“How lucky I was born in China,” a young Chinese scholar declared last month in his WeChat. He was proud: Following the worst domestic Covid-19 outbreak since Wuhan, China had brought daily new case counts down to a few dozen.
The case numbers — when contrasted with the United States, which has less than a quarter of China’s population yet daily average cases above 130,000 — might not seem too concerning on their own. But they illustrate that China’s zero-infections policy is no longer working as designed. At the outset of the pandemic, the policy successfully drove down cases — and was adopted by other countries — but the Delta variant changed the game and shows that this strategy no longer fits. It’s time for China to change tack, as the socioeconomic and public health costs now outweigh the benefits with this highly transmissible new variant. If it doesn’t, China and its people will suffer.
While other countries were still in the grips of the pandemic, China by early April 2020 had managed to get the virus under control within its territory. It implemented a zero-infections policy, under which the identification of even one local Covid case would trigger draconian measures in order to reset local cases to zero. To fend off imported cases, China imposed some of the world’s toughest international travel restrictions.
China is not the only country to pursue a zero-tolerance approach toward Covid-19. Other countries that did, like New Zealand, are also now seeing less success. But few would dispute that China’s authoritarian government, with unrivaled power and resources, is in a much better position than almost any other nation to quickly eliminate new cases and make the strategy work. So the fact that the policy isn’t working as intended is bad news for China and any other country aiming to fully stamp out the virus in the same manner.
For more than a year, the policy showed good results. Small and sporadic outbreaks were usually quelled before cases could spread to other regions. Local officials relied on the extreme-measures songbook: They launched mass testing for Covid-19, used QR codes to trace and control people’s movements and rounded up entire neighborhoods for mandatory quarantine.
Then came the Delta variant. An outbreak that started in Nanjing, in China’s eastern Jiangsu Province, on July 20 quickly spread to at least 17 provinces, causing the worst outbreak since Wuhan. Now more than a month has elapsed since the first Nanjing cases were identified — and the Chinese government still has been unable to completely break the domestic transmission chain. As of Sunday, there were still three intermediate-risk Covid areas nationwide, according to the government’s classification system. In Yangzhou, which became the new outbreak epicenter in Jiangsu Province, residents were prevented from leaving their homes for a month and underwent at least 12 mandatory rounds of nucleic acid testing.
The failure of such high-profile and high-powered measures to bring a speedy end to this outbreak highlights the diminishing returns of the zero-tolerance approach.
There also are signs that approach is becoming counterproductive: Some 10 percent of the cases in Yangzhou were traced to a site for Covid testing.
There are worrying long-term secondary effects, as well. Increased absenteeism, drops in employee productivity and disruption to supply chains threaten overall economic growth in China. Newly released data from the National Bureau of Statistics suggest that strict lockdown measures during the recent Delta variant outbreak have contributed to a slowdown in the Chinese economy, sending nonmanufacturing activity into contractionary territory for the first time since February 2020.
Some Chinese health experts have begun to question the zero-tolerance strategy, though the government has not looked kindly upon it. A teacher in Jiangxi Province was detained for 15 days in August for suggesting that Yangzhou experiment with a different approach to epidemic control. Dr. Zhang Wenhong — dubbed China’s own Dr. Anthony S. Fauci — said China should learn to coexist with the virus, though later backtracked.
One rationale for sustaining the existing approach has been to buy time for China to reach herd immunity through vaccination. Delta makes this argument irrelevant. Zhong Nanshan, a top public health adviser, said China can achieve herd immunity with around an 80 percent vaccination rate. But he appears to have used an unrealistically high efficacy rate for Chinese vaccines. Based on my calculations, reaching herd immunity is not possible with the existing vaccine regimen in China. It’s likely there will continue to be some cases, though vaccination can still prevent the most severe impacts of the disease. It’s no wonder, then, that a senior official with China’s C.D.C. admitted that the country could continue to experience outbreaks even after reaching 80 percent vaccination.
But sticking with the current approach would transform China into a hermit nation that could be dangerous. If there are low levels of natural immunity and vaccines are less effective at protecting against new variants of the virus, then reaching zero infections will not be possible as the country opens up.
China can’t afford to keep its borders closed forever. And the pandemic is not over. Given the still-low and unequal coverage of Covid vaccines worldwide and the rampant spread of the Delta variant, this pandemic may last another two years or more.
Other governments already have shifted to policies aimed at “living with,” not eradicating, Covid-19. Singapore turned to a strategy of phased and contingent reopening backed by mass vaccination. Even Australia, arguably the most zealous liberal democracy in pursuing a zero-tolerance strategy, now has proposed a road map to reopen. China would be wise to take heed and pivot. A strategy focused on preventing severe cases and deaths and administering vaccines with high efficacy would be in China’s best interest, both in the short and long term.