J. Stephen Morrison, Scott Kennedy, and Yanzhong Huang. "China May Move beyond Zero-Covid. That Could Benefit Us All.." CSIS Commission on Strengthening America's Health Security, Center for Strategic and International Studies, February 09, 2022. Accessed September 20, 2022. https://healthsecurity.csis.org/articles/china-may-move-beyond-zero-covid-that-could-benefit-us-all/
Recently many experts have spotlighted China’s acute vulnerability in the face of Omicron and predicted the virus may soon overrun the fearsome defenses of China’s Zero-Covid policy, infecting millions of weakly protected Chinese, in particular a massive elderly population with little immune protection, who in turn could swamp China’s poorly prepared, under-resourced health system.
Such a nightmare may or may not materialize. In the meantime, more careful consideration—and a measure of humility and caution—should be front and center. We need to weigh what we know and the many key things we do not know, the different scenarios that might arise, and the tools at China’s disposal. We also need to consider the possibility that Omicron, unleashed in China, might actually favor a constructive reset in China’s outlook in its quest for mass-scale mRNA vaccines and antivirals, including a shift in outlook toward the United States and others in the Western world, made even more urgent by the reality that China’s own mRNA vaccine candidates are still far away in their development and of unproven quality. China will inevitably move beyond Zero-Covid, a patently unsustainable approach that makes less and less sense as effective treatments arrive and immune protections from vaccines and infection rise elsewhere in the world. The only question is how orderly and at what price this transition to a new long-term strategy will occur. To navigate successfully, this change will require tough decisions, leadership, skill, and luck, while the exact path may remain murky for some time. China will likely avoid disaster, but there are difficult adjustments that, if executed successfully, may improve prospects for mitigating the worst effects of the virus.
The Temporary Logic of Zero-Covid
China’s Zero-Covid approach presumes an unending emergency and relies on severely restricted international travel, mass testing and quarantines, exceptionally intrusive technological and human surveillance, and brutal large-scale lockdowns. Until recently, the fierce Chinese state has successfully controlled infections and deaths. It is clear that some of these steps are beyond what is necessary, for example, testing or shutting in their homes millions of people in the wake of a handful of cases, but local officials are responding to Covid-19 with the same vigor with which they used to pursue the one-child policy and keep generating economic growth. So even while disrupting the economy and society at large—creating anxiety and frustration over the risk of suddenly getting swept into protracted isolation—the Zero-Covid policy also seems to have retained broad public support in China.
But Zero-Covid may have met its match in Omicron if the variant’s extraordinary transmissibility and ability to escape immune protections pierce China’s stringent controls, mirroring the patterns seen in Europe and North America. By this reasoning, Omicron stands poised to exploit China’s enormous “immunity gap.” China’s population has almost no protection acquired through infection (thought to be less than 1 percent of the population) and very low protections against infection acquired from Chinese vaccines, which have proven significantly inferior to Western mRNA vaccines. China’s vulnerability is further compounded by two other conspicuous vacant spaces in the toolbox: the lack of timely access to both mRNA vaccines (including third shot boosters to partly cover the immunity gap) and antivirals on a scale that will make a difference in the near to medium term.
China’s immunity gap is a serious, glaring problem today. It could become even starker when the virus becomes endemic in much of the rest of the world, as the emergency pandemic phase transitions to the management of a seasonal virus against which most populations elsewhere have built up considerable immune protections.
Without mRNA vaccines or antivirals ready at hand, imagining what playbook might replace China’s Zero-Covid policy is a puzzle. Not surprisingly, the signs thus far are that China’s rulers are for sticking to what they know best, for better or worse. As more outbreaks occur across China, along coastal areas, in the interior, and now near Beijing, the reflex has been to double down on stringent controls. Over 20 million people recently have been placed in lockdown across three megacities (Xi’an, Tianjin, and Shenzhen). Meanwhile, the government has suspended international flights and reinforced media campaigns that exaggerate the threat of Omicron.
There are, however, several unknowns in the China equation which argue for humility and caution in predicting what may ultimately transpire in China.
We do not really know what level of protection the Chinese vaccines confer against Delta and Omicron in terms of hospitalizations and death. The available evidence is quite murky. We also do not have a very good understanding of the resilience of China’s health system and the speed with which it is currently being fortified. Nor do we know how effective China’s brutal isolation of populations at risk will be in containing Omicron. Each of these factors is critical in reaching an accurate estimate of China’s true vulnerability.
We also do not have much insight into how Chinese public opinion is evolving at this moment in time. It was thought that the majority of those in urban settings and who enjoy more settled, secure economic status have bought into the deal that President Xi Jinping has tabled: freedom from the virus and a relatively normal, virus-free life gained through collective discipline and sacrifice. However, that compact has been severely tested in Xi’an and other urban centers forced into extended lockdowns, where dissent has been loud and resonated nationally and globally. For China’s 300 million migrant laborers, the constant disruptions, and the inability to travel home reliably over the Lunar New Year, likely carry a psychic toll and may already be fueling discontent.
We also do not know President Xi’s state of mind. Thus far, the daily count of domestic transmissions remains extremely low, and there seem to be few cases and little to no spread of Covid cases inside the Olympic “closed-loop” system. China’s success in containing the spread of Omicron during the Olympics may encourage the choice to sustain Zero-Covid until after the 20th Party Congress in late 2022. Indeed, the leadup to the Congress is the test of whether Xi entrenches his near total powers in a third five-year term, and his success hangs to a profound degree upon the management of the pandemic. Moreover, he has discovered that expanded pandemic controls bring greater political control and reinforce strategic directions he favors including increased economic self-reliance and greater flexibility in modulating the extent of its ties with other countries. Zero-Covid may also provide proof of concept for a “surveillance state” that aspires to control every facet of behavior in the post-pandemic era. It probably seems politically inadvisable in 2022 to pivot away in the near term from Zero-Covid, with all the risks of losing control that might imply. But then again, Zero-Covid imposes a not insignificant economic price, and the Xi’an debacle has cut into public support. Omicron may begin to override controls and vaccine immunity protections, as it has in many settings in Latin America, the Middle East, and Asia, where over 1.6 billion Chinese vaccines have been administered. These realities are not lost on Xi, who may already be recalculating the risks and weighing a pivot post-Olympics.
Possible Scenarios and Policy Options
Several scenarios may emerge. China could experience scattered, modestly scaled outbreaks, perhaps in rural areas with relatively weak surveillance and health infrastructure. It could see major urban center flare-ups. Worse still, it might see waves sweep across the country.
As a result, the choices before China are neither white nor black, but gray. China may lack sufficient mRNA vaccines and antivirals for now—one domestic vaccine candidate is undergoing stage-3 trials—but it is not without a mix of options to help ease itself beyond Zero-Covid and avoid the whiplash recently experienced by Australia’s population following an abrupt and clumsy reopening. Most importantly, China has the means to create a new narrative about how to better protect its population and ensure economic prosperity against an evolving virus.
Even while using intense lockdowns, mass testing, and repressive surveillance controls, the Chinese government has the capacity to redefine the problem posed by Omicron through an education and propaganda campaign on the lower true risks posed by Omicron. It could prepare the public systematically, appealing for a change of outlook and risk tolerance and arguing for a phased transition. The management of expectations will likely require a blunt acknowledgment that a difficult phase of heightened disruption, hospitalizations, and deaths may lie ahead, in certain areas, but that it can be short-lived and contained if enough prior preparations are in place to correct for shortages in staff, tests, intensive care unit (ICU) beds, and anticipated interruptions in supply chains. These measures, in aggregate, might lower the threat of panic and any attendant economic and political downsides.
Authorities can introduce some mRNA vaccines and antivirals in support of control efforts targeting the elderly and other high-risk populations and accelerate efforts to strengthen the capacities of hospitals and clinics. For the demographic that fears they are infected but are asymptomatic or only mildly ill and relatively low risk, the state can steer patients away from core health institutions and toward alternate sites for testing and care. China has the option to reduce the frequency and size of mass nucleic acid testing, redefine close contacts of Covid-19 cases to reduce the number of people required to be quarantined or relocated, and aggressively do better to blunt the economic and social impacts of lockdowns and narrow their scope.
China can learn from Australia’s experience: a high vaccination rate is not the sole factor upon which to move beyond Zero-Covid. Australia has experimented with phased, partial openings, including travel corridors with partner countries, and endured a burst of infections that quickly subsided. China may take a similarly incremental and increasingly flexible and adaptive approach toward opening up: maintaining travel restrictions on foreign visitors and intra-China travel while reducing the quarantine period for both foreign and domestic travelers.
What about the Outside World?
Xi might decide to vilify the West as the source of its Omicron troubles. Already, we are seeing Beijing health authorities attributing flare-ups in the city to international mail and imported frozen food.
That, of course, will not be helpful in stamping out Covid-19. But other paths also exist. China might take the challenge of mRNA vaccines and antivirals as an opportunity to bolster its scientific acumen, which has lagged behind the West in these vital technologies, through new partnerships forged between the Chinese biomedical industry and external interests. This narrative could leverage China’s huge production capacities and bring forward vaccines and therapies at scale that have a Chinese brand and that might also fulfill needs outside China and sustain China’s vaccine diplomacy. Such a reset, a new national campaign to carry China into the next phase of a post-Omicron future, is not inconceivable.
Cynically, one might argue that an Omicron tsunami engulfing China would be in the interest of the United States. But “letting China suffer” is not a moral, smart, or even marginally effective approach to bring the world back to some semblance of stability and order where markets and supply chains return to functionality, inflationary forces abet, and a global path out of emergency and into internationally coordinated management of the endemic virus becomes feasible.
There may be many flaws in the crisis management carried out by the Chinese Communist Party (CCP), but its commitment to ensuring its survival should not be underestimated. From Tiananmen to Wuhan, history has repeatedly taught us how resilient the CCP is in muddling through grave crises by mobilizing resources and bureaucratic capacities for high-priority actions. In the worst-case scenario, the inability to tackle an Omicron pandemic in China may prompt the party-state to whip up nationalist sentiment and deflect domestic criticism in an attempt to shore up its political legitimacy.
U.S. Policy Choices
The United States should approach the complex predicament China faces in Zero-Covid from four angles.
The United States, with almost 80 million infections and over 900,000 deaths, is in no position to preach to China, which has reported 107,000 cases and over 4,600 deaths. The trick diplomatically will be turning the conversation away from the past and toward a constructive consideration of a post-pandemic future in which China seeks to return to normal life at home uninterrupted by mass lockdowns as well as regular interactions with the rest of the world.
Second, this is a moment for genuine empathy and generosity and for a high-level recognition of the gravity of what is at stake in human terms for Chinese citizens should Omicron spread widely there. This perspective could be implemented through statements, sharing of its own mRNA vaccines and antivirals, and active encouragement of the pharmaceutical firms to conclude agreements with China to transfer technologies for mass producing mRNA vaccines and oral antivirals for use in China (similar to the break-even deal between Merck and China’s Ministry of Health on sharing Hepatitis B vaccines).
Third, this is a moment to remind the world of the global security dimension of what China is experiencing: uncontrolled transmission in China could fuel the proliferation of variants and set back efforts for the world to move beyond the emergency phase of the pandemic and into a phase with reliable and predictable management of outbreaks. It could also cause further disruption to global supply chains and increase inflationary pressures worldwide. Helping China avoid a massive outbreak due to Omicron is in everyone’s self-interest.
And finally, this moment is a chance for the United States and China alike to circumnavigate the current quagmire surrounding the Covid-19 origins controversy and test the possibility of a health security détente. The United States and other countries need to continue to press China on cooperating with the World Health Organization-led investigation while simultaneously engaging China on areas of significant mutual self-interest, such as preparing for a transition to an era beyond Zero-Covid. Such diplomatic outreach will not impede or alter U.S policy toward China in other critical areas. It will, however, give China a continuing stake in stable Sino-U.S. ties and perhaps provide an opening for thawing of some other elements of the relationship. Realistically, any such shift in tone, substance, and policy by the United States will be a difficult sell at home. It will be made far more feasible if China is willing to take a more pragmatic and constructive approach toward improving the bilateral relationship.
J. Stephen Morrison is senior vice president and director of the Global Health Policy Center at the Center for Strategic and International Studies (CSIS) in Washington, D.C. Yanzhong Huang is a senior fellow for global health at the Council on Foreign Relations. Scott Kennedy is a senior adviser and trustee chair for Chinese Business and Economics at CSIS.
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