With record cases of covid, China is trying to close the immunity gap

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

Chinese authorities, which announced a record 31,656 infections on Thursday, are trying to protect the most vulnerable groups of the population. They launched a more aggressive vaccine to boost immunity, expanded hospital capacity and began restricting the movement of at-risk groups. The main target is the elderly, who have a particularly low vaccination coverage.

These efforts, which are stalling before foreign vaccines are approved, are an attempt to prevent the virus from overwhelming a health system ill-prepared for a flood of very sick covid patients.

More intensive care beds and better vaccination coverage “were supposed to start 2.5 years ago, but the single-minded focus on containment meant fewer resources were directed at this,” said Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations.

Huang believes that even the mRNA boosters that have been shown to be more effective in fighting disease than the latest omicron variants would not now solve the underlying problem with China’s goal of eliminating infection rather than alleviating symptoms. Boosting immunity by allowing some degree of community transmission “is still unacceptable in China,” he said.

China’s outbreak containment strategy initially protected daily life and the economy while preventing serious illness and death. However, it is becoming more and more expensive as increasingly stringent measures are not enough to keep up with more portable options.

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

But the effort to break the cycles of disruptive blockages is off to a rocky start. Some cities have relaxed measures, while counties in others have ordered residents to stay indoors. The result: confusion, fear and anger.

Confrontations have erupted in several locations, most prominently at the huge Foxconn factory in central China that makes half 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 failed to comply with the terms of employment contracts.

Limiting outbreaks has priority again. Shijiazhuang, a city of 11 million people about 285 miles from the capital, suspended its reduced mass testing requirements on Monday and announced five days of citywide screening.

The first deaths reported since May – albeit only one or two a day – have heightened fears that hospitals are ill-prepared to handle the onslaught of severe cases. Bloomberg Intelligence estimates that a full easing of coronavirus controls could leave 5.8 million Chinese in need of intensive care in a system with just four beds per 100,000 people.

Chinese health officials said at a press conference on Wednesday that more than 100 critical cases meant more hospital beds and treatment facilities were “very necessary” given the health risks to the elderly and those with pre-existing conditions. The spread of the infection was accelerating in many places, they added, with some provinces facing their worst outbreaks in three years.

Major cities including Beijing, Guangzhou and Chongqing have ordered residents of certain neighborhoods to stay at home. Shopping malls, museums and schools were closed again. Large convention centers are being turned back into temporary quarantine centers, mirroring the approach taken in Wuhan at the start of the pandemic. Some of the strictest restrictions are on nursing homes, with 571 such facilities in Beijing imposing the strictest level of control measures, barring all but essential exits and entries.

Opening up to a world now largely living with the virus would cause a wave of deaths, officials fear. China’s vaccines were initially restricted to adults between the ages of 19 and 60, a policy that continues to impact vaccination coverage today. Only 40 percent of Chinese over 80 have received a booster dose, despite months of campaigning and handing out gifts to encourage acceptance. (Among people over 60, two-thirds received a booster.)

Since the start of the pandemic, China has relied solely on domestic vaccine manufacturers. It has approved nine locally developed options, more than any other country, with the oldest and most widely used vaccines coming from state-owned Sinopharm and privately held 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 have distributed their products widely around the world as part of China’s efforts to become a leading provider of global public goods and improve China’s image. However, in late 2021, demand for Chinese vaccines began to dry up as production and distribution by Pfizer and Moderna increased.

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

BioNTech has a development and distribution agreement with Fosun that gives the Chinese company exclusive rights to supply the country. However, Chinese regulators have repeatedly delayed signing off on the vaccine, despite it being available in Hong Kong, Macau 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 vaccine plan that would be released soon.

Without access to the most effective mRNA-based candidates from Pfizer-BioNTech and Moderna, which have been updated to fight 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 restraint 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 the BioNTech vaccine to foreigners in China. It’s like they think Chinese are inferior to foreigners.”

China is instead looking to develop 10 of its own mRNA candidates. The furthest one is from the biotech group Abogen Biosciences and the state Academy of Military Medical Sciences. Indonesia approved it for emergency use in September, but has not received approval from Chinese regulators and may not receive it until data from phase 3 clinical trials in Indonesia and Mexico are available. The trials are expected to conclude in May.

Other options in China include an inhaled vaccine developed by CanSino, which has been available in Beijing, Shanghai and Hangzhou since October. The Chinese-developed antiviral drug Azvudine, originally used for HIV patients, was approved to treat covid in July. Traditional Chinese medicine is widely used.

However, new and more effective vaccines remain a top priority, and the country’s leading pharmaceutical companies are ready to mass-produce them. CanSino is completing a manufacturing facility in Shanghai that will be able to produce 100 million doses per year – subject to approval.

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