Can China still avoid a massacre due to Covid-19? The country must reopen its borders completely this Sunday, January 8 after more than two years under strict confinement, and thus put an end to the zero Covid strategy, its epidemiological compass since the start of the pandemic. This deadline, on which the government does not seem to go back while the country is facing an unprecedented number of contaminations, is above all an internal challenge.
Since December 7, China has abandoned all restrictions in the face of the virus. An incomprehensible choice for many when its population is still very fragile today in the face of the virus. “With the arrival of highly contagious variants, the pretension of remaining in the zero Covid strategy was shattered, but what is amazing is that there was no anticipation of the reopening”, is still surprised Antoine Flahault, epidemiologist and director of the Geneva Institute of Global Health.
A good part of the citizens have received two doses of inactivated virus vaccines developed by Chinese laboratories, but many still lack a booster, yet essential to avoid hospitalizations and deaths. At the end of November, only 40% of people over 80 had received this third injection according to official figures, which must be put into perspective. Several factors may explain this low vaccination coverage. Initially, the zero Covid strategy itself, which favored the use of tests and isolation, to the detriment of injections. But China also faces cultural opposition from the elderly to the vaccine. “This is a problem that we find in Asia, but which is even clearer in China, with a cultural reluctance even within families to impose the vaccine on their elders”, notes François Godement, historian and sinologist and adviser for Asia from the Institut Montaigne.
Up to 2 million deaths according to the models
Added to this is a campaign of denigration of vaccines and the strategy led by Western countries, which has slowed down the development of an effective vaccine policy. Even today, the authorities seem to lack the will to resort to massive injections. Especially since Chinese products, long presented as ineffective, have ultimately shown themselves to be up to the task in the prevention of serious cases and mortality, provided however that the booster injection is respected. “The problem of vaccination in China is not that of the effectiveness of the products”, abounds Antoine Flahault.
For several weeks, the consequences of this epidemic have been visible in the country. Personalities, politicians, and even scientists are dying, without the virus being officially the cause. Since December, China has only announced about twenty deaths, and only people with pneumonia are counted. “The data only imperfectly inform us about the extent of the epidemic”, confirms the infectious disease specialist at Saint-Louis Hospital and member of the Academy of Medicine, Anne-Claude Crémieux. “The choice to count only people with pneumonia is extremely restrictive, and it must be added that it is a disease that we cannot find if we do not look for it on a scanner…” So many uncertainties prohibit any calculation giving some idea of the scale of the epidemic in such a vast country.
Several modeling studies of the evolution of cases, based in particular on the trajectory of the epidemic in Hong Kong, painted in mid-December a gloomy picture of the months to come. According to experts from the British center Airfinity, the death toll in China could stand at 9,000 a day today, and reach 1.7 million by the end of April 2023. This summer, a study carried out by researchers from the University of Fundan in Shanghai, estimated that even 90% vaccinated with the booster, the epidemic could cause 1.55 million deaths in the coming months, including a very large majority of unvaccinated people.
A form of “fatalism”
These alarming signals should not, however, divert the government from relaunching the vaccination campaign. “The first solution is a reminder, and this regardless of the vaccine, which would allow people at risk to avoid hospitalization or death as a priority”, assures Anne-Claude Crémieux. For the moment, very few elements make it possible to measure the scale of the vaccination campaign. Is it really carried out with a bang as announced by the authorities? “There is an additional difficulty in accessing the figures, with authorities who are now overwhelmed by new cases”, explains Antoine Flahault. “The proportion of vaccinated people over 80 would have increased by almost 20 points. It is possible, but it is also very possible that these figures are false…”, warns the epidemiologist.
If the Chinese strategy still leaves a good number of observers speechless, some note that by not taking new restrictive measures, China has also chosen a form of normalization of the virus… Even if it means accepting a certain number of death. “The authorities are counting in part on the reduction in the severity of the variants, and have chosen to pass the obstacle with a certain fatalism”, comments François Godement. A perilous strategy as the descendants of Omicron continue to cause massive deaths in people not protected by vaccination.
An unequal healthcare system
In recent weeks the United States, like the European Union, has offered to provide the country with doses of messenger RNA vaccines. A very political outstretched hand, which has not yet found an answer from China. Asked by the Reuters news agency, Chinese Foreign Ministry spokesman Mao Ning said only that China’s vaccination rate and treatment capacity continue to increase and that its supplies were “adequate”, without officially sweeping the proposal.
“We know that the choice not to use messenger RNA vaccines developed by Pfizer in China for its vaccination campaign is clearly political”, underlines François Godement. Chinese communication on these Western vaccines having been unfavorable since their use, and the country had all the financial capacity to buy a sufficient number of doses for its population. The sinologist thus considers the use of American vaccines from Pfizer and Moderna unlikely, considering this as a “turnaround which would have more important political implications”.
Without sufficient vaccine protection, China will have to rely on its health system and its hospitals. Another black spot while the supply of care is still very unequal in the country, with well-equipped urban centers but very shortfalls in more rural areas. At the beginning of December, Jiao Yahui, director of the medical affairs department of the national health commission, declared that China had one resuscitation bed for every 10,000 inhabitants, a figure sometimes three times less than in certain European countries. “China has some well-developed hospital infrastructures, but still lags behind in terms of health, there are not enough beds to take care of patients and this remains the main problem”, judge Antoine Flahault. Even if the Chinese authorities now believe that the peak of infections has passed in several large cities, such as Beijing and Tianjin, scientists remain worried, the New Year celebrations and its traditional displacements of populations between provinces raise fears of a new fatal mixing.