China signals it could soften its zero-Covid policy, but there are more questions than answers

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Hong Kong

China has given its most significant signal yet that the country may seek to adjust its stringent zero-Covid policy that has transformed daily life, roiled its economy and – in recent days – sparked a wave of protests across the country.

The top official in charge of China’s Covid response told health officials Wednesday that the country faced a “new stage and mission” in pandemic controls.

“With the decreasing toxicity of the Omicron variant, the increasing vaccination rate and the accumulating experience of outbreak control and prevention, China’s pandemic containment faces (a) new stage and mission,” Sun Chunlan, China’s vice premier, said Wednesday, according to state media Xinhua.

The remarks follow a surge in public frustration with China’s restrictive zero-Covid policy and its high human cost, which erupted into unprecedented demonstrations in at least 17 cities since last Friday.

Sun – who has been the face of the Chinese Communist Party’s enforcement of the policy – made no mention of “zero-Covid,” as reported by Xinhua. Her comments came a day after a separate body of top health officials pledged to rectify some approaches to Covid control and said local governments should “respond to and resolve the reasonable demands of the masses” in a timely manner.

The high-level statements – alongside minor adjustments of rules and some easing of lockdown measures in major Chinese cities in recent days – suggest that China is taking a hard look at its policy, which has become increasingly disruptive as it struggles to counter highly transmissible coronavirus variants and record case numbers.

But the shifting tone has not come with any road map to an end goal or mention of transitioning away from the zero-Covid policy, and it remains uncertain how it will impact realities on the ground or ease mounting public frustration.

Thousands of buildings and residential communities across 32 cities in China remain under lockdown restrictions due to their classification as “high risk” as of Thursday.

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Local officials may be reticent to let cases rise for fear of retribution from a central government that has long prided itself on its zero-Covid stance. Meanwhile, experts say, the country continues to lag in key areas of preparedness for a widespread outbreak.

Chinese health officials and experts have long argued that the costs of the zero-Covid policy are scientifically justified, citing uncertainties in how the virus will evolve in the future, unknowns about its long-term effects, as well as gaps in medical preparedness, including a lagging elderly vaccination rate and inadequate intensive care infrastructure – especially in rural areas.

These weaknesses, they have warned, could see the healthcare system overwhelmed if the virus spreads freely in the country of 1.4 billion – a situation which could exacerbate the deaths expected with an opening up.

This remains a key concern for the government, according to health security expert Nicholas Thomas at the City University of Hong Kong, who said: “There is still a substantial part of the population that is trusting in the government’s actions in dealing with the virus. An unmanaged engagement with the virus could not only erode that trust but it could also expose vulnerable populations (to risk).”

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The recent comments around the policy are “not a sign that China is ready to transition to living with Covid, but a sign that the virus has slipped out of control and that the government is unable to return to a zero-Covid environment,” he said.

Case numbers in the last week have hovered around record highs, with more than 35,000 new cases reported on Wednesday – posing a steep challenge to efforts to return case numbers to a low level.

Instead of preparing for wide spread of the virus as a top priority, observers say that China has focused on the infrastructure and manpower needed to maintain zero-Covid, which relies on lockdowns, mass testing and forced quarantines of both cases and close contacts.

One reason for this has been the government’s own narrative about its success and the backing of the policy by leader Xi Jinping, according to Alfred Wu, an associate professor at the National University of Singapore’s Lee Kuan Yew School of Public Policy.

After bringing its initial outbreak in Wuhan under control in 2020, China’s border restrictions and swift method of detecting and suppressing the virus allowed the country to live relatively virus-free, while hospitals in much of the rest of the world were overrun with sick and dying patients. By China’s official count, it has seen only 5,233 Covid-19 deaths since early 2020, with fewer than 600 reported in 2022.

Chinese leader Xi Jinping visits a community in Wuhan in March 2020, following the initial outbreak of the coronavirus in the city.

Xi has touted China’s measures and its relatively low number of Covid deaths as a triumph of Chinese governance. The country stuck to that system even as others transitioned to living with the virus following mass vaccinations and the spread of the milder, but highly transmissible Omicron variant. However, Omicron also made China’s controls more disruptive and less effective.

“The number one (reason) is propaganda – they want to claim that China is doing a much better job than the United States,” said Wu, adding that expanding state control over the population could be another motivation for maintaining the zero-Covid policy – as Xi has stressed state security as a key policy goal.

But while pursuing this strategy, China “lost so many golden opportunities,” to prepare to live with the virus, and to prepare the public for a larger scale of deaths from Covid-19, he said.

One concern is the low level of booster vaccination in the elderly population most vulnerable to Covid-19 – a weakness that health officials on Tuesday launched a new plan to address.

As of November 11, 40% of China’s over-80 population had received a booster shot, according to state media, while around two-thirds had received two doses – a result of both vaccine hesitancy and an initial vaccine roll-out that did not prioritize the elderly.

A World Health Organization advisory group last year recommended that elderly people taking China’s inactivated-virus vaccines receive three doses in their initial course to ensure sufficient protection. Vaccine protection is known to wane over time and decrease against the Omicron variant.

Meanwhile, China’s immunity rests almost entirely on vaccination as so few people have been exposed to the virus. Around 90% of the population is fully vaccinated. While China’s vaccines have been shown to protect against severe disease and death, studies show they offer lower antibody protection than the mRNA vaccines used widely elsewhere in the world. Beijing has yet to approve any mRNA vaccine.

Residents line up for Covid-19 testing at a residential complex in Hohhot, Inner Mongolia, China on December 1, 2022.

A stark warning of the risks for the mainland played out in Hong Kong, where low vaccination rates among that most at-risk group played a role in pushing the Chinese territory’s Covid-19 death rates to some of the highest in the world last spring.

While vaccination will not eliminate an increase in deaths when restrictions ease, shots and boosters, as well as other preparations to reduce risks, are critical for countries transitioning away from policies aimed at “zero-Covid,” according to infectious disease physician Peter Collignon of the Australian National University Medical School.

“The preparation isn’t just vaccines, it’s surge capacity, it’s making sure you have enough hospital staff, you have enough beds and particularly making sure the elderly (are protected),” he said.

China has signaled that it may make more concerted efforts to bolster its defenses against the virus. Officials on Tuesday released an action plan to boost elderly vaccination rates. This echoed a target mentioned in a 20-point plan to optimize zero-Covid measures, released last month, which also called for hospitals to increase intensive treatment facilities and to stockpile anti-viral drugs and medical equipment.

The same notice also relaxed certain measures around testing and quarantine, and cautioned against excesses in policy enforcement at the local level – all messages that have been echoed by top health officials in recent days.

After that guidance – and in the wake of the recent protests – state media has highlighted a number of cities making minor changes to their policies, largely around testing and quarantine rules.

On Wednesday, officials in the southern hub of Guangzhou relaxed lockdowns in four districts and eased a quarantine requirement. In Xinjiang’s Urumqi on Saturday, local officials said they would gradually ease lockdown measures in neighborhoods categorized as “low risk,” and moved to reopen essential businesses and public transport the following day.

The protests across the nation were sparked by a deadly fire on November 24 in Urumqi, where at least 10 people died, and videos of the incident appeared to show lockdown measures had delayed firefighters from reaching the victims. They joined a list of deaths that have been widely linked in public conversation to Covid-19 controls.

On China’s heavily moderated social media, a topic discussing the comparative “decreased pathogenicity” of Omicron was trending on Thursday – a possible sign of authorities aiming to shift public perceptions about the virus, following years of focusing on its risks.

But some social media users remained skeptical, saying the changes to testing requirements were too minor to ease the impact of zero-Covid on daily life.

And at least one city, Jinzhou in northeast China pushed back against adjustments in other cities, saying in a notice on Thursday that it would not relax measures ahead of schedule and give up its progress containing an ongoing outbreak, saying that regardless of whether the coronavirus was less virulent “not having (the virus) is still better than having it.”

Experts say the real test of the country’s direction remains to be seen in the coming months.

If the vaccination push and other proposed measures bolstering medical readiness were “seriously implemented,” then China would have “a way forward for future opening,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations in New York. “But so far they have not been prioritized in the implementation process.”

Another problem is the disconnect between Beijing’s policies and how they are implemented by local governments, who are under pressure to control case numbers for fear of being removed from their posts – a regular punishment in the past for officials who have allowed outbreaks to spread.

“If you open up and you mess up, then there will be trouble,” Huang said. “You have to change the incentive structure of the local governments before any meaningful changes can be introduced,” he added.

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