With record covid cases, China scrambles to plug an immunity gap

Suspension

The coronavirus outbreak on the verge of becoming China’s largest pandemic has exposed a critical flaw in Beijing’s “zero Covid” strategy: a large population without natural immunity. After months of only occasional hot spots in the country, most of its 1.4 billion people have not been exposed to the virus.

The Chinese authorities, which on Thursday reported 31,656 infections, are seeking to protect the most vulnerable population. They have launched a more aggressive vaccine campaign to boost immunity, expand hospital capacity and begin restricting movement of high-risk groups. The elderly, who have a particularly low vaccination rate, are a prime target.

These efforts, which stop short of approving foreign vaccines, are an effort to prevent the virus from overpowering a health care system ill-prepared for a flood of COVID-19 patients.

More intensive care beds and better vaccination coverage “should have started two and a half years ago, but the single focus on containment means fewer resources focused on this,” said Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations.

Huang believes that even mRNA boosters, which have proven effective in fighting disease from the latest Omicron variants, will now not solve the underlying problem with China’s goal of eradicating infections rather than relieving symptoms. He said that lifting immunity by allowing a degree of community transmission “is still not acceptable in China”.

China’s strategy of eliminating the outbreak originally protected daily life and the economy while preventing severe illness and death. But it has become increasingly costly as stricter measures fail to keep pace with more transmissible variants.

Earlier this month, the government announced what appeared on paper to be the most significant relaxation of censorship yet, with shorter quarantine periods and Less testing requirements. Officials insist the 20-point “improvement” plan is not a prelude to accepting the outbreak.

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But efforts to break pesky shutdowns have had a rocky start. Some cities have relaxed measures, while districts in others have ordered residents not to set foot outside their homes. The result: confusion, fear and anger.

Confrontations have broken out in a few locations, most notably at Foxconn’s massive factory in central China that 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 to abide by the terms of their employment contracts.

Curbing the outbreak takes priority again. Shijiazhuang, a city of 11 million people 185 miles from the capital, suspended its reduced requirements for mass testing on Monday and announced a five-day city-wide check-up.

The first deaths reported since May – albeit one or two per day – have intensified concerns that hospitals are ill-prepared to deal with the surge in severe cases. Bloomberg Intelligence estimated that full control of the coronavirus could leave 5.8 million Chinese people needing intensive care in a system with only four beds per 100,000 people.

At a news conference on Wednesday, Chinese health officials said the 100-plus critical cases meant more hospital beds and treatment facilities were “absolutely necessary” given the health risks for the elderly and individuals with pre-existing conditions. They added that the spread of infection is accelerating in multiple locations, with some governorates facing their worst outbreaks in three years.

Major cities, including Beijing, Guangzhou and Chongqing, have ordered residents in certain neighborhoods to stay home. Malls, museums and schools are closed again. Major conference centers are being returned to temporary quarantine centres, mirroring the approach taken in Wuhan at the start of the epidemic. Some of the strictest restrictions are on nursing homes, with 571 such facilities in Beijing implementing the strictest levels of control measures and barring all but essential exits and entry.

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Officials fear that opening up to a world mostly living with the virus could cause a wave of deaths. Vaccinations in China were initially restricted to adults between the ages of 19 and 60, a policy that still has ramifications for vaccination rates today. Only 40 percent of Chinese people over the age of 80 received a booster dose, despite months of campaigns and gift-giving to encourage uptake. (Among people over 60, two-thirds got a booster shot.)

Since the beginning of the epidemic, China has relied solely on domestic vaccine makers. It has approved nine domestically developed options, more than any other country, with the oldest and most widely used vaccines from state-owned Sinopharm and privately owned Sinovac. Both gained approval from the World Health Organization early last year after they were shown to significantly reduce deaths and hospitalizations.

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

China has not yet approved any foreign vaccines or made clear its decision to avoid what could be an effective way to close its immunity gap. A visit to Beijing by German Chancellor Olaf Scholz 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 deal with Fosun that gives the Chinese company exclusive rights to supply the country. But Chinese regulators have repeatedly delayed signing up for the vaccine, even though it has been made available in Hong Kong, Macao and Taiwan.

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When asked last week if the government would approve BioNTech for public use, the director of the Chinese Center for Disease Prevention and Control said that authorities are working on a new vaccination plan that will be launched 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 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 BioNTech and Moderna’s vaccine for the general Chinese population as soon as possible,” said Jin Dongyan, a virologist at the University of Hong Kong. “It’s ridiculous that they only allowed foreigners in China to receive the BioNTech vaccine. It’s as if they think Chinese people are inferior to foreigners.”

China is instead trying to develop 10 of its own mRNA filters. the furthest It is from biotechnology group Abogen Biosciences and the state-run Academy of Military Medical Sciences. Indonesia approved its emergency use in September, but has not received approval from Chinese regulators and may not until data from Phase III clinical trials in Indonesia and Mexico are available. Trials are expected to conclude in May.

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

But new and more effective vaccines remain a top priority, and the country’s leading pharmaceutical companies are preparing to mass-produce them. CanSino completes a production facility in Shanghai that will be able to manufacture 100 million doses annually – subject to approval.

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