With record high covid cases, China struggles to close an immunity gap

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A coronavirus outbreak on the verge of being China’s biggest of the pandemic has exposed a critical flaw in Beijing’s “zero covid” strategy: a huge 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.

Chinese authorities that Thursday reported a record 31,656 infections, fighting to protect the most vulnerable population groups. They have launched a more aggressive vaccine drive to boost immunity, expanded hospital capacity and begun to limit the movement of at-risk groups. The elderly, who have a particularly low vaccination rate, are a key target.

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

More intensive care beds and better vaccination coverage “should have started 2½ years ago, but the targeted focus on containment meant 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 been shown to be more effective in fighting disease than the latest omicron variants, would now not address the fundamental problem with China’s goal of eliminating infection rather than alleviating symptoms. Raising immunity by allowing some level of community transmission “is still not acceptable in China,” he said.

China’s strategy of suffocating outbreaks initially protected everyday life and the economy while preventing serious illness and death. But it has become increasingly expensive as increasingly stringent measures cannot keep pace with 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 periods and fewer testing requirements. Officials insist the 20-point “optimization plan” is not a prelude to accepting outbreaks.

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

Confrontations have broken out in a few places, most prominently at a huge site Foxconn factory in central China so do 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 adhere to the terms of employment contracts.

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

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

At a press conference on Wednesday That’s what Chinese health authorities say the more than 100 critical cases meant more hospital beds and treatment facilities were “much needed” given the health risks to the elderly and people with pre-existing conditions. The spread of infection accelerated in several places, they added, with some provinces facing their worst outbreaks in three years.

Major cities including Beijing, Guangzhou and Chongqing have ordered residents in certain neighborhoods to stay at home. Malls, museums and schools have been closed again. Large conference centers are being turned into temporary quarantine centers, mirroring the approach adopted in Wuhan at the start of the pandemic. Some of the tightest restrictions are for nursing homes, with 571 such facilities in Beijing implementing the strictest level of control measures, barring all but essential entry and exit.

Opening up to a world now mostly living with the virus would cause a wave of deaths, officials fear. China’s vaccines were initially restricted to adults aged 19 to 60, a policy that continues to have implications for vaccination rates today. Only 40 percent of Chinese over 80 have received a booster shot, despite months of campaigns and giveaways to encourage enrollment. (Among people over 60, two-thirds have received a booster.)

Since the beginning of the pandemic, 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 from state-owned Sinopharm and privately owned Sinovac. Both received approval from the World Health Organization early last year after being shown to significantly reduce deaths and hospital admissions.

Sinopharm and Sinovac distributed their products widely around the world as part of a Chinese push to become a leading provider of global public goods and to improve China’s image. However, at the end of 2021, the demand for Chinese vaccines began to increase dry up as Pfizer’s and Moderna’s production and distribution 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. A visit by German Chancellor Olaf Scholz to Beijing in early November ended with a appointment that the Pfizer-BioNTech vaccine is made available to foreigners living in China via 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 signing off on the vaccine, despite it being made available in Hong Kong, Macao and Taiwan.

When asked last week whether the government would approve BioNTech for public use, the director of the Chinese Center for Disease Prevention and Control said authorities were working on a new vaccination plan to 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 virus strain.

Some health experts believe Beijing’s restraint is 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’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 candidates. The furthest forward is from the 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 received the nod from Chinese regulators and may not get it until data are 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. A Chinese-developed antiviral drug, Azvudine, originally used for HIV patients, was approved to treat covid in July. Traditional Chinese medicine is widely used.

But new and more effective vaccines remain a top priority, and the country’s leading pharmaceutical companies are poised to mass-produce them. CanSino is nearing completion of a manufacturing facility in Shanghai that will be capable of producing 100 million doses per year – subject to approval.

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