Crisis manager China: How digitalization is driving the vaccination process in the country

Over a year ago, in February 2020, we published our first POV on Covid-19, describing how China is increasingly managing the pandemic through the use of new technologies . A few months later, in July, we followed up with a second article focused on how Chinese citizens are organizing themselves in lockdown and how businesses are adapting (e.g., contactless supermarkets and delivery services). This article is thus the third to focus on the China-Covid context. The focus is on the vaccination process.

 It has been a year since a new type of virus appeared in Wuhan. For eleven weeks, more than 60 million people had to stay home. Then the leadership in Beijing managed to bring the infection under control. Virtually no new cases have been reported for months, and China's cities are bustling again. Life in China is returning to normal, and the economy is running at full speed again. This is also due to the ongoing vaccinations. Here, too, China is now clearly one of the pioneers, thanks in part to digitalization.

 In the following we will look at 1. government goals & regulations, 2. ecosystem structure, 3. digital solutions, and 4. takeaways for Europe.

1.  Government goals & regulations

 Figures China:

 As of May 30, 2021, more than 1.86 billion doses of coronavirus (COVID-19) vaccine have been administered worldwide, according to Bloomberg. China accounted for the largest number of vaccine doses, at around 620 million.

China has set a goal of vaccinating about 40 percent of the population, 560 million people, by about June, and 64 percent, 890 million people, by the end of the year, to avoid an "immunity gap" with other countries. The daily production of vaccines is 5 million doses, the annual capacity of vaccine production is divided as follows: Sinovac Biotech 2 billion doses, Sino Pharm 1 billion doses and CanSino Bio 500 million doses. Currently, 2.62 million doses are administered per day. The plan is to reach 4.8 million doses per day. The number of vaccination sites is to be expanded from 20,000 to 50,000.

Statista: Vaccinations against coronavirus (COVID-19) by selected countries worldwide since the start of the vaccination campaign in December 2020 (as of May 30, 2021)

Figures Germany:

 According to the vaccine dashboard of the Federal Ministry of Health 595,125 vaccine doses were administered in Germany on May 25, 2021. This means that 12,274,086 people (14.8% of the total population) are now fully vaccinated. In total, 49,255,748 people (have received at least one vaccine dose.

1.1 Status quo which foreign vaccine doses are used in China

Hongkong: The Hong Kong government has agreed to buy 7.5 million doses each from Sinovac, Btitish-Swedish company AstraZeneca, and Fosun Pharma, which supplies the BioNTech Pfizer vaccine Comirnaty-

Macau: BioNTech Pfizer and Fosun Pharama received the special import permit for Macau's local COVID-19 vaccination program from the Health Bureau of Macau on Feb. 25, 2021, with the maximum quantity being 105,000 doses. Macau intends to purchase a total of 400,000 doses of Comirnaty (including the 105,000 doses for which a special import permit was granted) for the local COVID-19 vaccination program

 China Mainland: Five domestically developed COVID-19 vaccines are used in the country, while no foreign vaccines have received approval. A joint venture between Fosun Pharma and BioNTtech Pfizer has agreed to provide a factory with an annual production capacity of up to 1 billion doses of Comirnaty and expects to receive the green light from China's health authority for the product by the end of July.

1.2 Milestones for key immunization initiatives: Rolling out vaccine solutions at Chinese speed

• In February 2020, Tencent's WeChat introduced a health QR code in Shenzhen. This helps track a person's travel, contact history, and biometric data (e.g., body temperature) directly by scanning the QR code with a smartphone. Almost at the same time, Alibaba introduced the health code in the Alipay app at its Hangzhou headquarters. Later, a universal health code system was adopted by the State Council and rolled out across the country.
• In March 2020, under the health code rules initiated by Alibaba and Tencent, a nationwide standard was introduced to regulate and prescribe the functions of personnel management, authorization management and collection point management, data protection, and digital access for the elderly and children 

• April 2020: Clinical trials of three domestically developed vaccines begin.
• September 2020: Ali health and Sinovac biotech to launch internet + vaccine program. This includes the use of online platforms and internet capabilities for the vaccine lifecycle from research to injection.
• October 2020: Ali Health Immunization Program Center launches "Vaccine Service Platform 2.0", opening platform services to all immunization sites nationwide

• December 15, 2020: China's State Council announces the launch of the nationwide vaccination campaign.
• December 19 , 2020: State Council officials announce that three vaccines, all based on inactivated viruses, will be used for emergency deployment, two from SinoPharm and one from Sinovac.
• December 31, 2020: State Council announces approval for emergency use of SinoPharm's vaccine developed by subsidiary China National Biotec Group (CNBG).
• January 20, 2021: Vaccine rollout progressing steadily, with more than 15 million doses administered.
• March 27, 2021: authorities announced that 100 million people had been vaccinated (it took another 26 days to reach 200 million, and then 17 days to hit 300 million.
• March 29, 2021: Shanghai starts to include foreigners of appropriate ages in the city into the program of receiving domestically-developed COVID-19 vaccines on the basis that they are informed and willing to be inoculated. These foreigners who are willing to be inoculated may book the vaccination appointment online via Jiankang Yun (Health Cloud) APP, and each will receive in total two doses of domestically-developed inactivated vaccine now available in Shanghai.
• May 2021: Sinopharm's vaccine is approved by WHO for emergency use, giving it the green light for global rollout under the COVAX program, which distributes doses to developing countries.
• May 19, 2021: more than 14 million people were vaccinated across China - over 400 million doses of Covid-19 vaccines have been administered in China (The latest 100 million doses were given in nine days after hitting the 300 million doses mark)

 1.3 Strict travel regulations to China and the use of digital tools

Before travel:

Generally, passengers traveling to China by air must present a negative nucleic acid and IgM antibody test result within 48 hours prior to boarding. The visa is open to applicants who have been vaccinated with Chinese-made vaccines and have the appropriate vaccination certificates. China will accept U.S. travelers who have been vaccinated with U.S.-manufactured vaccines since April 21. Vaccination certificates from Pfizer-Biontech, Moderna and Johnson & Johnson will be considered for travel applications.

 Before boarding:

Passengers must upload their test results or vaccination certificates on the "Health Declaration Certificate" website - together with the flight check-in information. After checking the results, one receives the green QR code with Health Declaration Certificate via the Chinese Consulate General in Frankfurt. Upon arrival in China, the HDC QR code is checked and one must take a nucleic acid test and scan a QR code to fill out forms. There is a 14 + 7 + 7 quarantine policy for overseas entrants. Specifically, this means 14 days of central quarantine at the hotel, followed by 7 days of quarantine at home, then 7 days of loose health surveillance.

1.4 Milestones for Vaccine supplies for additional countries and mutual recognition of vaccines

China's goal is for Sinopharm's Chinese vaccine to be accepted worldwide, and it is already donating doses to other countries with WHO approval. The latter approved Sinopharm on May 7 for use in low-income countries as part of the global vaccination campaign - the COVAX initiative - under which China has pledged to initially supply 10 million doses to developing countries in Asia, Africa and Latin America.

Distribution of the vaccine: Prior to WHO approval, Sinopharm's vaccine was already being widely used, with an estimated 65 million doses administered. Countries already using the vaccine include the United Arab Emirates, Pakistan and Hungary. China has donated or is in the process of donating COVID-19 vaccine to 69 much-needed developing countries and is exporting vaccines to 43 countries.

Mutual recognition of vaccines and vaccination passports is important: Currently, the health passport (Digital Green Certificate) applies across the EU only to vaccines approved by the European Medicines Agency (EMA), but individual member states may deviate and accept other vaccines. Hungary, the Czech Republic, and Slovakia use or plan to use Chinese vaccines that are not currently approved by the EMA.

To achieve mutual recognition, Chinese COVID-19 vaccine manufacturers must obtain approval from the EMA, and China must relax its vaccination passport criteria to expand the pool of approved foreign travelers vaccinated with a Chinese-produced vaccine to those travelers who have received WHO-approved vaccines that are safe.

2.  Ecosystem structure

Key players in the Chinese vaccination system - from production to vaccination - include 

• vaccine manufacturers such as Sinnovac, BioNTech Pfizer, Sinopharm and CanSinoBi and their Vakkinators
• Digital providers like Ali Health, Tencent with WeChat and the official Healthcare cloud
• Public service, which includes government, public transportation, public places, among others
• The public health service, including the National Health Commission, regional communities, hospitals

Collaboration between digital providers (e.g., Ali Health) and vaccine providers can enable end-to-end, full-process monitoring. On the vaccine provider side, each vaccine has a traceable source that ensures safe production. On the demand side, vaccine providers can be provided with follow-up services through the digital health platform.

Based on the digital platform, transparent medical information is available along the vaccination processes: Vaccine companies can identify the direction of this vaccine batch, vaccination institutions and vaccinators - Doctors can track the vaccine batches they use and vaccinators' information - Vaccinators can find out vaccine sources, information and acquire relevant vaccine knowledge according to the vaccine number, etc.

By enabling the digital platform, a triple-win situation can be achieved for vaccine companies, public services and institutions, and vaccine producers.

2.1 Vaccine Management

The Vaccine Management Law required the state to have a complete electronic tracking system for vaccines. After vaccines are released to the market, there must be accurate and standardized records during production, shipment, storage, transportation, vaccination, and other aspects of the process. Information recorded during this process includes the vaccine variety, manufacturer, dosage and type, specification, lot number, expiration date, and vaccination information per case.

By digitizing the vaccination process, the above information is entered into the system in a timely manner to achieve a reliable system of electronic traceability for vaccine circulation and use. This ecosystem is also critical for tracking vaccine adverse events. This vaccine side effect surveillance system has achieved information sharing, real-time analysis, and regular collaborative research among various departments such as disease control, health services, and drug administration.

2.2 Public institutions and health authorities

 Immunization facilities and government agencies can track - among other key data points - available doses, the number of residents vaccinated, and both first and second doses, as well as formulate appropriate vaccination schedules via the number of vaccination appointments. The digital platform helps the government identify the health status of residents in a timely manner and meets the needs of residents to receive accurate epidemic prevention measures and news in real time. A series of epidemic services such as epidemic notice reporting on the health platform, fever clinic navigation, hospital empty bed inquiry and free online consultation are important in various life scenarios and are convenient for citizens.

2.3 For vaccinators

People who want to be vaccinated can use the digital platform to schedule an appointment so that the vaccination can be administered in an orderly manner. In addition, AI-based chatbot technology can provide personalized answers for individuals who have questions about COVID-19. Immunization officers are able to verify eligibility for vaccination and provide answers. After vaccination, individuals receive convenient electronic confirmation in QR code format that they have received the vaccine, with vaccine information and records recorded - including dates, dose information, manufacturer, location, phase, etc.

2.4 For public services and practices

The health code avoids the use of paper certificates by the public, which could cause cross-contamination. The health code program is also rapidly iterating technology and introducing several services, including the international version of the health code, the student readmission code, the business readmission code, and resident consumption vouchers, to manage epidemic prevention and control. In addition, there is a service for foreigners in China in the later stage of the epidemic to enable them to return to school, resume work and resume production.

The following graphic shows how the use of data enables greater transparency in the vaccination process. The key factor here is traceability.

3.  Digital solutions

From registration to implementation to monitoring: How does the digitally managed vaccination process look from the customer's point of view? The process is divided into four parts:

3.1 Campaign increase incentive for vaccination

In China, one-fifth of the world's population needs to be vaccinated, a real challenge. However, COVID-19 vaccination is currently voluntary in China and not required by law. Moreover, there are many vaccination skeptics in China as well. Therefore, in addition to pressure from governments, Chinese are currently being motivated to vaccinate with some measures, including some digital ones. Here are a few examples:

a.  Mobile vaccination vehicles: Here people can get vaccinated without an appointment by simply showing their ID card

 b.  Fast-restaurant chain promotion: Vaccinated are rewarded by buy-one-get-one-free ice cream cones

c.  Reward local governments, businesses and neighborhood associations: To motivate the retired and the over-80s to get vaccinated, many neighborhood authorities are offering free products. In a residential area in Beijing, for example, eggs are given to those who have been vaccinated. In Shanghai, authorities in some neighborhoods offer milk and oil for vaccination.

d.  Discounts and bargains: Various cities are teeming with bargains for the vaccinated. Grocery stores offer discounts to customers who can prove they have been vaccinated. A Lego store offers a free kit for a chick hatching from an egg. A street stall advertises a 10 percent discount on tea. A government photo studio entices customers with a discount on wedding photos etc.

As part of China's global campaign to vaccinate its citizens abroad, China also began a program in March to vaccinate Chinese passport holders abroad. Dubbed the "Spring Sprout Operation," the initiative was part of an extensive effort to protect its citizens and help them receive vaccinations in an orderly manner. Chinese embassies in countries such as the United Arab Emirates, Thailand, Turkey, Ukraine and Chile have been active in helping local Chinese citizens get vaccinated in accordance with host country laws and regulations.

3.2 pre-registration:

People can register for vaccination through the WeChat mini program. Some circumstances that exclude potential registrants from vaccination, such as age, pregnancy, recent vaccinations, must be filled in. People can choose a clinic in the borough where they work or live. There are two to three vaccination clinics in each borough that are open to foreigners. After filling in the data, people receive an SMS confirming the date, time and place of the vaccination.

3.3 Onsite vaccination process

To get vaccinated, people who want to be vaccinated must bring their valid ID card to their neighborhood vaccination center (usually a health clinic or ward), where they first scan the health QR code and then join the queue. There, their temperature is taken, and medical staff confirm that the health QR code is green. When it is a person's turn, they are asked to carefully read and sign a consent form before going through the pre-screening process. The person must answer a series of questions about her current health and recent medical history to ensure she is fit enough to receive the vaccine. She then signs in by showing her national ID card to the doctor/nurse and is vaccinated. If there are no serious side effects or discomfort in a 30-minute observation period, the person can leave the ward. The on-site medical staff will communicate the appointment for the second dose before she leaves the ward.

receiving a text confirmation of the date, time and location for the vaccination 

Arrive at the vaccination site during the time window (most vaccination sites allow flexible arrival times). As long as the person arrives during the time window in which the vaccination site offers vaccinations to their group, it is okay to arrive a little earlier or later. Each testing site has assigned times, usually once or twice a week, when they allow foreigners to be vaccinated. One can check these dates and times by, for example, logging into the Jiankang Yun app (for Shanghai), selecting the testing center closest to where you live or work, and clicking on the various dates to see when vaccinations are available

Upon arrival at the test center, there is a separate check-in for foreigners with English speaking staff. The person at the front desk photocopies the passport, has them sign a consent form, tells them which vaccine they are receiving (Beijing SinoPharm, Wuhan SinoPharm, or Sinovac), and pulls up a barcode that is used for tracking. Next, people are charged (for foreigners without social security) RMB100, which you can pay via Alipay or WeChat.

 After payment, the person can enter one of the vaccination rooms and show the nurse the barcode from before. The person then receives the vaccination document (with a stamp to confirm the vaccination) and goes to a waiting area. Then follows a waiting period of about 30 minutes to ensure that there are no unwanted side effects.

3.4 Record and certification

Once vaccinated, the immunization record is automatically linked to the individual's social security account and health codes.

 Regional/city health codes for domestic travel

Health codes can be accessed via Alipay, WeChat and the official government website. For example, they can be used to enter shopping malls, airplanes, subway stations, and attend public events. They are displayed as a green arrow if the person has not been to medium- or high-risk regions in the past 14 days.

Digital vaccination passport for citizens traveling overseas

The vaccination certificate can be used to apply for an international travel health certificate. The certificate contains information about the holder's current COVID-19 vaccination status and the results of the nucleic acid test and IgM antibody test, including the dates of vaccination and testing and the manufacturer and type of vaccine received.

3.4 Post-injection

Thanks to accelerated digitization, the pandemic has fundamentally changed the medical experience of citizens in China. Ali Health, for example, added remote medical appointment features to the Health Code app, allowing local citizens to use the Health Code app instead of their health insurance card to make online video appointments with doctors.

 In turn, iFlytek, an artificial intelligence platform, provides speech recognition programs to assist physicians in recording prescriptions. The platform is directly linked to online consultations, a 14-day domestic travel health code, regional/provincial health QR codes, and real-time maps of risk levels for specific regions.

Meituan, one of the two giants among food delivery platforms in China, has started to integrate door-to-door delivery of medicines, including prescription drugs. If the product requires a prescription, the customer must go through a short registration process for verification.

4.    Conclusion: Takeaways for Europe

Of course, you can't compare Europe or especially a federally governed country like Germany 1:1 with such a large, centrally controlled country like China. Moreover, there are problems in Europe such as insufficient procurement (and thus distribution possibilities as well as strong vaccination prioritization) of vaccines for the federal states. Strong state governments and courts in Germany also stand in the way of a unified central vaccination policy - despite the Infection Protection Act, which temporarily gives more power to the federal government. And last but not least, there are the regulations of the European Medicines Agency (EMA), which is responsible for evaluating and monitoring medicines.

Still, it's worth taking a look at China. What are the conclusions to be drawn from this? In addition to the willingness in China to massively restrict oneself at times and consistently wear masks in order not to break out of quarantine and thus risk infecting others, advanced digitization plays a central role with regard to speed, transparency and dynamics in the vaccination process. This goes hand in hand with the general willingness of the Chinese and also other Asian countries to disclose and use data. For the Chinese, the focus here is primarily on convenience and efficiency, coupled with a generally strong affinity for digital technologies and innovations and a willingness to experiment. Why are we in Europe willing to give our data in the form of animal or food photos to Facebook or Google, but not to the local health department or a Corona app for data protection reasons?

The digital vaccination passport for documenting vaccinations gives cause for optimism. Vaccinated people in Germany and Europe are to be able to store information such as the date of vaccination and the vaccine on their smartphone in a convenient, personalized and timely manner. Meanwhile, the European Commission has also presented a draft regulation to regulate an EU-wide recognition framework for (digital) certificates for vaccinations, tests and for persons with COVID-19 curative status to facilitate free travel. The EU green certificate provides the legal framework for member state solutions.

We at China Bridge are also very much looking forward to it. Not only because of the so important topic of health for each individual, but especially because of the freedoms it brings, such as the freedom to travel. So we can finally do our deep-dive safaris to China with you and your clients again. Because no matter how digital we all are or are increasingly becoming: Real life still takes place primarily outside in the analog world.

 Looking forward to hearing your thoughts on this topic!

Mei Wang, Global Program Lead - China Bridge

About China Bridge

 China Bridge is a global program implemented and promoted by Accenture Open Innovation. With a presence in 15 global regions and over 200 partnerships with top startups, Accenture Open Innovation is identifying the next wave of technology partners to deliver the most innovative solutions to Accenture’s Global 2000 clients. As an innovation and exchange program, China Bridge helps clients of Accenture unlock growth opportunities by bringing them together with best-in-class Chinese digital players and to co-create responsible technologies for the future.