What China’s zero-COVID policy means for global health

Protests in several Chinese cities on the strict COVID-19 policies enforced by the Chinese government reflect the growing sentiment of people around the world. We are tired of the pandemic and tired of the myriad ways the SARS-CoV-2 virus has changed our lives forever. But the protests in China also reflect more specific local frustration with a virus control strategy that every other country in the world has long since abandoned.

China zero COVID strategy is an extension of the drastic measures instituted, not only in this country but in others around the world, including the United States, during the early days of the pandemic with the aim of eliminating the virus as quickly as possible. It made sense in the beginning when people had no immunity to the virus and there was no vaccine or treatment to fight it. In fact, instituting lockdowns and preventing people from mixing are among the public health pillars of infectious disease control. “Quarantine, isolation, and testing are all basic public health strategies we use in all kinds of outbreaks,” says Caitlin Rivers, epidemiologist at the Johns Hopkins Center for Health Security. “And they remain viable. But they don’t always violate basic freedoms and rights in the same way we’ve seen in China. Obviously, in this case, they have become very extensive.

China’s strategy has been to regularly test people before they leave their residences or enter public facilities, and when someone tests positive, to immediately quarantine the facility where the case arises. is produced, even if it means preventing people from returning home after work or from a day trip. Disneyland. From there, people who test positive are moved to isolation facilities where they remain until they produce negative tests before being allowed to return home.

But while chasing after the virus in this way can limit its spread, such harassment can only go so far. Eventually, the virus escapes and new infections are sown. In the case of SARS-CoV-2, this likelihood is increased by the fact that the virus also lives in animal hosts where it continues to thrive and mutate, awaiting opportunities to infect vulnerable human hosts with few defensive immunity against him. “It’s hard to imagine how a zero COVID policy would eradicate this virus,” says Dr. Ian Lipkin, director of the Columbia Mailman School of Public Health’s Center for Infection and Immunity. “Even if you exclude all humans from being hosts, there are still animal reservoirs capable of carrying the virus and reintroducing it into human populations.”

While other countries, including Australia, the United Kingdom and the United States, instituted a quarantine system similar to that of China at the start of the pandemic, health officials have always recognized that this would be a temporary solution, until the population’s immunity can be built up, both from exposure to natural infections and eventually from vaccines.

For China, however, the strategy has been inflexible and without a clearly defined exit strategy, largely because of its close connection to the authority and stature of the ruling Chinese Communist Party. “Politically, the response to the pandemic was framed as a competition between two political systems, and Xi Jinping used China’s early successes to show the superiority of the Chinese political system,” said senior researcher Yanzhong Huang. for Global Health at the Council on Foreign Relations. , and Professor of Global Governance and Asian Health Issues at Seton Hall University. “” Theoretically, if they are able to maintain a low level of infection after other countries have moved away from zero COVID policies, they could claim that they are the only winners in the fight. Thus, the high political stakes have also contributed to China maintaining these policies.

Meanwhile, for the rest of the world, when effective vaccines became available in late 2020, a zero-tolerance strategy quickly became obsolete. As a population’s protection against the virus increases through vaccinations, there is no longer a need to confine infected people and try to shut down large areas. This is the approach Australia has taken, following a zero COVID policy at the start of the pandemic. But, says Rivers, the difference was that Australia set a limit on strict lockdowns, promising to lift them when 80% of the population has been vaccinated and will therefore be better protected against serious illness. “There has to be an exit strategy,” she says. “Australia laid out that strategy clearly to keep the public on board and understand what the way forward was. It was also important to make sure the country didn’t get stuck in an unsustainable place.

China may find itself in such a situation, with no end clearly articulated to its current policy.

Global Public Health Threats Posed by Chinese Policy

Keeping people isolated gives the virus fewer opportunities to spread and infect locally, but in a global pandemic, that may not be the most desirable end result. People who are not sufficiently vaccinated or who have not had much exposure to natural infection with the virus fail to generate strong T-cell responses, which scientists believe is important for longer-lasting protection against the disease. severe from COVID-19. Much of the rest of the world has built up this T-cell defense, due to a combination of vaccination, stimulation, exposure, and infection with COVID-19. The Chinese population may still be in the early stages of accumulating this kind of protection. “Basically, they have a population insufficiently protected by previous infection or vaccination, which is now at risk of spreading the virus,” says Lipkin.

It contributes to the fact that studies show that vaccines taken by the majority of the Chinese population, produced in the country by two local companies, Sinovac and Sinopharm, did not provide as much protection against infection or serious illness as those produced in the United States and China. Europe. These vaccines use inactivated forms of the SARS-CoV-2 virus to boost the immune system, while other approaches have used novel mRNA Where viral vector technologies. This means that the Chinese population, although they may be immune, may not be as protected as they could be. Indeed, Lipkin says that if China were to deploy vaccines like mRNA taken from Pfizer-BioNTech and Moderna, or virus-vectored vaccines from AstraZeneca, as booster shots, it could improve the protection started by virus vaccines. inactivated that the Chinese have used to this day. . Chinese scientists have been working on these other types of vaccines, including mRNA injections, but health officials have yet to approve them for widespread use in the country.

Then there is the human and economic toll of quarantining people, cutting them off and disrupting their social, professional and cultural ties. The result has been that pent-up frustrations have erupted into protests not just against restrictive COVID-19 policies, but against the entire communist system in recent weeks, in a stunning and fast-spreading movement. “I think the Party was caught off guard when it saw protests in several cities,” Huang said.

How to take the next step forward

Health experts agree that the way out of zero-COVID is to accelerate the vaccination of the population, which Chinese leaders have tried to execute in recent weeks. However, party officials are battling a problem of their own making, as many elderly members of the population have not been vaccinated as they do not feel the urgency in a country where cases were relatively low. given the strict containment measures. In a report released Nov. 28, government health officials in China said 65.8 percent of people over 80 received a booster dose. That’s up from the 40% reported mid-month, but it’s still far too low.

Even if more people are boosted, given the diminishing protection provided by these injections, especially against newer Omicron variants, these boosters may not be enough to boost population immunity to levels that would warrant suppression. progressive zero COVID policy. As long as the virus is able to produce more copies of itself, it will continue to evolve and generate new mutations, some of which could become variants that spread faster or cause more severe disease. The roulette wheel of viral mutations continues to spin, and the best defense to slow it down is immunity, either from vaccinations or from infections.

“China has a population with very little acquired immunity against infections. And the vaccine-acquired immunity hasn’t held up well over time against newer variants,” says Rivers. “So we expect a largely susceptible population. And these are conditions for large waves of infections. From a public health perspective, I would expect widespread vaccination and a strengthening of the elderly. But this is as much a political issue as a public health issue.

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