With a record number of covid cases, China is trying to close an immunity gap

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A coronavirus outbreak on the verge of becoming the largest of the pandemic in China has exposed a critical flaw in Beijing’s “zero covid” strategy: a massive population with no natural immunity. After months of only occasional hot spots in the country, most of the country’s 1.4 billion people have never been exposed to the virus.

The Chinese authorities, who reported a record 31,656 infections on Thursday, are doing everything they can to protect the most vulnerable populations. They have launched a more aggressive vaccination campaign to boost immunity, expanded hospital capacity and started restricting the movement of high-risk groups. The elderly, who have particularly low vaccination rates, are a major target.

These efforts, which stop approving foreign vaccines, are an attempt to prevent the virus from overwhelming a healthcare system ill-prepared for an influx of very sick covid patients.

More intensive care beds and better vaccine coverage “should have started 2½ years ago, but the determined focus on containment meant fewer resources were directed to it,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations .

Huang believes that even mRNA boosters, which have proven more effective in fighting disease from the latest Omicron variants, would now not solve the fundamental problem with China’s goal of eliminating infection rather than reducing symptoms. Boosting immunity by allowing some level of community transmission “is still not acceptable in China,” he said.

China’s outbreak suppression strategy originally protected daily life and the economy and prevented serious illness and death. But it has become increasingly expensive as increasingly stringent measures cannot keep up with the more transferable variants.

Earlier this month, the government announced what appeared on paper to be the most significant easing of controls yet, with shorter quarantine times and less testing requirements. Officials insist the 20-point “optimization” plan is not a prelude to accepting outbreaks.

But efforts to break cycles of disruptive lockdowns have had a shaky start. Some cities eased restrictions, while districts in others told residents not to set foot outside their homes. The result: confusion, fear and anger.

Clashes have broken out in a few locations, most notably at a massive Foxconn factory in central China, which makes half of the world’s iPhones. The scene there turned violent this week as thousands of workers protested the company’s failure to isolate people who tested positive and breach the terms of employment contracts.

Reducing outbreaks is a priority again. Shijiazhuang, a city of 11 million about 300 kilometers from the capital, on Monday suspended reduced requirements for mass testing and announced five days of citywide screening.

The first deaths reported since May — though just one or two a day — have raised concerns that hospitals are ill-prepared for a surge in serious cases. Bloomberg Intelligence estimated that fully relaxed coronavirus controls could leave 5.8 million Chinese in need of intensive care in a system with just four beds per 100,000 people.

At a news conference Wednesday, Chinese health officials said the more than 100 critical cases meant more hospital beds and treatment facilities were “very much needed” given the health risks for the elderly and those with pre-existing conditions. The spread of the infection accelerated in multiple locations, she added, with some counties experiencing the worst outbreaks in three years.

Major cities such as Beijing, Guangzhou and Chongqing have ordered residents in certain neighborhoods to stay at home. Shopping centers, museums and schools are closed again. Large conference centers are being converted back into temporary quarantine centers, mirroring the approach taken in Wuhan at the start of the pandemic. Some of the strictest restrictions apply to nursing homes, with 571 such facilities in Beijing applying the strictest control measures, barring all but essential entrances and exits.

Opening up to a world now largely living with the virus would spark a wave of deaths, officials fear. China’s vaccines were initially limited to adults ages 19 to 60, a policy that continues to impact vaccination rates today. Only 40 percent of Chinese over the age of 80 have received a booster shot, despite months of campaigning and gift giving to encourage acceptance. (Two-thirds of the over-60s received a booster.)

Since the start of the pandemic, China has relied solely on domestic vaccine makers. It approved nine locally developed options, more than any other country, with the earliest and most commonly used vaccines coming from state-owned Sinopharm and private Sinovac. Both received approval from the World Health Organization early last year after they were found to significantly reduce deaths and hospitalizations.

Sinopharm and Sinovac widely distributed their products around the world as part of China’s effort to become a leading provider of global public goods and improve China’s image. But in late 2021, demand for Chinese vaccines began to dry up as Pfizer and Moderna production and distribution increased.

China still hasn’t approved foreign vaccines or explained its decision to shun what could be an effective way to close its immunity gap. A visit by German Chancellor Olaf Scholz to Beijing in early November ended with an agreement to make the Pfizer-BioNTech vaccine available to foreigners living in China through the company’s Chinese partner, Shanghai Fosun Pharmaceutical.

BioNTech has a development and distribution agreement with Fosun that gives the Chinese company exclusive rights to supply the country. But Chinese regulators have repeatedly delayed approval of the vaccine despite it being available in Hong Kong, Macao and Taiwan.

When asked last week whether the government would approve BioNTech for public use, the director of China’s Center for Disease Prevention and Control said authorities were working on a new vaccination plan that will be released soon.

Without access to the most effective mRNA-based candidates from Pfizer-BioNTech and Moderna, which have been updated to combat the omicron variant, the world’s most populous country remains dependent on vaccines developed using the original strain of the virus.

Some health experts find Beijing’s reluctance hard to justify. “China should approve the BioNTech and Moderna vaccines for the general Chinese population as soon as possible,” said Jin Dong-yan, a virologist at the University of Hong Kong. “It is ridiculous that they only allowed foreigners in China to get the BioNTech vaccine. It’s like they think Chinese are inferior to foreigners.”

China is instead trying to develop 10 of its own mRNA candidates. The one that is furthest is from biotechnology group Abogen Biosciences and the state-run Academy of Military Medical Sciences. Indonesia approved it for emergency use in September, but it has not yet received approval from Chinese regulators and may not get that until data is available from Phase 3 clinical trials in Indonesia and Mexico. The trials are expected to be completed in May.

Other options in China include an inhalable vaccine developed by CanSino, which has been available in Beijing, Shanghai and Hangzhou since October. An antiviral drug developed in China, Azvudine, originally used for HIV patients, was approved for the treatment of covid in July. Traditional Chinese medicines are widely used.

But new and more effective vaccines remain a top priority, and the country’s largest pharmaceutical companies are poised to mass-produce them. CanSino is completing a production facility in Shanghai that can produce 100 million doses per year – upon approval.

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