This article is a guest post from Daisy Moulton for VaccineNation.

In July 2023 it was announced that Moderna had established an agreement with China to develop mRNA products for use in the country. This news comes amid tensions between the US and China but suggests a potential opportunity to navigate a historically tricky relationship. Moderna, the company that became a household name during the COVID-19 pandemic, will develop products “exclusively” for Chinese people, according to reports in the Financial Times.  

Moderna makes mRNA waves

The Moderna mRNA SARS-CoV-2 vaccine, Spikevax, was developed in record time, compared with pre-pandemic vaccines that took up to 15 years from development to mass production. The pipeline for SARS-CoV-2 was rapid due to the global impact of the pandemic, with clinical trials starting just two months after the start of development 

This allowed great success for the company, with Spikevax being fully approved by the FDA for adults in January 2022 (with prior emergency approval in April 2021 by WHO) 

This facilitated the second-highest administration in the US as of April 2023, with over 230,000,000 doses, only behind Pfizer-BioNTech’s, Comirnaty, which uses the same mRNA technology as the Moderna vaccine 

How does the mRNA SARS-CoV-2 vaccine work?

The mRNA vaccine technology works by encoding the antigenic Spike (S) protein which is expressed on the surface of the SARS-CoV-2 virus particle.  

The normal function of the spike protein is to bind to the ACE2 (angiotensin-converting enzyme 2) receptor on alveolar cells in the lungs, allowing the virus to insert its genome into the host cell 

The spike protein mRNA in the Moderna and Pfizer-BioNTech vaccine is translated by the host cells to produce the S protein, allowing the host to mount an adaptive immune response and produce memory cells to prevent reinfection without the virion being present.  

China’s go-it-alone approach to vaccine development.

China had negotiations with Moderna in 2020 and 2021 about the prospect of mRNA. However, Moderna refused China’s request to share knowledge of the mRNA technology leading to a breakdown in negotiations, leaving China’s ageing population without access to the most effective vaccines on the market 

The main vaccine used in China is Sinopharm, which uses the dated technology of attenuated or inactivated virus particle inoculation. Although it provides a 79% efficacy in stage 3 clinical trials after two doses, this is lower than Moderna’s 95% efficacy in their initial stage 3 trials 

This inferior efficacy may have contributed to the increase in vaccine hesitancy within the Chinese population, with 8.4% having received primary vaccination as of August 2021. Worries about the efficacy and safety of the Sinopharm vaccine emphasise the role of confidence in the 5Cs model regarding vaccine hesitancy). Beyond COVID-19 vaccines, this could also be due to deep-rooted mistrust in China’s pharmaceutical manufacturing capabilities 

The world watches.

There was global criticism of China’s over-independence during the pandemic, with a German government spokesperson openly criticizing China for not using the superior mRNA Western technology in 2022.   

So, what’s changed?

As of the 6th of July 2023, Moderna is set to sign a proposed US$1 billion deal (although Moderna has not confirmed the amount) with China to begin the manufacture of mRNA vaccines and technology in Chinese borders as well as setting up a Chinese headquarters in Shanghai 

The deal includes plans to bring already available Western mRNA medicines to the Chinese populations and conduct new clinical trials. Products are strictly for China’s population only and not to be exported.  

This should bring new hope for the Chinese population by gaining access to world-leading multi-national pharmaceuticals and hopefully increase the vaccine uptake by decreasing vaccine hesitancy, which is a major global concern and improves the welfare of China’s 1.4 billion population. 

Do you think this deal will better relations between China and other countries? Is Moderna the first of many to establish this connection? For more like this, don’t forget to subscribe