China Can’t Open Up Like U.S. Despite Vaccination, Official Says

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China can’t start easing pandemic restrictions like the U.S, even as its inoculation campaign gathers pace, because it has no way of analyzing how well its vaccines have worked in its largely Covid-free population, according to a top health official.

Despite administering more than 40% of its citizens with at least one dose, Feng Zijian, the deputy director General of China’s Center for Disease Control and Prevention, said the country “has some unique difficulties” and is unable to match the U.S.’s ability to examine vaccine effectiveness in real-time as cases and deaths ebbed.

China has largely eliminated infections -- there’s been only one Covid-19 related fatality in the last 13 months -- which means it’s harder to gauge if vaccination is having an immediate impact.

“I don’t think we’ve got to that point - if we try to open even when 60% or 80% of population are vaccinated, it could still lead to a severe outbreak,” Feng said Thursday at a conference in the eastern city of Qingdao. “It largely depends on the technical considerations, societal consensus and political concerns,” he said.

Though Feng didn’t elaborate on what he meant by technical considerations, it’s unknown if China’s vaccines can prevent onward transmission, and not just serious sickness. Messenger RNA shots made by Pfizer Inc., BioNTech SE and Moderna Inc. appear to be able do both, diminishing outbreaks in the U.S., Israel and other places.

Feng’s comment signals that China intends to remain closed off even as other major economies race to open up following large-scale vaccine efforts. After a lackluster start dogged by vaccine hesitancy and some supply shortages, China has now deployed more than 704 million shots, putting the country’s 1.4 billion people on track for herd immunity territory in just a few months.

‘Long Way’

However, officials seem to have no intention of shifting away from a Covid playbook of closed borders, strict quarantine for foreign arrivals, and aggressive lockdowns when flareups return. In contrast, many countries with similar or even lower levels of vaccination have started rolling back restrictions, reviving travel and lifting mask mandates, accepting that Covid-19 is endemic as long as most people won’t get seriously ill thanks to vaccination.

China’s only goal right now is to vaccinate all its citizens, said Feng. “But we haven’t figured out or decided at what rate of vaccination can we adjust containment measures.”

Those considerations may change as more Chinese vaccines become available. Li Yunchun, the chief executive officer of Walvax Biotechnology Co., told Bloomberg on Thursday he expects its mRNA shot to be as effective as the ones already deployed in Western nations. That vaccine will undergo Phase 3 clinical trials in more than seven countries in South America, Southeast Asia, South Asia and Central Asia, he said.

Existing shots being used in China “still have a long way to go,” in terms of proving their long-term effectiveness at controlling the disease, said Zhang Wenhong, director of infectious diseases at Shanghai Huashan Hospital and an adviser to China’s government on Covid-19.

“I’m hoping China could conditionally resume travel with some countries, but it depends on the vaccination pace,” Zhang said at the conference on Wednesday. “If we do not vaccinate fast enough, we’d be unwilling to open up.”

— With assistance by Chris Kay, and Claire Che

The introduction of vaccine passports could pose 'extremely high risks' of discrimination and exclusion - GETTY

How China can safely open its borders as it recovers from the coronavirus pandemic

• Quarantine cannot be China’s primary policy instrument against preventing outbreaks of Covid-19

• Apart from facilitating vaccination at home and abroad, China must also boost its public health leadership

As China moves to reopen its borders with the rest of the world, it faces a difficult choice. So far, the state narrative has been focused on the eradication of Covid-19 as a key indicator of legitimacy. In terms of case/fatality ratios relative to its population size, China has been very successful indeed.

The problem for China is that most of the world has not adopted a similar approach. Instead, most countries have developed a strategy of simply coping with the virus while trying to minimise the economic and social impact.

This means that, as China recovers from the pandemic, it will need to reopen its borders not just to trade and travel, but also to the virus. We are seeing a snapshot of this with the current outbreaks in Guangdong.

So, how does China balance this equation? How does it open up and keep itself safe at the same time? The first element has to be the creation of a firewall against community transmission. While strategies such as quarantines are useful, they are reactive policy instruments. They are what states use when the virus is already present.

As China reopens, the need for such instruments should be reduced to a supporting role rather than a core platform. Put simply, China cannot afford to reopen to the world when all travel into China requires 14- or 21-day quarantine.

The only way this can be avoided is through a robust vaccination programme. China has already made a very strong start with its inoculations, but it needs to deepen this across the entire country, especially in the outlying areas where people cross borders without official control and in rural communities where uptake is relatively lower. Vaccinations are essentially just individual firewalls against virus transmission.

The more widespread the vaccination take-up rate, the harder incidental transmission becomes. It has the additional protective benefit that, if Chinese people are already vaccinated when they travel overseas, then not only are they safer abroad but, when they return home, they are less likely to be carrying the virus into the local population as well.

This then leads to the second element: a proactive control of China’s borders beyond its borders. That is, to require all travellers to be fully vaccinated prior to arrival, rather than just ensuring inbound travellers have polymerase chain reaction (PCR) tests or similar before flying.

The pre-travel checks can fail or return false positives. There is significantly less risk if travellers are fully vaccinated before arrival in China. A common platform for recognition of vaccinations will be crucial if such conditions are to be met.

It is here that vaccine passports are emerging as the next major international policy challenge for governments. These are nothing new. In the past, international travellers had to carry a yellow card in their passports to show they were inoculated against yellow fever, cholera, typhus fever, and smallpox. As international travel resumes, a similar document for the Covid-19 virus will be necessary.

This is one area where China can leverage its standing as a major trading country, as well as one of the largest source countries for international travel, to set the best-practice standard for the rest of the world. This would also help to obviate the need for mandatory quarantine, except for arrivals from high-risk countries.

The third element necessitates that China increase its vaccine supplies. It is already doing so domestically, with 20 vaccine candidates currently undergoing trials. Now that the vaccines from Sinovac and Sinopharm have World Health Organization approval, there is also a greater capacity to support international efforts.

Doing so not only helps affected countries, it also helps to provide greater health security to Chinese people when they travel overseas. As most of Chinese trade and travel activities are focused on the countries along its periphery, these are the logical focus for China’s

vaccine diplomacy, either multilaterally through the WHO’s Covax Facility or bilaterally.

The final element requires China to move beyond a vaccine-led approach to its global public health leadership. All the public health data across countries shows that social and economic inequalities have the biggest impact on health.

Moving forward, China will need to focus on these structural determinants of health in the countries where it provides health aid, to see a bigger impact from its efforts. In doing so, China will not only deliver more effective health aid to those recipient countries but the spillover from such activities will improve global-level resilience to future health threats.

It is only by implementing an endgame strategy that incorporates all four elements that China can guarantee its long-term exit from the risks of the pandemic. To do otherwise would only invite greater social and economic risk with a return of the coronavirus, while restricting China’s ability to fully re-engage with the geopolitical economic order as it reopens its borders and lets the world back in.

Source:

1.Bloomberg News. https://www.bloomberg.com/news/articles/2021-06-03/china-can-t-open-up-like-u-s-despite-vaccination-official-says?sref=O17fWJNl

2. South China Morning Post. by Nicholas Thomas. https://www.scmp.com/comment/opinion/article/3136055/how-china-can-safely-open-its-borders-it-recovers-coronavirus