With record Covid cases, China is scrambling to close an immunity gap

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A coronavirus outbreak on the verge of becoming China’s biggest pandemic has exposed a critical flaw in Beijing’s “zero Covid” strategy: a vast population without natural immunity. After months of only occasional hotspots in the country, most of its 1.4 billion people have never been exposed to the virus.

Chinese authorities, which reported a record 31,656 infections on Thursday, are scrambling to protect the most vulnerable populations. They have launched a more aggressive vaccination drive to boost immunity, expanded hospital capacity and started restricting the movement of at-risk groups. Older people, who have a particularly low vaccination coverage, are an important target group.

This effort, halting at the approval of foreign vaccines, is an attempt to stop the virus from overwhelming a healthcare system ill-prepared to deal with a spate of very ill Covid patients.

More ICU beds and better immunization coverage “should have started 2½ years ago, but the single-minded focus on containment meant fewer resources were focused on it,” said Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations.

Huang believes that even mRNA boosters, which the latest Omicron variants have shown to be more effective at fighting diseases, would not now solve the fundamental problem with China’s goal of eliminating infections rather than alleviating symptoms. Increasing immunity by allowing some level of community transmission “is still unacceptable in China,” he said.

China’s strategy of smothering outbreaks originally protected everyday life and the economy, and prevented serious illness and death. But it has become increasingly costly as increasingly stringent measures can’t keep up with more transferrable variants.

Earlier this month the government announced what appeared on paper to be the most significant relaxation of controls yet, with shorter quarantine periods and fewer exam requirements. Officials insist the 20-point “optimization plan” is not a prelude to outbreak acceptance.

But efforts to break cycles of disruptive lockdowns got off to a rocky start. Some cities eased restrictions, while districts in others ordered residents not to leave their homes. The result: confusion, fear and anger.

Confrontations have erupted in some places, most prominently at a huge Foxconn plant 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 those who tested positive and honor the terms of employment contracts.

Containing outbreaks is once again a priority. Shijiazhuang, a city of 11 million about 185 miles from the capital, suspended its reduced mass testing requirements Monday and announced five days of citywide screening.

The first deaths to be reported since May – although just one or two a day – have heightened concerns that hospitals are ill-prepared to handle a surge in serious cases. Bloomberg Intelligence estimated that a full relaxation of coronavirus controls could leave 5.8 million Chinese needing critical care in a system with just four beds per 100,000 people.

At a news conference on Wednesday, Chinese health officials, who mean over 100 critical cases, said more hospital beds and treatment facilities are “very necessary” amid health risks for the elderly and those with pre-existing conditions. The spread of the infection is accelerating in several places, they added, with some provinces facing the worst outbreaks in three years.

Major cities like Beijing, Guangzhou and Chongqing have ordered residents in certain neighborhoods to stay home. Shopping centers, museums and schools were closed again. Large conference centers are being converted back into temporary quarantine centers, reflecting 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 implementing the strictest control measures, preventing all but essential entry and exit.

Opening it up to a world now mostly living with the virus would cause a spate of deaths, officials fear. China’s vaccines were initially limited to adults aged 19 to 60, a policy that continues to affect vaccination rates to this day. Only 40 percent of Chinese over 80 have received a booster shot, despite months of campaigning and gifts to encourage uptake. (Among those over 60, two-thirds have received a booster shot.)

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

Sinopharm and Sinovac sell their products worldwide as part of a Chinese push 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 ramped up production and distribution.

China has still not approved foreign vaccines or explained its decision to eschew an effective way to close its immunity gap. A visit by German Chancellor Olaf Scholz to Beijing in early November ended with an agreement that Pfizer’s BioNTech vaccine would be made available to foreigners living in China through the company’s Chinese partner, Shanghai Fosun Pharmaceutical.

BioNTech has a development and distribution agreement with Fosun, giving the Chinese company exclusive rights to supply the country. However, Chinese regulators have repeatedly delayed approving the vaccine even though it has been made available in Hong Kong, Macau and Taiwan.

Asked last week whether the government would approve BioNTech for public use, the director of the China Center for Disease Prevention and Control said authorities are working on a new vaccination schedule that is expected to be released soon.

Without access to the most potent mRNA-based candidates from Pfizer-BioNTech and Moderna, updated to target 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 reticence difficult 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’s ridiculous that they only allowed foreigners in China to get the BioNTech vaccine. It’s like they think the Chinese are inferior to the foreigners.”

Instead, China is attempting to develop ten of its own mRNA candidates. The furthest away comes from the biotechnology group Abogen Biosciences and the State Academy of Military Medical Sciences. Indonesia approved it for emergency use in September, but it hasn’t received a nod from Chinese regulators and may not receive it until data from phase 3 clinical trials in Indonesia and Mexico become available. 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. A 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 poised to mass-produce them. CanSino is completing a manufacturing facility in Shanghai that will be capable of producing 100 million cans per year – upon receipt of approval.

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