Residents of Shanghai screaming at their window for food, children separated from their parents, foreigners fleeing the country… The harshness of confinement in the Chinese economic capital, now extended to around fifty other cities, has caused astonishment all over the world.
The difficulties of the Middle Kingdom have often been interpreted as the failure of the “zero covid” strategy, which had so far enabled it to fight very effectively against the circulation of the virus. Wrongly, according to Professor Antoine Flahault, epidemiologist and director of the Institute of Global Health at the University of Geneva (Switzerland): “In reality, China’s problem lies above all in its unsuitable vaccination strategy.”
The numbers speak for themselves. If 88% of the population is vaccinated, including 51% with three doses, the elderly are on the other hand very poorly protected: in mid-March, 33% of those over 60 had received only two doses of vaccine and 19% no injections. A proportion that rises to … 50% among those over 80, according to statistics from the British company Airfinity, which specializes in health data. “From this point of view, China is not in a much better situation than that of Hong Kong, where Omicron caused a massacre. The Chinese leaders saw there the premises of who awaits them if they do not quickly take very strict measures”, explains Professor Flahault.
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Even for an authoritarian regime, it is difficult to immunize by force
With the arrival of this particularly transmissible variant, it quickly became clear that the “zero covid” strategy, which is widespread in Asia and Oceania, would represent a disproportionate social and economic cost. Most of the States that had adopted it therefore gradually relaxed their control measures. This was particularly the case for New Zealand, South Korea and Australia. But these countries had vaccination coverage equivalent to that of Europeans, or even better, with very well protected elderly populations. If the number of cases increased rapidly, mortality did not follow.
Even if it begins timidly to relax certain restrictions, China obviously cannot expect such a favorable development in the event of the complete lifting of control measures. How could she have come to this? “There is this persistent rumor that vaccines have threatening adverse effects for fragile people. Many therefore refuse vaccination, especially since the belief in the virtues of traditional Chinese medicine is very strong in these slices of To this is added a distrust of state pharmaceutical companies”, summarizes Antoine Flahault. This reluctance is combined with the inappropriate organization of the vaccination campaign, which relies on hospitals, which are not necessarily accessible to people who are not very mobile. Finally, there is a great respect for the oldest, very rooted in Chinese culture: “Even in an authoritarian regime, no one is going to force them to be immunized”, specifies the scientist.
The quality of locally produced vaccines – often singled out – would not necessarily be the cause of the difficulties experienced by the country. In any case with regard to the Coronavac developed by Sinovac, one of the pillars of the Chinese vaccine strategy, for which data are available. A study carried out in Hong Kong, still in pre-publication (not peer-reviewed), has indeed compared the effectiveness of this vaccine to the messenger RNA vaccine developed by Pfizer and BioNtech.
Two doses of the Chinese product prove to be less protective than two doses of Pfizer, but once a third injection is administered, the two vaccines show equivalent – and very good – results against Omicron. With one nuance, however: the persistence over time of this protection, which the authors of the study were unable to assess. A question that is all the more crucial since inactivated vaccines such as Coronavac do not generate very good cellular immunity, precisely that involved in longer-term protection.
“The authorities are trying to buy time”
One thing is certain: given its vaccine strategy, China today has little choice but to put a large part of its population under glass. At the risk, otherwise, of experiencing a very large wave of deaths which could well destabilize the power in place. “The authorities are trying to buy time to vaccinate their elderly people as quickly as possible. But we can clearly see that it is ultimately much more difficult to fight against vaccine hesitation than to apply these very strict containment measures, despite their high social and economic cost”, observes Professor Flahault.
Getting out of this rut could therefore take time. “It will eventually happen sooner or later,” note two Chinese scientists, Ji-Ming Chen (Foshan University) and Yi-Qing Chen (Tsinghua University, Beijing), in a letter published by the journal Nature medicine. For them, this shift towards a policy of “living with the virus” should take shape in the course of the year 2022.
In addition to the race for vaccination, the two researchers propose a roadmap to put an end to this crisis in the best possible conditions: development of a range of remote health services, increase in stocks of protective equipment and in particular FFP2 masks, artificial respirators for resuscitation and antiviral pills which have proven their effectiveness against severe forms.
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For these experts, the country should also take advantage of the hot season, which is less favorable to the virus. A bet which however seems risky to Professor Flahault: “In the southern hemisphere, New Zealand experienced a major wave during the summer period”, he warns. Other experts are also advocating for China to turn to messenger RNA vaccines, as their protection appears to be more durable. The country had also made an agreement with BioNtech from the start of the epidemic, in case the “national” vaccines had failed. But the government having flooded a large part of the planet with its products, it can hardly turn to American injections today without losing face. The weeks and months to come will be difficult for the Chinese authorities.
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