On Wednesday, Beijing municipal officials announced that anyone visiting libraries, stadiums, gyms, and entertainment venues in the city must now show proof of vaccination—imposing China’s first-ever vaccine mandate as the country tries to counter a lagging vaccination rate. 

Both national and local public health officials have largely avoided mandating shots before now, relying instead on lockdowns and mass testing to control COVID transmission. In April last year, China’s National Health Commission said that vaccines should be voluntary, criticizing efforts by some local governments to bar the unvaccinated from receiving public services or government services.

Yet officials in charge of public health have grown more forceful in telling people to get vaccinated as China struggles to get COVID outbreaks, especially those from more transmissible variants, under control.

China’s capital has been unable to quash COVID flare-ups 10 weeks after local health officials first detected COVID cases in the city, despite mandating rounds of mass testing and localized lockdowns. On Wednesday, the Beijing Center for Disease Control reported 12 cases of the BA.5 Omicron subvariant (specifically, the BA.5.2 strain), which scientists believe evades immunity better than previous COVID variants.

Several other Chinese cities are reporting cases of the BA.5 variant, now dominant in the U.S. In Macau, a BA.5 outbreak—now standing at over 1,000 cases since June 18—has caused the city’s first-ever COVID deaths. And in Xi’an, local officials have closed businesses, restaurants, and schools for one week after discovering 13 BA.5 cases over the weekend.

On Wednesday, Beijing also announced that elderly residents in the city would not be allowed to enter community spaces, like game rooms, without proof of vaccination. Municipal officials also said that mass testing—which the national government views as a long-term COVID control measure—would continue, with testing required every three days regardless of vaccination status, for those who want to enter public venues. 

Almost 90% of Chinese citizens are fully vaccinated, according to official government data collated by Our World in Data. However, vaccination rates have lagged among the elderly, most at risk from serious disease and death. As of March, only half of those over age 80 have received two doses, notes Bloomberg. (China has not released more up-to-date data since then.)

China’s vaccination efforts have also slowed in recent months. As new variants like Delta and Omicron managed to break through the country’s COVID-zero defenses, the government has directed more energy and resources toward conducting mass testing and lockdowns. The number of new COVID doses China administers each day has fallen from 13 million at the beginning of the year to just 600,000 today (The U.S., by comparison, delivered about 150,000 doses per day in the past week).

Chinese officials cite a relatively low vaccination rate among at-risk populations like the elderly as a reason for preserving the country’s COVID-zero policy of snap lockdowns in response to COVID flare-ups and quarantines for domestic and international travel. They argue that opening up the country would lead to a surge in cases, and put a strain on the country’s health care system.

China President Xi Jinping said during a trip to Wuhan on June 28 that he “would rather temporarily affect a little economic development, than risk harming people’s life safety, and physical health, especially the elderly and children.”

Hong Kong, which is administratively separate from mainland China, implemented its own vaccine mandate in February, requiring at least one vaccine dose to enter government venues, restaurants, and shopping centers. Only 30% of Hong Kong residents over age 80 were fully vaccinated when the government introduced the mandate, but 63.5% of that age group are fully vaccinated now.

Countries like the U.S., France, Italy, and Singapore imposed vaccine mandates in late 2021 and early 2022 as well, requiring proof of full vaccination to enter restaurants, workplaces, and other public venues. However, in the face of legal challenges and public frustration with COVID measures, some governments are repealing mandates, citing the lower severity of the Omicron variant.

Studies show that two doses of China’s vaccines, like those from Sinovac and Sinopharm, are less effective at preventing serious disease and death from new COVID variants than mRNA-based vaccines like BioNTech’s and Moderna’s. Yet the gap closes significantly after three doses.

Chinese firms are working toward developing local mRNA vaccines as well, but experts are worried that the rise of more transmissible variants may mean China’s homegrown mRNA jabs will be out-of-date by the time they’re released.