With record covid cases, China struggles to fill immunity gap

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China’s coronavirus outbreak, poised to become the biggest 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 sporadic hotspots 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 population. They began a more aggressive vaccination campaign to increase immunity, expand hospital capacity, and restrict the movement of at-risk groups. The elderly, who have a particularly low vaccination rate, are a prime target.

The effort to halt the approval of foreign vaccines is an attempt to prevent the virus from overwhelming a health care system unprepared for the flood of sick covid patients.

More intensive care beds and better vaccination coverage “should have started 2½ years ago, but a single-minded focus on protection meant fewer resources were devoted to this work,” said Yanzhong Huang, senior global health fellow at the Council on Foreign Relations.

Huang believes that even mRNA enhancers, which have proven more effective in fighting the disease than the latest omicron variants, will not address the underlying problem now that China is aiming to eliminate infection rather than reduce symptoms. “It’s still unacceptable in China,” he said, to increase immunity by allowing for the rate of community transmission.

China’s strategy of suppressing epidemics initially preserved daily life and the economy, while preventing severe disease and death. But increasingly stringent measures have become increasingly costly as more and more transmitted options have not been matched.

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

But efforts to break the destructive lockdown cycles have gotten off to a rocky start. Some cities relaxed measures, while in others districts ordered residents to stay indoors. The result: confusion, fear and anger.

Clashes have broken out in several locations, most notably at the giant Foxconn factory in central China, which produces half of the world’s iPhones. The scene turned violent there this week as thousands of workers protested the company’s failure to isolate people who tested positive and violate the terms of their employment contracts.

Prevention of epidemics is again a priority. Shijiazhuang, a city of 11 million about 185 miles from the capital, suspended its reduced requirements for mass testing on Monday and announced a five-day city-wide screening.

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

At a news conference on Wednesday, Chinese health officials said more hospital beds and treatment facilities were “very necessary” given the health risks for more than 100 critical cases, the elderly and those with pre-existing conditions. The spread of the infection was accelerating in many places, they added, with some provinces facing their worst outbreaks in three years.

Major cities including Beijing, Guangzhou and Chongqing ordered residents in certain neighborhoods to stay indoors. Shopping centers, museums and schools have been closed again. Large conference centers are once again being turned into temporary quarantine centers, 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 controls, barring all but the main exits and entrances.

Officials fear that opening up to a world now largely living with the virus would trigger a wave of deaths. China’s vaccinations were initially limited to adults between the ages of 19 and 60, a policy that continues to affect vaccination rates today. Only 40 percent of Chinese over 80 have received the booster shot, despite months of campaigning and giveaways to encourage uptake. (Among people over 60, two-thirds received a booster.)

Since the start of the pandemic, China has relied solely on domestic vaccine manufacturers. It has approved nine domestically developed variants, more than any other country, with the earliest and most widely used vaccines coming from state-owned Sinopharm and privately held Sinovac. Both received approval from the World Health Organization early last year after they were found to significantly reduce deaths and hospital admissions.

Sinopharm and Sinovac have widely distributed their products globally as part of China’s push to become a leading supplier of global public goods and improve China’s image. Again, in late 2021, demand for Chinese vaccines began to decline as Pfizer and Moderna ramped up production and distribution.

China has yet to approve any foreign vaccine or explain its decision to avoid what could be an effective way to close the immunity gap. In early November, German Chancellor Olaf Scholz’s visit to Beijing 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, despite its introduction in Hong Kong, Macau and Taiwan.

Asked last week whether the government would approve BioNTech for public use, the director of China’s Centers for Disease Prevention and Control said authorities were working on a new vaccine plan to be released soon.

Without access to the most effective mRNA-based candidates from updated Pfizer-BioNTech and Moderna to fight the Omicron variant, the world’s most populous country remains dependent on vaccines made using the original strain of the virus.

Some health experts say Beijing’s silence 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 is ridiculous that only foreigners are allowed to buy BioNTech vaccine in China. It’s as if they consider the Chinese inferior to foreigners.”

China is instead trying to develop 10 mRNA candidates. The farthest one Abogen Biosciences is from the biotechnology group and the state-run Academy of Military Medical Sciences. Indonesia approved it for emergency use in September, but has not received the go-ahead from Chinese regulators and won’t until data from Phase 3 clinical trials in Indonesia and Mexico is available. The trials are expected to conclude in May.

Other options in China include an inhalable vaccine made by CanSino and available in Beijing, Shanghai and Hangzhou since October. Azvudine, an antiviral drug developed in China originally used for HIV patients, was approved for the treatment of 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 gearing up to mass-produce them. CanSino is completing a manufacturing facility in Shanghai that will be able to produce 100 million doses per year, once approved.