With Covid cases at record highs, China is struggling to close the immunity gap

With Covid cases at record highs, China is struggling to close the immunity gap

With Covid cases at record highs, China is struggling to close the immunity gap


The coronavirus outbreak on the brink of China’s biggest pandemic has exposed a critical flaw in Beijing’s “zero-covid” strategy: a vast population with no natural immunity. After months of only sporadic outbreaks in the country, most of the 1.4 billion people have never been exposed to the virus.

Chinese authorities, which on Thursday reported a record 31,656 infections, strive to protect the most vulnerable populations. They launched a more aggressive vaccination drive to strengthen immunity, expand hospital capacity and begin restricting the movement of at-risk groups. The elderly, who have particularly low vaccination rates, are a key target.

The effort, which stops short of approving foreign vaccines, is an attempt to prevent the virus from overwhelming a health care system that is ill-prepared for a flood of very sick patients.

More intensive care beds and better vaccination coverage “should have started 2½ years ago, but the focused focus on containment has meant fewer resources directed at this,” said Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations.

Huang believes that even mRNA enhancers, which have proven more effective against the disease than the latest omicron variants, would now not address a fundamental problem with China’s goal of eliminating infection rather than alleviating symptoms. Raising immunity by allowing some degree of community transmission “is still not acceptable in China,” he said.

China’s epidemic suppression strategy originally protected daily life and the economy while preventing severe disease and death. But it became increasingly expensive because increasingly strict measures fail to keep pace with more portable variants.

Earlier this month, the government announced what on paper appeared to be the most significant easing of controls yet, with shorter quarantine times and fewer testing requirements. Officials insist the 20-point “optimization” plan is not a prelude to embracing the epidemic.

But efforts to break cycles of devastating blockades have had a rough start. Some cities relaxed measures, while districts in others ordered residents to stay indoors. Result: confusion, fear and anger.

Conflicts broke out in several locations, and the most pronounced in the large one Foxconn factory in central China it accounts for half of the world’s iPhones. The scene there turned violent this week as thousands of workers protested the company’s failure to isolate positive tests and honor the terms of its employment contract.

Suppression of epidemics is again a priority. Shijiazhuang, a city of 11 million about 285 miles from the capital, suspended its reduced mass testing requirements on Monday and announced five days of citywide screening.

The first deaths reported since May – albeit only one or two a day – have heightened concerns that hospitals are ill-prepared to cope with a surge in severe cases. Bloomberg Intelligence estimates that a complete relaxation of coronavirus controls could leave 5.8 million Chinese in need of intensive care in a system with just four beds per 100,000 people.

At a press conference on Wednesday, Chinese health officials said more than 100 critical cases meant more hospital beds and treatment facilities were “very necessary” given the health risks for the elderly and individuals with pre-existing conditions. The spread of the infection is accelerating in several locations, they added, and some provinces are facing the worst epidemics in the last three years.

Major cities, including Beijing, Guangzhou and Chongqing, have ordered residents in certain neighborhoods to stay at home. Malls, museums and schools are closed again. Major conference centers are once again being turned into temporary quarantine centers, mirroring the approach adopted in Wuhan at the start of the pandemic. Some of the strictest restrictions apply to nursing homes, with 571 such facilities in Beijing applying the strictest level of control measures and barring all but essential egress and entry.

Opening up to a world now mostly living with the virus would cause a wave of death, officials fear. China’s vaccines were initially restricted to adults aged 19 to 60, a policy that continues to affect vaccination rates today. Only 40 percent of Chinese people over the age of 80 have received the booster shot, despite months of campaigns and giveaways to encourage take-up. (Among people over 60, two-thirds got a boost.)

Since the beginning of the pandemic, China has relied exclusively on domestic vaccine manufacturers. It has approved nine locally developed options, more than any other country, with the earliest and most widely used vaccines coming from state-owned Sinopharma and privately held Sinovac. Both were approved by the World Health Organization early last year after they were found to significantly reduce mortality and hospitalizations.

Sinopharm and Sinovac have distributed their products worldwide as part of China’s push to become a leading supplier of global public goods and improve China’s image. However, at the end of 2021, the demand for Chinese vaccines started to increase to dry as Pfizer’s and Moderna’s production and distribution scale up.

China still has not approved any foreign vaccines or explained its decision to stay away from what could be an effective way to fill its immunity gap. German Chancellor Olaf Scholz’s visit to Beijing at the beginning of November has ended agreement to make the Pfizer-BioNTech vaccine available to foreigners living in China through its Chinese partner Shanghai Fosun Pharmaceutical.

BioNTech has a development and distribution agreement with Fosun that gives the Chinese company exclusive rights to supply the country. But Chinese regulators have repeatedly delayed signing off on the vaccine, despite it being available in Hong Kong, Macau and Taiwan.

Asked last week whether the government would approve BioNTech for public use, the director of the Chinese Center for Disease Prevention and Control said authorities were working on a new vaccination plan that would be released soon.

Without access to the most effective mRNA-based candidates from Pfizer-BioNTech and Moderna, which have been updated to combat the omicron variant, the world’s most populous country continues to rely on vaccines developed using the original strain of the virus.

Some health experts say Beijing’s reticence is hard to justify. “China should approve the BioNTech and Moderna vaccines for the general Chinese population as soon as possible,” said Jin Dong-yan, a virologist at the University of Hong Kong. “It’s ridiculous that they allowed foreigners in China to receive the BioNTech vaccine. It’s like they think the Chinese are inferior to foreigners.”

China is instead trying to develop 10 of its mRNA candidates. The farthest one is from the biotechnology group Abogen Biosciences and the state Academy of Military Medical Sciences. Indonesia approved it for emergency use in September, but has not received approval from Chinese regulators and may not until data from phase 3 clinical trials in Indonesia and Mexico are available. The end of the trial is expected in May.

Other options in China include an inhaled vaccine developed by CanSino, which has been available in Beijing, Shanghai and Hangzhou since October. A Chinese-developed antiviral drug, Azvudine, originally used for HIV patients, was approved to treat covid in July. Traditional Chinese medicines are widely used.

But new and more effective vaccines remain a top priority, and the country’s leading pharmaceutical companies are ready to mass-produce them. CanSino is completing a manufacturing facility in Shanghai that will be able to produce 100 million doses a year — once approved.

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