Why China is sticking with zero-COVID despite protests and economic havoc

Even for a government used to doing what it wants with little regard for the public will, China’s zero-COVID policy can seem mystifying.

The draconian measures to contain any hint of virus transmission have fueled an ever-rising public unhappiness — in a place where few people dare voice dissent about anything.

That restiveness exploded in recent days, sending Chinese citizens into the streets for the most significant anti-government protests since the student occupation of Tiananmen Square in 1989.

So why then has President Xi Jinping stuck so stubbornly to zero-COVID — as it corrodes his economy and provokes historic opposition?

The answer, say medical experts and China watchers, lies in a blend of ideology and virology: the influence of the Communist Party’s increasingly nationalistic bent, and fears that the alternative could be just as painful — and more embarrassing.

Thanks to waning vaccination, inferior vaccines and the lack of natural immunity that widespread infection generates, it’s assumed that ending zero-COVID would create a tsunami of coronavirus sickness, hospitalization and death.

That leaves the government with an unenviable choice. Should it open the floodgates and try to weather the deluge, or keep its finger in the dyke as long as possible?

“They’ve just painted themselves into a corner that’s going to be hard to get out of,” says Dr. Paul Hunter, professor of medicine at the UK’s University of East Anglia. “Whatever you do, at some point you will get a pretty scary surge of infections.”

China faces a “great challenge,” echoed Yi-Chun Lo, deputy head of Taiwan’s Centers for Disease Control.

If they open up there will be a huge wave of infection among their population

Yi-Chun Lo, deputy head of Taiwan’s Centers for Disease Control

“If they open up, if they don’t stick to the zero-COVID strategy any more, there will be a huge wave of infection among their population, and it’s a big-population country,” he told the National Post and other international journalists last month.

But Beijing is not just concerned about the health consequences of ending its restrictions, argues a prominent China observer.

Ever since it was harshly criticized by the World Health Organization for its handling of the 2003 SARS outbreak, China has striven to not be “humiliated” that way again, says Guy Saint-Jacques, Canada’s ambassador to Beijing from 2012 to 2016.

For starters, China promoted Ethiopia’s Dr. Tedros Ghebreyesus to be World Health Organization director general, assuming Ghebreyesus would be susceptible to its influence given the aid Beijing has provided to his country, said Saint-Jacques.

In fact, the WHO has been widely criticized for its sympathetic approach to China, failing to call it out when it withheld key information while praising it lavishly for virus-containment efforts.

And then, despite local attempts to cover-up COVID-19 when it first emerged in Wuhan, Xi has boasted repeatedly — including in the speech he gave to the party’s recent 20th National Congress — that China has handled the pandemic better than arch-rival United States.

“He owns the (zero-COVID) policy,” said Saint-Jacques, noting how power has consolidated increasingly around the president. “It’s very difficult for anyone to come to him now and say, ‘Sir, we have to change our approach, because this is having a huge impact on the economy.’ ”

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At its heart, though, zero-COVID is still a public-health issue. And China’s dilemma over the strategy stems largely from the way the virus spreads, the tools humanity has developed to stave it off and how those tools are used.

Hunter says a recent, Canadian-led study points to the optimum approach.

The paper by researchers at the Universities of Toronto, UBC, Johns Hopkins, Oxford and others analyzed past studies and concluded that vaccination is effective at preventing serious illness and death, contracting the virus is even better at doing so, and that a combination of vaccination and infection — what’s called hybrid immunity — provides the most lasting shield against severe COVID illness.

That means controls like lockdowns and mask mandates were most important before populations were widely vaccinated, says Hunter.

Loosening restrictions after that point, especially amid the more readily transmitted Omicron variants, led to broad infection in many countries — but also the benefits of hybrid immunity, he said. And with the protection of recent vaccination, contracting COVID-19 then was less risky.

Canada, for instance, has achieved high immunity levels through use of effective vaccines, plus infection that rose to about 60 per cent of the population during the Omicron phase, says Dr. Prabhat Jha, executive director of the Centre for Global Health Research at Toronto’s St. Michael’s Hospital.

China has fully vaccinated a relatively large 89 per cent of the population. But it kept zero-COVID in place after doing so, isolating huge chunks of people at home or in government facilities because of a few cases, conducting mass testing, shutting businesses and forcing some quarantined workers to sleep in their factories.

Infection — and the add-on value of natural immunity — were sharply curbed as all the while the effectiveness of those initial doses waned.

“What China has done is frittered away the benefits of the vaccination program,” said Hunter.

But that’s not its only problem.

Beijing focused its immunization efforts on working-age adults, a decision Hunter calls a “mistake.” The result is that older Chinese residents — the type who are most likely to clog hospital ICUs or die from COVID — have relatively low vaccination rates. By this March, only about half of the people over 80 had been fully immunized.

The government this week promised to boost vaccine coverage among the elderly, but loosening restrictions now would take a heavy toll, experts say.

“China might prove to be the major contributor to global COVID-19 deaths in 2022, perhaps exceeding one million,” says Jha. “The virus is apolitical and will spread where immunity walls are low.”

Then there are the vaccines themselves.

The most powerful ones have proven to be cutting-edge mRNA shots like Pfizer’s and Moderna’s and adenovirus vaccines like that made by AstraZeneca. The former inject pieces of genetic material into people that prompt cells to make the virus’s trademark spike protein, causing the body to produce antibodies against it. The latter uses harmless virus to deliver bits of the SARS-CoV-2’s genetic material, also provoking an immune response.

China did have access to the mRNA vaccine developed by Germany’s BioNTech in partnership with Pfizer, but never approved its use. It has instead relied mostly on products made by domestic companies Sinovac and Sinopharm which use an older technology involving inactivated — killed — versions of the virus. And which have proven less effective.

Those vaccine decisions were undoubtedly driven by nationalism, suggests Saint-Jacques, as Xi strives to show that his country and its Communist rulers are technologically competitive with the West.

“In China, ideology now is driving everything.”

Meanwhile, a flood of severely ill COVID patients could overwhelm the country’s hospitals. China has only about four intensive-care beds per 100,000 people, compared to 13 in Canada and 34 in Germany.

Beijing has signalled in recent days it will loosen some of the restrictions. But what would convince Xi and colleagues to end them completely?

They may be waiting for higher rates of vaccination, a less-virulent strain of COVID to emerge — or just more medical resources to handle the fallout, says Taiwan’s Lo.

“Their health-care facilities or capacity will have to be transformed before encountering that kind of challenge,” he said. “I do think they have to have second thoughts about getting away from the zero-COVID strategy.”