After being sealed for 2 years, China must take 3 critical steps before opening back up

March 11, 2022, 7:03 AM UTC

Each morning, Ankita Kulkarni, a 21-year-old university student living in Mumbai, wakes up, makes a pot of tea, and then takes out her phone to search for updates about China’s COVID-zero policies. If there is even a slight hint that China may be relaxing some COVID-zero measures, Kulkarni, who is going by a pseudonym owing to concerns about her Chinese visa, immediately shares the news with a group chat of dozens of her classmates.

Kulkarni is desperate to reenter China to finish her medical degree in person at Shandong University in China’s eastern city of Jinan. But Kulkarni—along with hundreds of thousands of other foreign students at Chinese universities—has been locked out of the country for over two years as part of China’s campaign to keep COVID out of the country. For the past two years, China’s borders have only been open to its own citizens and a select group of foreigners, such as people with valid work permits or those coming for funerals of family members.

Kulkarni and others are frustrated by the seemingly arbitrary nature of China’s rules, and at this point, it’s unclear what threat students like Kulkarni pose to China’s population. Kulkarni says she is willing to endure the two- to three-week quarantine required of all China arrivals. But Kulkarni and other students say that when they press Chinese consular officials about why China has continued to keep them out, they’re told China still needs time to facilitate their “safe return” to the country.

“The main problem that we are facing is China’s zero-COVID policy,” says Kulkarni. “Even after two years [of waiting], I’m still optimistic and still hope China will reopen its borders.”

Kulkarni’s upbeat outlook belies China’s hard-line stance.

Two years into the global COVID-19 pandemic, China has shown little willingness to deviate from its strict COVID defenses.

China started sketching out its COVID-zero approach with its first lockdown in Wuhan, in the spring of 2020. After 76 days, the lockdown wiped out the world’s first COVID wave. Chinese authorities have since refined their “dynamic COVID-zero” approach, deploying an arsenal of intense border restrictions, mass testing, and lockdowns when sporadic outbreaks pop up. This week, authorities doubled down on China’s COVID-zero strategy in response to a surge of infections. On Friday, China confirmed 1,100 COVID-19 cases, the most in a single day in more than two years. The country vowed to battle the new wave with localized lockdowns and mass testing measures in the northern cities of Changchun and Jilin and the eastern cities of Shanghai and Qingdao.

For the past two years, China’s COVID-zero tactics have worked. The country has reported 112,000 cases of COVID and 4,636 COVID deaths since the beginning of the pandemic, equivalent to a single bad day in the U.S. But China is now an island in a world that’s opening up. Early on in the pandemic, China thought it could eliminate the virus with vaccination, but the highly transmissible Omicron variant that can bypass vaccine protection killed that notion. If China unlocks its borders, the virus will spread, just as it did when other COVID-zero adherents like Singapore and Australia pivoted to living with the virus. Before Omicron emerged, mathematicians at Peking University last year estimated that China would report more than 630,000 cases per day if it dropped its COVID-zero policies. If China battled an Omicron wave proportional to what Singapore and Australia faced, it would record millions of infections each day. Such an outbreak would almost certainly overwhelm China’s hospital system, which has 3.6 intensive care unit beds per 100,000 citizens, a fraction of the U.S.’s 25.8 ICU beds per 100,000 people.

Airport staff in hazmat suits
Airport staff in hazmat suits wheel baggage carts at Beijing Capital International Airport on Feb. 21, 2022.
Annice Lyn—Getty Images

At the same time, China can’t seal itself off forever. China’s manufacturing and export sectors have been resilient, but experts say that intermittent lockdowns and closed borders continue to be a drag on China’s economy, especially in areas like consumption. The central government recently set a 5.5% target for GDP growth this year, which economists say may be overly ambitious if the country remains closed. China’s enormous size raises the stakes for a reopening, but experts say it can be done safely if China reinforces its vaccination coverage with mRNA jabs, stockpiles therapeutics, and shifts the mindset of its 1.4 billion people who’ve been taught that even a single case of COVID is an unacceptable threat.

Change in message

China’s first step in reopening will be to convince its population that reopening is a good idea. That may be a difficult task for a government that has staked its legitimacy on the effectiveness of its COVID-zero measures.

“Our pandemic control measures…[show] the superiority of our nation’s socialist system,” Guo Weimin, a spokesman for China’s top political advisory body the Chinese People’s Political Consultative Conference, said at a press conference this week.

The benefits of China’s laser focus on eliminating infections are clear. In China, 4,636 people have died from COVID-19 since the beginning of the pandemic, a fraction of the nearly 1 million people in the U.S.—and over 6 million globally—who have succumbed to the virus. “If China didn’t take its necessary, effective measures, the outcome would be unimaginable for a nation of 1.4 billion,” Guo said.  

Nicholas Thomas, a professor of global health governance at the City University of Hong Kong, says that China’s largely state-controlled media often highlights reports about deadly COVID outbreaks in Western democracies like Europe and the U.S. to promote its own COVID-zero policies. Last month, the People’s Daily, the mouthpiece of the Chinese Communist Party, published an editorial doubling down on China’s COVID-zero policies, saying that foreign media outlets and “western countries represented by the U.S.” criticize China’s COVID-zero policies to shift attention away from high COVID death tolls in their own countries.

Internally, China’s government has largely quashed debate about COVID zero. Last fall, when Zhang Wenhong, one of China’s top epidemiologists, suggested that China should learn to coexist with the virus, a nationalist backlash ensued, prompting Zhang to retract his comments and his university to investigate newfound academic misconduct claims (that he was later cleared of).  

Xing Yun—Costfoto/Future Publishing/Getty Images

But a by-product of China’s messaging is that much of China’s population may be fearful of reopening and unwilling to tolerate any level of COVID spread in their communities.

China’s propaganda organs have “undoubtedly raised concerns among the Chinese population as to the threat posed by the virus,” Thomas says. “It will be difficult but not impossible for the Chinese government to change its messaging,” he says.

And there are some signs that China is adjusting its tune.

On Feb. 28, Zeng Guang, former chief scientist at China’s Center for Disease Control and Prevention, suggested that China could move away from its COVID-zero policy “in the near future.” Without providing a specific date, he noted, “At the right time, the road map for Chinese-style coexistence with the virus should be presented.”

The statement “is a sign [China is] trying to tweak the narrative to prepare for reopening, or prepare for softening of their COVID-zero policy,” says Bo Zhuang, China economist at Loomis Sayles.

mRNA vaccines

China has one of the world’s highest vaccination rates; it has fully vaccinated 87% of its population from COVID compared with 65% in the U.S. But experts say China’s most vulnerable populations may still be at risk despite the campaign’s success.

China’s elderly vaccination rate may be lagging the rest of the country, making older populations susceptible to dire outcomes in the event of a large-scale outbreak, says Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.

As of the beginning of March, just over 50% of people in China over age 80 were fully vaccinated.

“China has a very high vaccination rate…but until November of last year, China’s mass vaccine rollout did not prioritize elderly people,” says Huang. China may have been slow to distribute vaccines to the elderly because of limited clinical data on how its vaccines performed in people older than 60 when it started its campaign, he notes. Hong Kong has similarly struggled with low vaccination coverage among its elderly population, which has contributed to its current Omicron outbreak becoming one of the world’s deadliest COVID waves.

But even if China vaccinates and boosts its most vulnerable communities, it is unclear how effective China’s existing vaccines will be at protecting the population in the event of mass COVID spread.

China has relied on inactivated vaccines from domestic firms Sinovac and Sinopharm for its vaccination campaign. But studies show that the vaccines have almost no ability to stop Omicron infections. The World Health Organization has said that the vaccines still likely protect against severe disease and death, but relying on the vaccines alone may not be enough for China to be comfortable reopening.

“China’s ability to significantly increase antibody levels [in its population] remains a concern,” says Huang. Ashley St. John, a virologist at the National University of Singapore, says it’s difficult to tell how protected China’s population is against Omicron since there is “limited information” about how Sinovac and Sinopharm perform against the variant.

Huang says China should consider deploying mRNA vaccines as booster jabs—either by approving German maker BioNTech’s mRNA jab or producing its own version—in order to reopen. China’s leading mRNA vaccine developer, Walvax Biotechnology, aimed to bring its vaccine to market by the end of last year, but early clinical results were mixed, and recent studies showed that the shot may not hold up against Omicron. It is unclear if or when the vaccine will be approved and distributed.

Antiviral treatment

China should also ensure widespread access to antiviral treatment pills before it allows any level of spread in communities as an extra line of defense against severe disease and deaths.

China approved Pfizer’s Paxlovid treatment pill in February, and Chinese state-owned pharmaceutical firm China Meheco confirmed Thursday that it made a deal with Pfizer to commercialize the pill in China. “We still don’t know when and how Chinese people might have access to those drugs,” says Huang.

Estimates about when China will fully reopen range from the end of this year—presumably after Chinese President Xi Jinping secures another five-year term—to some time next year or even 2024. But each of those projections assumes China will bolster its immunity wall first by improving vaccination rates among the elderly, understanding if its vaccines work against Omicron, and distributing a homegrown mRNA jab—all efforts with unknown time frames.

“At the moment, all we can do is speculate,” says Zhuang.

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