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

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A coronavirus outbreak poised to be China’s largest of the pandemic has exposed a critical flaw in Beijing’s “zero covid” strategy: a large population with no natural immunity. After months of only occasional hot spots 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 campaign to boost immunity, expanded hospital capacity and begun restricting the movement of at-risk groups. The elderly, who have a particularly low vaccination rate, are a key target.

These efforts, which fall short of approving foreign vaccines, are an attempt to prevent the virus from overwhelming a healthcare system ill-prepared for a flood of very sick covid patients.

More intensive care beds and better vaccination coverage “should have started 2 1/2 years ago, but the heavy-handed focus on containment meant fewer resources focused on it,” said Yanzhong Huang, senior fellow for global health at the Foreign Relations Council.

Huang believes that even mRNA boosters, which have proven more effective in combating the latest omicron disease variants, would now not solve the fundamental problem with China’s goal of eliminating the infection instead to mitigate the symptoms. Boosting immunity by allowing some degree of community transmission “is not yet acceptable in China,” he said.

China’s strategy for quelling outbreaks originally protected daily life and the economy while preventing serious illness and death. But it has become increasingly costly as increasingly stringent measures fail to keep up with the more transmissible variants.

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

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But the effort to break cycles of disruptive lockdowns has had a rocky start. Some cities relaxed the measures, while other districts ordered residents to stay indoors. The result: confusion, fear and anger.

Confrontations have erupted in some places, most notably at a large 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 to honor the terms of employment contracts.

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

The first deaths reported since May, although 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 the full relaxation 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.

At a news conference on Wednesday, Chinese health officials said 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 the infection is accelerating in several locations, they added, with some provinces facing their worst outbreaks in three years.

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

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

Since the start 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 coming from state-owned Sinopharm and privately-owned Sinovac. Both received World Health Organization approval early last year after they were found to significantly reduce deaths and hospitalizations.

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, in late 2021, demand for Chinese vaccines began to dry up as Pfizer and Moderna ramped up production and distribution.

China has yet to approve any foreign vaccine or explain its decision to shun what could be an effective way to plug its immune gap. A visit by German Chancellor Olaf Scholz to Beijing 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 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, even though it is available in Hong Kong, Macau and Taiwan.

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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 that would be released soon.

Without access to the more effective mRNA-based candidates from Pfizer-BioNTech and Moderna, which have been updated to combat the omicron variant, the world’s most populous country remains dependent on vaccines developed with the original strain of the virus.

Some health experts say Beijing’s reluctance 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 allow foreigners in China to receive the BioNTech vaccine. It’s like they think Chinese people are inferior to foreigners.”

Instead, China is trying to develop 10 of its own mRNA candidates. The farthest is from biotechnology group Abogen Biosciences and the state’s Academy of Military Medical Sciences. Indonesia approved it for emergency use in September, but it has not received approval from Chinese regulators and may not get it until data from phase 3 clinical trials in Indonesia and Mexico are available. The trials are expected to end in May.

Other options in China include an inhalable vaccine developed by CanSino, which has been available in Beijing, Shanghai and Hangzhou since October. An antiviral drug developed in 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 priority, and the country’s top pharmaceutical companies are poised to mass-produce them. CanSino is completing a production facility in Shanghai that will be able to manufacture 100 million doses per year, after receiving approval.

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