J. Stephen Morrison, Scott Kennedy, and Yanzhong Huang. "China’s Zero-Covid: What Should the West Do?." CSIS Commission on Strengthening America's Health Security, Center for Strategic and International Studies, June 27, 2022. Accessed February 13, 2023. https://healthsecurity.csis.org/articles/china-s-zero-covid-what-should-the-west-do/
A Turning Point
China’s Zero-Covid approach in the aftermath of the Wuhan outbreak of early 2020 rested on an 85-day mass lockdown, mass testing, intense surveillance, isolation, quarantines, and border closures. Though brutal, it is credited with holding the Covid-19 virus at bay during 2020 and 2021, keeping excess deaths to remarkably low levels, and restoring China’s economic growth following an almost 7 percent, precipitous drop in GDP. It was a dramatic, forceful demonstration of Chinese might and resolve, in stark contrast to what was seen in the United States and other wealthy Western states. Denial, delays, incompetence, and polarization left over 360,000 Americans dead by the end of 2020. One million Americans had officially died from Covid-19 by May 2022, at which point China reported a mere 5,200 fatalities. (This figure is likely a woeful undercount, but even if wrong by tenfold, it remains modest for a population of 1.4 billion and a fraction of U.S. losses.)
Jumping ahead to 2022, after 60 days of lockdown this spring, Shanghai nervously reopened on June 1, with a mere 29 cases reported the day before, down from a peak of more than 26,000 per day in April. To China’s leadership, this transition is proof that Zero-Covid has succeeded, again. By contrast with the West, where populations have acquired, at least temporarily, a wall of immunity through infection and vaccinations and where life is returning to some level of pre-pandemic normality, China’s leadership argues it simply cannot afford at present to shift course and reopen. So much of China’s population is immunologically naïve that the losses might exceed a million deaths if China reopens before proper protective measures have been introduced. From the Chinese leadership’s perspective, Hong Kong’s exceptionally high death rate in the spring provides stark proof of that possible scenario.
Two years post-Wuhan, however, the ground has shifted, and the challenges have become far more complicated. Today, Omicron subvariant infections often outstrip China’s controls. A confirmed half million cases were counted in Shanghai between March and late May. Outbreaks spread subsequently across many other major urban centers, including Beijing. Chasing the virus has in effect meant rolling closures across much of China. In March, an estimated 345 million people across 46 cities were in full or partial lockdowns, a population accounting for 40 percent of GDP.
The Covid-19 cases in Shanghai have been wrestled to the ground, for now, but many fear this progress will not hold and the government will be required to reach for ever more extreme measures. Shanghai’s massive quarantine hospitals have not been shuttered. PCR testing every two to three days is becoming the norm in major cities to gain access to offices, groceries, and public services. Indeed, China has built a machinery that can test half a billion people every 48 hours. While the Chinese leadership believes that massively expanded mass testing will identify infections early and trigger measures to contain the outbreak without causing harmful disruption to the economy, it is still too early to know whether that approach will succeed. One thing is known: testing at this scale costs tens of billions of dollars, which may amount to 1.5 percent or higher of China’s GDP. Even as Shanghai reopened, an estimated 133 million people in 16 cities remained under some form of lockdown, and outbreaks continue. There is widespread fear that as long as China’s Zero-Covid policy remains in place, persistent outbreaks will continue to trigger the reimposition of sudden lockdowns or other severe restrictions that will disrupt normal life. Just a day after the June 1 reopening in Shanghai, cases of Covid-19 community transmission appeared outside government-mandated quarantine areas. In the days that followed, there have been outbreaks again in Beijing as well as more recently on the south coast in the technology hub, Shenzhen, and the gambling center, Macau.
Costs have steadily mounted. An uncompromising Zero-Covid strategy has had deep and likely long-lasting societal, political, and economic impacts. Popular exasperation at rigid and inhumane treatment has filled social media, while at the same time China’s economy froze up even worse than in early 2020. The economic dislocations are now spilling into the larger world, fueling inflation, disrupting supply chains, triggering a retreat or pause by some foreign businesses in China, and increasing external concern over China’s deepening isolation.
As the summer unfolds, what major lessons can be gleaned from China’s Zero-Covid battle against the Omicron virus, a struggle that the World Health Organization (WHO) has openly and repeatedly described as “unsustainable”? What do the shocks of the spring foretell for China’s future? Has a moment arrived for the United States and the West to test whether a health security détente is feasible? If so, what specifically should be done?
This spring, Zero-Covid has come to be understood, in a remarkably short period, as doing excessive harm to China’s economy while threatening popular trust in the government. In practice, Zero-Covid does not offer a potentially acceptable trade-off, sacrificing the economy in order to protect the public’s health. Instead, it leaves China dangerously vulnerable to infection, especially among the elderly. An estimated 100 million Chinese above 60 have not received more than one dose. Distrust and vaccine hesitancy within this population remain high. While nearly 90 percent of China’s population has had two doses, booster rates remain stubbornly low. The Chinese vaccines offer significantly lower protection compared to Western mRNA and other vaccines, and the immunity they do confer wanes rapidly. Indeed, the WHO recommends that those who have received an inactivated vaccine, which is the most widespread in China, should receive a booster shot to protect against waning immunity.
Enforcement of Zero-Covid, in the absence of targeted and sufficient vaccination and boosting of the elderly and others, creates higher—not lower—danger for vulnerable populations. Having hundreds of thousands of health workers presently dedicated to testing, isolation, and quarantine leaves far fewer staff available to accelerate vaccinations. The refusal on nationalist grounds to move strategically on introducing Western mRNA vaccines and antivirals at scale (combined with China’s failure thus far to develop its own mRNA vaccines and effective antivirals) means that closing China’s immunity gap is being unnecessarily delayed.
Omicron Changes the Equation
Zero-Covid may slow the virus’s spread, but it no longer works effectively against the virus. Ultimately, the Omicron variant will continue to defy lockdowns, mass testing, isolation and quarantine, and closed borders, leaving much of China stuck in a cycle of outbreaks and lockdowns with no off-ramp.
China’s defense of Zero-Covid, laid out in a November 2021 study by the Chinese Center for Disease Control and Prevention, posits that ending Zero-Covid will inexorably invite mass extreme illness and deaths and cripple the health system. Yet this “science-based” rationale for Zero-Covid rests on worst-case scenarios that do not take into account new realities. Indeed, between April 1 and May 31, Shanghai registered a Covid death rate of 0.1 percent, the same level of the case fatality rate for seasonal influenza.
A doctrinaire Zero-Covid approach simply does not work in a world of swift, widespread, asymptomatic transmission where mild illness and low hospitalizations can be expected (if and when a large majority of Chinese are vaccinated and boosted). A more recent study conducted by leading Chinese public health experts found that only 22 of the nearly 34,000 Covid cases hospitalized in Shanghai during March 22 to May 3 (excluding severe cases in early stages) developed into severe cases. All of them were in patients who were over 60, were immunosuppressed, or had noncommunicable diseases. Overlooked is what is possible under an incremental mixed strategy, as evidenced by Japan, South Korea, Taiwan, New Zealand, and Australia. Although there have been differences among them over the last two-plus years, their common playbook of late includes: targeted vaccination and boosting of the elderly and others who are most vulnerable; gradual narrowing and loosening of the protocols for testing, isolation, and quarantine; strengthening the quality of primary care and increasing the reliance on home quarantine and recovery; introduction of antivirals; and transition of the national conversation from zero tolerance to a dialogue over how to achieve an orderly, managed approach to the risk of living with an evolving, endemic virus.
Costs Become Prohibitive
In the meantime, Zero-Covid has exacted high economic, social, and political costs in a remarkably short period.
Widespread popular resentment, most visibly in Shanghai, has worked its way into open public protests and recurrent social media outbursts over the rigidity and arbitrary nature of controls and the obstacles to obtaining sufficient food, necessities, and access to regular medical services. Online complaints far surpassed the expressions of sorrow for the death of Dr. Li Wenliang in January 2020; although street-level protests have been limited, social media has been a constant game of cat and mouse between those reacting to harsh, protracted quarantine and the censors charged with suppressing dissent. In addition, prominent economists, business leaders, public health experts, and political figures have all reportedly begun to register their misgivings, however discreetly, on the direction Zero-Covid is taking the country. Graduate students at the elite Peking University have come out in open opposition. In the view of some close observers, a historic turning point in state-society relations in China may be unfolding.
Zero-Covid has disrupted manufacturing, supply chains, and consumer spending. Economic growth has leveled out, edging China toward recession. There is little chance China will hit its original 5.5 percent growth target, and it is quite possible that the country will grow no more than 1 to 2 percent this year despite a massive fiscal and monetary stimulus. And the battle with Omicron is not yet over; indeed, the government itself sees the crisis stretching far into the distance. It recently announced the postponement of the Asian Games (to be held in Hangzhou) until June 2023. At an emergency meeting held by Premier Li Keqiang with 100,000 local officials across the country in the last week of May, he acknowledged the gravity of the economic setbacks, that they now reached virtually every corner of China, and that their impacts surpass what was experienced in 2020.
China’s Zero-Covid has extended its reach well beyond China itself. Zero-Covid is now routinely identified as one of the primary factors fueling worldwide inflation and heightening the risk of a global recession. In the meantime, foreign business confidence is plummeting. Many Western multinationals are reassessing their future in China; many have held off adding new capacity in China, while some have indeed begun to shift production elsewhere. U.S. ambassador to Beijing Nick Burns, in a recent virtual address to the Brookings Institution, made the point that Zero-Covid “had a major impact” on business sentiment. The hesitancy to expand investment will last until the end of Zero-Covid is in sight.
President Xi Jinping’s overriding objective appears to be ensuring a smooth pathway to the 20th Party Congress in the fall of 2022, when he will obtain a third five-year term. To give up Zero-Covid would be tantamount to admitting failure of his leadership. Nationalism plays an important role, which means Western solutions in the form of Western-owned mRNA vaccines and antivirals are out of bounds, at least until there has been more progress in the development of Chinese technologies. Tightened public health controls have the added attraction that they can harden the tools of suppression and facilitate state control.
President Xi appears to face no serious challenger. He appears to be insulated from dissent and to have pushed responsibility for the mistakes seen in Shanghai upon his subordinates. At his disposal are tools to sustain broad support and control—through pervasive propaganda, censorship, and surveillance.
Economists, public health experts, business leaders, discontented (and increasingly unemployed) youth, party officials, and former high-ranking party officers may be increasingly disaffected with Zero-Covid, but their voices remain muted and indirect. Loud, popular discontent emanates from Shanghai but not from other deeply impacted localities, such as Jilin and Dandong.
What Might the United States and Others in the West Do?
Though Secretary of State Antony Blinken primarily outlined a strategy centered around competition in his recent major speech on U.S. policy toward China, he also made a powerful case for engagement of China on urgent matters of global health security.
China is . . . integral to the global economy and to our ability to solve challenges from climate to COVID. . . . We stand ready to increase our direct communication with Beijing across a full range of issues. . . . on the COVID-19 pandemic, our fates are linked. And our hearts go out to the Chinese people as they deal with this latest wave. We’ve been through our own deeply painful ordeal with COVID. That’s why we’re so convinced that all countries need to work together to vaccinate the world – not in exchange for favors or political concessions, but for the simple reason that no country will be safe until all are safe. And all nations must transparently share data and samples—and provide access to experts—for new variants and emerging and re-emerging pathogens, to prevent the next pandemic even as we fight the current one (emphasis added).
Moving that agenda forward, of course, will not be easy. Relations between China and the West are at an historical nadir. Russia’s invasion of Ukraine has only compounded tensions. Trust is scarce.
Leaders in the United States and elsewhere in the West face serious domestic criticism if seen as “soft” on China and its continued stonewalling of the WHO-led investigation on the origins of Covid-19. Leaders also ask themselves reasonable questions: What might actually be accomplished if the Chinese leadership remains outright hostile to Western advice? And would China use any future dialogue for propaganda purposes? Chinese officials face their own potential penalties if they are seen as “soft” on the West.
These impediments notwithstanding, a path forward for the United States and its allies could be organized—and tested—around a few broad themes:
- Seek a détente that systematically builds a dialogue on those issues in which both sides still show a strong interest in cooperation and in which some concrete results might be delivered. It could focus on monitoring and preparing for shared global health security threats. That could begin with the broad imperative of vaccinating the world and better preparing for future pandemics. It might include, specifically, working together under the G20 to advance the launch of the Financial Intermediary Fund to support pandemic preparedness in low- and middle-income countries. It might also include continued efforts to quietly encourage coordinated action, with South Korea and UN bodies, to stem the threat of a runaway Covid-19 outbreak in North Korea.
- Seek a broad international dialogue on the risks of global economic recession and how solutions in managing Covid-19 can build greater global economic stability and lower the risks to the lives of millions.
- Specific to China’s Zero-Covid, register compassion for the potential human toll that Covid-19 might take on China if a reopening and easing of controls are not managed carefully enough. At the same time, offer to share mRNA vaccines and antivirals as well as data and best practices on emergency campaigns to introduce vaccines, therapeutics, and other measures.
- Encourage the private sector in the West to forge new mutually beneficial partnerships that expedite the mass production of mRNA vaccines and antivirals in China. Part of that could involve revisiting the BioNTech-Fosun Pharma production and distribution agreement with the Chinese government, which still awaits final approval. While China is not eligible to take advantage of the recent World Trade Organization agreement that removes intellectual property barriers for patents for Covid-19 vaccines for five years for low- and middle-income countries, the deal nonetheless is a diplomatic achievement that may open the way for broadened future negotiations.
- Encourage Western private sector, philanthropic, and religious groups to actively advocate for détente.
The world has entered a new phase in the Covid-19 pandemic, in which Omicron, its subvariants, and future still-unknown variants will continue to surprise the world. The virus will press all states to make the best use of the many tools now at their disposal while innovating and strengthening measures. The virus will test if in this new phase the United States, China, and other powers are able to transcend the disarray, fragmentation, and distrust that dominated the international response over the previous two-plus years. Will they show greater capacity and political will to prepare together for the future? Or will they continue to stand apart, disconnected, hostile, and full of distrust?
In this evolving moment, how China is to move effectively beyond Zero-Covid stands out conspicuously as a particularly urgent, complex puzzle that reaches well beyond China itself and begs for high-level diplomacy and far more thought and effort. The Zero-Covid challenge cannot be ignored, walled off, or left to another day—too much is at stake. Ultimately, the solution will rest on decisions made by President Xi and the Chinese government, and it is not possible to predict if change will follow soon after the 20th Party Congress or far later in 2023. In the interim, China and the West can adopt the mantle of détente and seek to bridge the chasm that divides them.
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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