on Wednesday. Alongside health ministers and the Indonesia’s top Muslim cleric, Indonesia President Joko Widodo received the first dose of Sinovac’s vaccine on Wednesday in a televised ceremony from his presidential palace.

But there’s no guarantee that others will be as willing to take up the jab.

“[Transparency] is a concern,” says Huang. “Transparency about the data, even for the interim results, could still be very important to convince people that the results were indeed trustworthy.”

Even with the lingering unknowns, the vaccine may prove useful in inoculating millions of people who lack access to any alternative.

Sinovac has deals to supply lower-income countries like Malaysia, the Philippines, and Thailand, and its jabs, which require regular refrigeration, could serve as a lifeline for nations without the ultra-cold storage infrastructure needed to distribute the Pfizer and Moderna vaccines.

“Initially, I was surprised by how low that efficacy rate was, but after I gave some further thought on this the 50% actually wasn’t that bad,” says Huang. “It can still reduce the risk of COVID infection and be considered a game changer in the fighting of the current pandemic.”

More health care and Big Pharma coverage from Fortune:

  • What we know about which COVID vaccine you’ll receive
  • The U.K. is delaying the second dose of COVID vaccines to 12 weeks. Is that even safe?
  • Backed by Chelsea Clinton’s venture capital fund, this startup aims to make having cancer less lonely
  • Why one country is vaccinating its young before its elderly
  • Biden’s health-equity adviser on her approach to addressing the politicization of COVID and misinformation

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Do government deficits matter?

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Do government deficits matter?


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In support of political contributions

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A deluge of feedback in a turbulent week


Good morning.

Most Americans don’t want CEOs involved in politics. A poll conducted last week by Golin and Ipsos found only 41% favored CEOs weighing in on disputed elections, and only 43% wanted them speaking out on impeachment. On the other hand, 74% say CEOs should call for unity and a peaceful transfer of power, and 57% believe it was appropriate for CEOs to speak out after the January 6 insurgency at the Capitol. That pretty well tracks with the way most CEOs and business groups have behaved since election day. They kept their powder dry until all legitimate avenues for disputing the election were exhausted, then came out strongly endorsing the election results and attacking efforts to undermine them. Relatively few have backed impeachment. (You can see the poll results here.)

But how about political contributions? That’s the question raised last week, as a host of companies—Marriott, AT&T, American Express, Best Buy, Cisco, Comcast, Dow and Amazon among them—suspended campaign contributions to members of Congress who challenged the election results. Another large group—Microsoft, Boeing, Blackrock, Coca-Cola, JP Morgan, Ford, GM, UPS, Goldman Sachs and Citigroup—temporarily halted all political contributions to members of both parties. (Quartz has a more comprehensive list of what companies did here.)

Some business leaders are even contemplating permanently shutting their political action committees and exiting the money game altogether. But absent a broader overhaul of campaign finance—which is unlikely anytime soon—I think that’s a mistake. Most big companies remain balanced players in the money game, dividing their dollars roughly equally between members of each party. Walmart, for instance, has kept its contributions at exactly 50-50. Their strategies have less to do with trying to influence outcomes, and more to do with assuring they have access to whoever wins.

The more important question for 2021 is how big business uses that access. There are a host of issues where business has the potential to help broker positive outcomes for the U.S. economy and society: economic stimulus, infrastructure, worker training, climate change. On each of these, business leaders occupy the center, and can help bring the parties together to solve urgent problems.

But on tax and regulatory issues, in particular, corporations will be playing defense. And they’ll be tempted to use what influence they can muster to seek tax breaks and regulatory exemptions that aren’t in the broader public interest. That’s where the commitment to stakeholder capitalism will be tested. The nation desperately needs business involved in government. But business, now more than ever, needs to use its influence to focus on solving long-term challenges.

News below.

Alan Murray
@alansmurray

[email protected]



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Why Big Tech regulation is good for private equity, according to one CEO

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Why Big Tech regulation is good for private equity, according to one CEO


Increased scrutiny of Big Tech’s power may have some shareholders sweating it. But not so for private investors.

With a new Biden administration and recent threats to crack down on some of the biggest tech behemoths (from Facebook to Amazon), there seems to be support for more regulation. And according to alternative investment manager Hamilton Lane’s CEO, Mario Giannini, that might be good news for the private equity industry.

“Reducing the dominance of large technology companies…is probably not great for some portions of the industry, but good for private equity,” Giannini tells Fortune. In Congress, which now maintains a slim Democratic majority, “I think everyone is interested in saying, ‘Amazon is too powerful, Google [is too powerful],’ pick your name,” he says, arguing there’s bipartisan support for more regulation.

As to what lawmakers do about it, “I’m not sure,” says Giannini, but “to the extent that they do anything to diminish the power of those companies, that’s good for private equity because it creates opportunity for smaller companies.”

To be sure, government scrutiny of large tech companies is a tale as old as time, but lately regulators appear to be turning up the heat on the biggest names: Facebook was recently hit with an antitrust lawsuit alleging it has squashed competition, while players like Amazon and Apple, big winners of the pandemic era, have found themselves the subject of government ire over antitrust concerns. Google, meanwhile, is in hot water once more for its search and search advertising practices. And companies like Facebook and Amazon could be facing their own headwinds in Europe, too.

According to Giannini, whose firm has $73 billion in assets under management and advises on $474 billion in additional assets, the dominance of those FAANG names has been top of mind for private equity firms when scouting for deals.

“Right now, when any private equity [firm] does a deal, …if it’s not their first question, it’s one of their top three questions: ‘Is Amazon going to enter this space, yes or no?’ And that has a huge impact—’Is Google in this space?’” he says.

It isn’t just an issue in tech. Companies like Amazon are moving into health care, for instance, by launching online pharmacies. “If all of the sudden the government [would] say, ‘I’m not going to allow Amazon to encroach in certain areas,’ then I think for private equity, oddly enough, that becomes a net positive because you do then have an opportunity with other companies,” says Giannini.

Though some on the Street argue the threat of sweeping legislative changes to hamper Big Tech’s reach is still minor, the new (albeit slim) Democratic majority in Congress poses “a clear negative for Big Tech as…we would expect much more scrutiny and sharper teeth around FAANG names,” Wedbush analyst Dan Ives wrote in a recent note.

For private investors, says Giannini, that just “creates different opportunity sets.”

More must-read finance coverage from Fortune:

  • What job security? Americans are feeling worn down and fearful of layoffs
  • Coinbase is pegged for a valuation of up to $75 billion. Is that realistic?
  • Still waiting on your $300 unemployment benefit to start? What you need to know
  • The U.S. now has a debt level that rivals Italy’s
  • In corporate America we trust? Despite perennial crisis, business reputations are rising

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