On 8 January, the port city of Tianjin reported China’s first locally transmitted Omicron case. In the weeks since, authorities have been playing public-health whack-a-mole as they race to tackle small but disruptive outbreaks in major cities including Beijing, Suzhou and Hong Kong. The numbers may be tiny in comparison to UK case rates, but they represent a major headache for China’s zero-Covid strategy.
China's no-tolerance Covid policy has, quite rightly, been held up as one of the greatest success stories of the early pandemic. Uncompromising lockdowns and sealed borders likely saved millions of lives, all while many Western countries floundered. At the same time, Chinese pharmaceutical companies have raced to develop promising new tech, including two of the world’s most commonly used vaccines. The pace of China’s vaccination drive has been astonishing: 3 billion doses have been administered to 1.2 billion people so far, including children down to the age of 3.
But Omicron threatens to throw a serious spanner in the works. Many of the same factors that convinced China’s leadership of the merits of its Covid approach now no longer seem to be working in its favour. In fact, faced with an agile new variant, China finds itself uniquely vulnerable to the virus. Even three shots of China’s homegrown vaccines, Sinopharm and Sinovac, offer worryingly little protection against Omicron. And with almost no natural immunity, the country is dangerously exposed to a variant that threatens to evade even the tightest lockdowns. Beijing’s exit strategy was unclear to begin with, but now it looks almost impossible.
Chapter 1
It’s hard to see what the next step is. Preserving China’s health infrastructure is, of course, a chief concern. Even with a milder variant, any serious Covid wave – beyond the localised outbreaks seen so far – could cause China’s health-care system to buckle. Nationwide ICU capacity is just a tenth of the US’s, at 3.6 beds per 100,000 people, and this disparity is only starker in rural areas. And even at the most fundamental level, Chinese health authorities lack the hands-on experience of other countries, which have had no choice but to spend the past two years getting to grips with how best to treat the virus.
But the problems aren’t only practical, they’re political too. It’s hard to overstate the political legitimacy that has been staked on China’s ability to protect its population from the virus. The merits of China’s zero-tolerance model haven’t been a hard sell – 1.4 billion people have enjoyed something approaching life as normal while much of the rest of the world has endured yo-yo lockdowns anddeaths on a vast scale. It’s no surprise that public and party alike have been convinced of the idea that China has carved out a uniquely successful path.
But strength of belief alone can’t be counted on to protect against Omicron. While there is no easy fix to China’s low immunity, there are a few ways that authorities could move to limit the potential damage. The recent decision to approve Paxlovid, Pfizer’s at-home antiviral, is a welcome step, but there are few signs that regulators are prepared to take the more significant symbolic hit of finally approving Pfizer’s vaccine. Plans to produce the German-US developed vaccine domestically have been purposefully held up in the final stages while Chinese companies race to develop their own mRNA vaccine.
The problem is, small steps like these don’t offer up a solution on the scale needed to move towards “living with the virus”. We know from experience that even three shots of the most effective vaccines allow for occasional breakthrough cases. Scaled up to China’s population as a whole, this would mean infections – and deaths – on a level currently unacceptable to both the party and the public. And, just as importantly, it would mean conceding that Chinese solutions alone weren’t enough.
Chapter 2
Instead, it appears that for now Beijing is sticking to its guns on zero-Covid. Any shift away from zero-Covid would likely begin with a change in messaging, emphasising that Omicron is a different beast from Delta – more transmissible but less dangerous – that requires a new set of tools. But so far, the official line is that China’s tried-and-tested measures will still work against it. Omicron is a foreign problem – state media recently even suggested that cases were being imported through international mail – but it can be tackled through homegrown solutions.
It’s hard to avoid the sense that China has been trapped into operating on an outdated set of calculations. A few months ago, the best-case scenario may still have just been within reach. Facing just Delta, China might well have been able to make it past the Winter Olympics and autumn’s Party Congress without any major upsets. And within the next 12 months or so, it might have been able to successfully develop and mass produce a homegrown mRNA booster and antiviral treatments that would have curbed some of the most serious risks to the health-care system, allowing a gradual shift towards living with the virus – all without having to turn to non-Chinese solutions.
But now that strategy, which was optimistic to begin with, seems more and more distant. Omicron couldn’t really have arrived at a worse time. The main problem is not the Winter Olympics but the recent Spring Festival which, in a normal year, would have seen as many as 3 billion trips taken over the new-year period. The holidays have brought local governments’ often excessive Covid regulations under intense public scrutiny, at just the point when a new variant means they can’t really be relaxed. The Chinese model of pandemic prevention, where central directives are filtered – and very often intensified – down the chain of command may have been the secret to the success of China’s early response, but now, as transmission remains low and localised, there’s been more and more bristling at the often weeks-long quarantines required to visit relatives. While this human impact may pale in comparison to the death and disruption experienced elsewhere, it will still have to be factored into Beijing’s future planning.
So too will the economic cost. So far, authorities have handled the economic fallout of zero-Covid with remarkable success. Short, sharp and localised lockdowns have kept the estimated drag on GDP to just 0.6 per cent, according to a recent report. But it’s one thing to maintain the status quo and another to move to a new normal. When authorities eventually stop kicking the can down the road, they’ll be facing an unenviable balancing act between the human, economic and political costs of reopening.
Chapter 3
So what could an exit strategy look like? As much as authorities might wish they could turn a blind eye to Omicron, the situation in Hong Kong, where cases are now reaching an all-time high, is a harsh reminder that the variant can quickly unravel two years of meticulous pandemic prevention.
This means that, for perhaps the first time in nearly two years, China finds itself on the back foot when it comes to Covid. The spread of Omicron marks a new stage to the pandemic which, with proper global coordination, shouldn’t require sealed borders and locked-down economies. But while China’s achievements so far have been immense, Beijing’s insistence that its response has been and must continue to be uniquely Chinese risks coming at a great cost to itself – and eventually, as supply chains begin to suffer, to us too.
The progressive instinct might be to want China to learn to live with the virus as soon as possible, but we need to realise that – at least in the immediate term – that’s a practical and political impossibility. Instead, even in Hong Kong, any progress will be cautious and considered, more likely playing out over years than weeks and months.
But there are things we can do to help smooth the way. Above all, we must recognise that this isn’t some gleeful moment of triumph of the UK or US’s approach to Covid over China’s – it’s a real battle to best protect more than a billion people from a virus we’ve seen first-hand cause real damage. International collaboration on tech and treatments, as well as a willingness to share expertise, should be at the heart of any successful move towards living with the virus. In other words, as China works to find its footing in a new stage of the pandemic, both sides will need to put politics to one side and focus on the science.
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