AFTER PROTESTERS IN China took to the streets in defiance of the nation’s zero-Covid policy, officials responded this week by affirming their strategy but promising tweaks to “reduce inconvenience” to the public. But that’s likely not enough to placate people who have endured measures that extend beyond inconvenience and include harsh lockdowns, food shortages, and economic hardship.
Now, as China finds itself caught in the tangles of its once-praised policy, there’s no clear road back to normal. Zero-Covid is a point of national pride, and it has saved lives. According to the World Health Organization, China has recorded just over 30,000 deaths during the pandemic, whereas more than 1 million people have died in the US.
But China's combination of leaning too heavily on lockdowns and failing to protect its older population with widespread booster shots give the country no long-term solutions. If China were to open suddenly, experts say, high case rates would overwhelm the health care system.
Containment measures have worked so well that citizens have close to no natural immunity, the kind briefly attained after people recover from infections. And while the nation’s initial vaccine rollout was swift, vaccinating 1 billion people in 10 months, older residents are less likely to be vaccinated or have a booster shot; just 40 percent over the age of 80 have been fully vaccinated and boosted, according to Chinese officials.
For the total population, full vaccination rates are at 90 percent. China is also using homegrown vaccines, which do not use mRNA technology. Sinovac was 51 percent effective in preventing symptomatic Covid infection in trials. Pfizer’s initial shot was more than 90 percent effective in preventing Covid.
Between 1.3 and 2.1 million people could die if China were to suddenly lift the policy, according to an analysis published in November by Airfinity, a London-based health analytics firm, which drew that conclusion from studying the fallout of Hong Kong shedding its zero-Covid strategy in February 2022. “What we have seen with countries that previously had zero-Covid, there’s a point where you need to bite the bullet and open up,” says Matt Linley, analytics director of Airfinity. “China is in a pretty difficult situation to be able to do that with their current protection levels.”
The comparison was made because Hong Kong’s older residents have a similar booster uptake to China’s and low levels of natural immunity. Like China, its population was vaccinated with Sinovac, but Pfizer was also available. The results of the Sinovac vaccine are mixed: A March 2022 study out of Hong Kong found that a third dose of Sinovac was 98 percent effective in preventing death during an initial Omicron wave. (It was too soon to know how long the immunity would last.) Another analysis found Sinovac less effective at preventing death than mRNA vaccines. Pfizer and Moderna have made updated boosters that provide better protection against the Omicron variant.
Other nations tried zero-Covid policies but have since shed them. Vietnam ended its policy in September 2021, making itself an attractive labor pool for manufacturing giants like Apple and Samsung seeking an alternative to China. Australia, too, abandoned the strategy in August 2021, with the government declaring it “not sustainable.” New Zealand followed suit in October 2021.
Dropping restrictions in these countries led to notable, but temporary, spikes in cases, Linley says. “We’ve seen big waves with other zero-Covid countries, and then after that, things become a little more normalized,” he says. “Cases do go up and down again. But the initial wave is always pretty dramatic.”
Scott Kennedy, senior adviser with the Washington, DC, think tank Center for Strategic and International Studies, visited China in October. “When I was there, it seemed clear to me that, privately, officials understood they needed to exit zero-Covid, and that plans were in the works to do so that would be implemented after the 20th Party Congress,” he says. That took place later that month and cemented President Xi Jinping’s third term.
In fact, China did relax some zero-Covid rules in early November, including softening quarantine restrictions for overseas travelers. But when cases rose, officials brought lockdowns back.
China faces a few specific problems that would exacerbate the spread of the virus if it entirely lifts the policy. The nation is an outlier in that its elderly population, one of the groups most at risk, is somewhat hesitant to get jabbed. Kennedy says the low uptake may be partly due to the low presence of the virus, to people’s negative experiences with the health care system in the past, and to the baseless belief that traditional Chinese medicine provides a safer alternative.
And the country has 3.6 critical care beds for every 100,000 people, far fewer than in high-income Asian countries like South Korea and Taiwan, or in the United States and Europe. So, if people become very ill with Covid-19, they could quickly overwhelm the hospitals, leading to higher death rates.
Xi Chen, a professor of health policy and economics at Yale University, says China has allocated medical resources to quarantine centers, where people must go even if they have no or mild symptoms. “I think this is simply a waste of resources,” he says. Allowing people to quarantine at home would free up some medical workers to vaccinate the vulnerable or care for the critically ill.
On November 29, Chinese officials said they would focus on giving more booster shots to vulnerable populations. And Chen says incentives for the vaccinated could be a game changer to get more people vaccinated. Because testing mandates have become burdensome, allowing those with booster shots to test less might make more people roll up their sleeves for another jab. “People don’t want to get a third dose, because they don’t have incentive to do so,” Chen says. “The civil unrest and protests are mostly against the lockdown and the frequent testing.”
These protests are the most significant the country has seen in decades, and they are a sharp criticism of Xi's administration as well as the lack of coordination between the central and local governments. “These protests are the consequences of a boggled effort to begin to exit zero-Covid,” Kennedy says. “I am amazed at how bumbling the Chinese government's efforts have been.”
Kennedy says the policy may not last through the winter, and Chen thinks China could potentially reopen by the spring, if it moves quickly to reach higher booster vaccination rates among vulnerable populations. “Either the Chinese government is going to proactively try to exit zero-Covid, as they were trying to do so in a sort of quiet manner earlier this month, or they're going to be pulled kicking and screaming to a post–zero Covid era,” Kennedy says. “They're going to exit zero-Covid willingly or unwillingly, one way or the other.”
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