China’s Zero-Covid Policy Succeeded—Until It Didn’t. Here’s What Went Wrong And What Experts Think Could Happen Next.

Topline

China announced it was relaxing some of its strictest Covid restrictions on Wednesday, a major policy shift that suggests Beijing is preparing to abandon its zero-Covid strategy in favor of learning to live with the virus, which experts told Forbes was inevitable but risks igniting a huge wave of cases that the world’s most populous country is poorly prepared to face.

China dropped several key zero-Covid policies on Wednesday.

AFP via Getty Images

Key Facts

Zero-Covid, Beijing’s signature policy of strict lockdowns and extensive testing designed to stamp out Covid infections, was very successful during earlier stages of the pandemic when the virus variant was less transmissible and before vaccines and treatments were widely available, Winnie Yip, a professor of global health policy and economics at Harvard, told Forbes.

However, the evolution of more transmissible variants, particularly the most recent omicron subvariants, means zero-Covid is no longer sustainable, explained Ben Cowling, a professor of epidemiology at the University of Hong Kong.

Cowling said a shift away from zero-Covid was “inevitable” but will likely lead to surges in cases that could, barring the reintroduction of stringent public health measures, grow until the virus “starts to run out of susceptible people to infect.”

As Covid vaccines do little to protect against infection—they instead help prevent serious illness, hospitalization and death—and there have been very few natural infections, this could be a very large fraction of China’s population of more than 1.4 billion people.

Reliance on homegrown vaccines, believed to be less effective at preventing serious illness than the mRNA shots used by many Western countries, and poor immunization rates among the elderly means China faces a “bigger impact on healthcare when they can no longer contain the virus,” Catherine Bennett, a professor of epidemiology at Deakin University in Australia, told Forbes.

Using antiviral drugs to mitigate the risk of severe disease will be “critical for China,” Bennett said, adding that an important advantage for China having held back the virus for so long is that “these drugs are now well tested and produced at scale.”

News Peg

China eased away from zero-Covid on Wednesday and relaxed some of its toughest pandemic restrictions. The changes, which include allowing home isolation for mild or asymptomatic cases and less stringent testing requirements, are a significant policy shift and signal Beijing’s willingness to move away from the policy that has guided its pandemic response so far. The decision follows waves of protests against the restrictions that spread across China in recent weeks, triggered in part by rising cases and the death of 10 people in an apartment fire in the western city of Urumqi, which many blamed the curbs for. President Xi Jinping staked a lot of political capital on the strategy and Beijing has staunchly defended the approach in the wake of widespread international criticism and both global and domestic economic harm.

Crucial Quote

Moving away from zero-Covid is “inevitable” and “it will cause major disruption to China and therefore to the world as they make the transition… to community transition,” Bennett told Forbes. “We know from experience in Australia how hard that transition can be until you have sufficient hybrid immunity from vaccination and infection to bring the severe illness and death rates down.”

Big Number

5,235. That’s how many Covid deaths China has reported since the pandemic began, according to government data collated by Our World In Data. It has also reported around 1.8 million confirmed infections in that time, recently recording a record high of more than 40,000 new cases in a single day. These figures, among the lowest in the world when accounting for population size, are likely an underestimate based on widely criticized government reporting.

What To Watch For

Moving away from zero-Covid, no matter how unsustainable, could cost China dearly. Given the questionable quality of its vaccines, poor immunization rates among the elderly, low levels of natural immunity and a healthcare system that will likely struggle under the weight of a large wave, projections suggest millions will get seriously ill or die if the virus spreads. Experts have warned the country faces a “tsunami” of cases that could overwhelm hospitals and kill more than 1 million people if it changes course. Wigram Capital Advisors, as reported by the Financial Times, predicts daily fatalities could reach as high as 20,000 in mid-March. Health analytics firm Airfinity predicts as many as 2.1 million will die if the policy is lifted. Ensuring vulnerable people are vaccinated, as well as encouraging widespread boosting, should be a priority for China, Harvard’s Yip told Forbes.

What We Don’t Know

It’s not clear what approach China will now take, how far it will relax restrictions or how long it could take to reopen completely. Cowling said a complete return to normal “could take more than a year.” Reopening should be a gradual process and follow a timetable that varies according to how much of the population is vaccinated and boosted, as well as other factors like hospital capacity, Yip told Forbes. Public education programs will be important to boost vaccination and ensure people know what to do if infected, Yip said, adding that as long as older people understand the vaccines are safe and can protect against the serious consequences of infection “they would be willing to be vaccinated.” Bennett echoed the sentiment, noting that “the messaging reinforcing Covid zero might have helped undermine the vaccine program if people didn’t see it as urgent or local community transmission a threat.”

Tangent

Bennett told Forbes there is a risk China’s departure from zero-Covid “may also speed up the chance of seeing new variants” by adding the nation’s 1.4 billion people—nearly a fifth of the world’s population—into the infection pool. Omicron subvariants are likely to continue to dominate “as they can cause reinfection and keep waves running,” while also boosting immunity against other variants, Bennett explained. The real threat of more people being infected comes from the greater risk of recombinant viruses forming—genetic mash-ups of different viruses—Bennet said. Such a virus could render existing immunity, testing and treatment less effective. Bennett warned it’s possible that the virus causing Covid-19 could even recombine with an animal coronavirus species, which could throw a very “different variant into the mix.”