Protests in several Chinese cities against the Chinese government’s tough COVID-19 policies reflect the growing sentiment of people around the world. We are fed up with the pandemic and the countless ways the SARS-CoV-2 virus has changed our lives forever. But the demonstrations in China also reflect a more specific, local frustration at a strategy to fight the virus that has long since left behind every other country in the world.
China’s zero-COVID strategy is an extension of the drastic measures taken not only in this country but in other countries around the world, including the US, in the early days of the pandemic to try to get rid of the virus as quickly as possible suppress. That made sense in the beginning when people had no immunity to the virus and there were no vaccines or treatments to fight it. In fact, establishing lockdowns and preventing people from mixing are among the public health pillars of fighting an infectious disease. “The use of quarantine, isolation, and testing are all core public health strategies that we use in all types of outbreaks,” says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “And they remain viable. But they don’t always violate basic freedoms and rights, as we have seen in China. In this case, they have clearly become very large.”
China’s strategy has been to test people regularly before they leave their homes or enter public facilities, and if someone tests positive, immediately quarantine the facility where the case arose, even if that means people being prevented from returning home from work or a day trip to Disneyland. From there, people who test positive are taken to isolation facilities, where they remain until they present negative tests before being allowed to return home.
But while tracking the virus in this way can limit its spread, such stalking can only go so far. Ultimately, the virus escapes and new infections are seeded. In the case of SARS-CoV-2, this likelihood is increased by the fact that the virus also lives in animal hosts, where it continues to thrive and mutate, waiting for opportunities to infect vulnerable human hosts with low levels of immunity to it. “It’s hard to imagine how a zero-COVID policy would eradicate this virus,” says Dr. Ian Lipkin, director of the Center for Infection and Immunity at the Columbia Mailman School of Public Health. “Even if you exclude all humans from the role as hosts, there are still animal reservoirs that can carry the virus and reintroduce it into the human population.”
While other countries, including Australia, the UK and the US, implemented quarantine systems similar to China’s in the early days of the pandemic, health officials there always conceded that it would be a temporary solution until the population’s immunity was boosted could be exposure to natural infections and ultimately through vaccines.
For China, however, the strategy was inflexible and lacked a clearly defined exit strategy – largely because of its close ties to the authority and prestige of the ruling Chinese Communist Party. “Politically, the response to the pandemic was framed as a competition between two political systems, and Xi Jinping used China’s early success to demonstrate the superiority of the Chinese political system,” says Yanzhong Huang, senior fellow on global health at the Council on Foreign Relations. and Professor of Global Governance and Health Issues in Asia at Seton Hall University. “In theory, they could claim that if they are able to maintain low levels of infection after other countries move away from zero-COVID policies, they are the only winners in the battle. So the high political stakes also helped China maintain this policy.”
Meanwhile, for the rest of the world, as effective vaccines became available in late 2020, a zero-tolerance strategy quickly became obsolete. As protection of the population from the virus through vaccination increases, there is no longer a need to lock up infected people and try to lock down large regions. That’s the approach Australia took following a zero-COVID policy early in the pandemic. But, Rivers says, the difference was that Australia capped the strict lockdowns, promising to lift them when 80% of the population was vaccinated and therefore better protected against serious diseases. “There has to be an exit strategy,” she says. “Australia clearly defined this strategy to keep the public on board and understanding what the way forward was. It was also important to ensure the country was not stuck in an untenable place.”
China may find itself in such a situation, without a clearly articulated end to its current policies.
The threats to global public health posed by China’s policies
While keeping people isolated gives the virus fewer opportunities to spread and infect locally, in a global pandemic that may not be the most desirable end result. People who are under-vaccinated or who have not had much exposure to natural infection with the virus do not generate strong T-cell responses, which scientists say are important for longer-lasting protection against severe COVID-19 disease. Much of the rest of the world built up these T-cell defenses as a result of a combination of vaccination, booster and exposure to and infection with COVID-19. China’s people may still be in the early stages of building up this type of protection. “Basically, they have a population that is inadequately protected by either previous infection or vaccination and who are now at risk of spreading the virus,” says Lipkin.
Also contributing to this is the fact that studies show that the vaccines taken by the majority of the Chinese population, which are manufactured in the country by two local companies, Sinovac and Sinopharm, do not offer as much protection against infection or serious diseases as those in China China-made USA and Europe. These vaccines use inactivated forms of the SARS-CoV-2 virus to stimulate the immune system, while other approaches have used new mRNA or viral vector technologies. This means that while China’s population may be vaccinated, it may not be as protected as it could be. Indeed, Lipkin says that if China used vaccines like Pfizer-BioNTech and Moderna’s mRNA syringe or AstraZeneca’s viral vector vaccines as booster shots, it could improve the protection started by the inactivated viral vaccines that the Chinese are using have used so far. Chinese scientists have been working on these other types of vaccines, including mRNA shots, but health leadership has not yet endorsed these for widespread use in the country.
Then there is the human and economic toll of quarantining people, cutting them off from their social, professional and cultural connections and disrupting them. The result has been that pent-up frustrations have erupted over the past few weeks in protests not only against restrictive COVID-19 policies but against the entire communist system in a breathtaking and fast-spreading movement. “I think the party was surprised to see protests in several cities,” says Huang.
How to take the next step forward
Health experts agree that the road to zero-COVID is to accelerate the vaccination of the population, which the Chinese leadership has been trying to do in recent weeks. But party officials are struggling with a self-inflicted problem, as many older members of the population have not been vaccinated because they don’t feel the urgency in a country where cases have been relatively low given the strict lockdowns. In a report released Nov. 28, state health officials in China said 65.8% of people over the age of 80 had received a booster dose. That’s up from the 40% reported mid-month – but still way too low.
Even if more people are boosted, given the diminishing protection these vaccines provide, especially against newer Omicron variants, such boosters may not be enough to boost population immunity to levels that would phase out the zero-COVID virus. policy would justify. As long as the virus is able to make more copies of itself, it will continue to evolve and create new mutations, some of which could become variants that spread faster or cause more severe disease. The roulette wheel of viral mutations keeps turning, and the best defense to slow it down is immunity — either through vaccinations or bouts of infection.
“China has a population with very low infection-acquired immunity. And vaccine-acquired immunity hasn’t held up well against new variants over time,” says Rivers. “So we expect a population that is broadly vulnerable. And these are prerequisites for large waves of infection. From a public health perspective, I would expect widespread vaccination and empowerment of older people. But this is as much a political issue as it is a public health issue.”
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