After the initial outbreak in early 2020, China managed to bring Covid-19 under control relatively quickly with strict, but effective containment measures. Two years later, China sees itself fighting multiple surges of new infections with the highly transmissible Omicron variant through broad and rigid regional lockdowns and mass testing.
China’s initial strategy of early detection and resolute prevention applied as of May 2020 was largely successful and allowed business and social life to bounce back relatively quickly, while large parts of the world were struggling with some form of “co-existence” strategy.
After rolling out the vaccine campaign in early 2021, by August 2021 China changed to a “dynamic zero-Covid” strategy, focusing on quick identification of new infection clusters and the cutting of transmission chains with much more targeted measures, allowing the rest of the city to continue life with relative normalcy.
The onset of the highly transmissible Omicron variant in March 2022, however, made often overwhelmed local authorities move to a more strict “static management” approach with large-scale lockdowns in places like Changchun, Shenzhen, Shanghai, and most recently in Beijing.
The problem: China’s initial vaccination strategy focused largely on people with regular human interaction – younger people and the working population. Conversely, the vaccination rate among the elderly population remains very low, with more than 130 million Chinese aged 60 and above having received fewer than 3 shots. A full 50 million of this age group remain completely unvaccinated. The early-stage successful dynamic clearance also caused the elderly to be less willing to get vaccinated because they did not see the need or the urgency.
A study by the University of Hong Kong conducted between January and March 2022 found that the effectiveness of the locally administered CoronaVac vaccine is much lower for people above 60, with 2 shots only providing 77% of protection against death, compared to 92% when vaccinated with a BioNTech mRNA vaccine. With three shots, the protection with both vaccines reaches an equal effectiveness of 98%.
So, despite having vaccinated 88% of all Chinese twice by March 2021 – among the highest rates globally – the lower overall protection puts the elderly population at a high risk. When Omicron hit Hong Kong in early 2022, only 14% of the people aged 80+ had received three jabs. While only accounting for 5% of the population, they represented 48% of all Covid hospitalizations and 71% of Covid deaths. Within three months, over 8’300 people died of Covid in Hong Kong, the world’s highest death rate--0.74%. Mainland China could face a similar scenario. A study to be published in Nature Medicine this month expects up to 1.55 million Covid casualties as a possible scenario given China’s current immunization rate and ICU capacity. China has a low 3.6 ICU beds per 100’000 persons, compared to 34.7 in the US, 29.2 in Germany or 11.4 in Singapore.
Making clear that he sees no alternative to “dynamic zero-Covid” at the moment, Xi Jinping at a meeting of the Politburo Standing Committee on May 5th emphasized again that “relaxing the prevention and control measures will inevitably lead to large-scale infections, a large number of serious illnesses and deaths, and will seriously affect economic and social development as well as people’s lives and health”.
In addition to above factors, and despite some rising social frustration, Xi might hesitate more before stepping back from a policy that is clearly associated with him, at least until the 20th CCP Congress in Fall. This is also a litmus test for political loyalty and a of stress test to simulate wartime conditions.
Nevertheless, there are reasons for careful optimism: lockdowns tend to be shorter, the number of cases overall is not very high and over 90% of cases are asymptomatic. So, until the 20th Party Congress in Fall, the rigid “zero-Covid” approach with selective “static management” will likely remain in place. Depending at least on the vaccination progress and the political will in Beijing, by early 2023, relaxations could follow, with a transition to a co-existence strategy by Summer 2023.
Xinhua: 中共中央政治局常务委员会召开会议 习近平主持会议