China’s strategy of controlling Covid-19 with lockdowns, mass testing and quarantines has provoked the greatest show of public dissent against the ruling Communist party in decades.
Initially, China succeeded in suppressing the virus, but then more transmissible variants emerged, and in recent weeks the outbreak has grown with record numbers of cases reported.
Global health experts have criticised China’s methods as unsustainable, so with both cases and public discontent rising, why is China still pursuing its zero-Covid strategy?
Almost three years on from when Covid-19 was first detected in Wuhan, China’s case numbers remain far lower than in most other countries.
However, this means the population has had very little exposure to the virus and the vaccination rate remains lower than in many similar countries.
China refused to import international vaccines and is using only domestically developed vaccines that have been found to be less effective than those widely used elsewhere.
“Unfortunately, the vaccines in China were not very good,” says Dr Paul Hunter, a professor of medicine at Britain’s University of East Anglia, adding that the vaccination levels of China’s most vulnerable people is low and much of the protection provided by the shots has now faded for those immunised long ago.
Many infectious disease experts say China should now import the mRNA vaccines made by Pfizer/BioNTech and Moderna, despite the obvious political challenges from acknowledging the shortcomings of its homegrown shots.
Vaccine scepticism and fatigue are also factors. Writing in the Guardian, Prof Devi Sridhar, chair of global public health at the University of Edinburgh, says reports suggest only about 40% of over-80s have received a booster shot, and millions remain unvaccinated.
“[China] didn’t promote the vaccine to elderly groups until November 2021, but by this time considerable vaccine scepticism had built up … the low effectiveness of the non-mRNA Chinese vaccines were also a concern: studies indicated that protection faded fast and was undetectable after six months.”
China has reported far fewer deaths compared with other large nations and has one of the lowest deaths per capita in the world, but it will eventually have to open its borders, a step that will inevitably bring a surge of disease, says Dr Hunter.
Restrictions should be lifted incrementally to avoid hospitals being overwhelmed and other restrictions, like mask-wearing, could be held in place to reduce spread as much as possible, Dr Hunter says.
“The surge will peak very quickly and also fade rather quickly. But while they are going through it, it will be dreadful.”
The health analytics firm Airfinity released projections on Monday estimating that up to two million people in China could be at risk of death if the country were to lift its zero-Covid policy, given its low vaccination rates and the lack of natural immunity among its population.
China’s preparations for life after zero-Covid have also been called into question by analysts. While many nations used the time given to them by lockdowns to increase intensive care capacity, China still lags behind many other Asian nations.
Recent data shows China has fewer than five critical care beds per 100,000 people, compared to almost 30 in Taiwan and more than 10 in South Korea and Thailand.
In what could be read as a rare criticism of the country’s health system, a recent comment article published in China’s state-run People’s Daily quoted a pharmaceuticals analyst as saying that a full reopening might “threaten a health system that currently has far fewer ICU beds than those of other developed countries”.
There is a general view that these factors, combined with an unequal access to healthcare, would probably see a huge death toll if the virus were allowed to sweep through the population of 1.4 billion people.
The consensus among global health experts is that zero-Covid is unsustainable in the long term.
But in the face of unprecedented public opposition, there’s little evidence that authorities are willing to diverge from the path they are currently on.
A recent editorial on the front page of China’s state-run newspaper, the Global Times, claimed that “compared with the past two years, China is facing a much tougher battle against the virus”. The authors of the article quote an unnamed expert who warns that authorities may have to take “excessive measures”.
However, in what could be seen as a nod to growing public discontent, the influential former Global Times editor, Hu Xijin has acknowledged the protests taking place and said that, “With the relaxation of the epidemic prevention and control measures, public sentiment will soon calm down.”
“Most Chinese people are no longer afraid of being infected. China may walk out of the shadow of Covid-19 sooner than expected.”
Associated Press contributed to this report