With record covid cases, China scrambles to plug an immunity gap

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The coronavirus outbreak, which is on the brink of China’s biggest pandemic yet, has revealed a major flaw in Beijing’s “Zero Covid” strategy: a vast population with no natural immunity. After months of occasional hotspots in the country, most of its 1.4 billion people have never been exposed to the virus.

Chinese authorities, which reported a record 31,656 infections on Thursday, are scrambling to protect the most vulnerable population. They have launched a more aggressive vaccine to boost immunity, expand hospital capacity and limit the movement of at-risk groups. The elderly, who have low vaccination rates, are a key target.

These efforts, which stop short of approving foreign vaccines, are an effort to avoid overwhelming a health care system that is ill-prepared for the flood of very sick Covid patients.

More intensive care beds and better vaccination coverage “should have started 2 1/2 years ago, but the single-minded focus on containment meant fewer resources were focused on that,” said Yanzhong Huang, senior global health expert at the Council on Foreign Relations.

Huang believes that even mRNA enhancers, which have been more effective in fighting disease than the latest omicron strains, now do not solve the fundamental problem with China’s goal of eliminating infection rather than reducing symptoms. Increasing immunity by allowing some degree of community transmission is “not yet acceptable in China,” he said.

China’s strategy to suppress the outbreak initially protected daily life and the economy while preventing severe disease and death. But since stricter measures are not compatible with the more transmissible varieties, this has become increasingly costly.

Earlier this month, the government announced what appeared on paper to be the most significant easing of controls yet, with shorter quarantine times and Fewer testing requirements Officials insist the 20-point “optimization” plan is not a prelude to accepting the outbreak.

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But efforts to break destructive quarantine cycles have had a rocky start. Some cities relaxed measures, while districts in others ordered residents to stay indoors. Result: confusion, fear and anger.

Clashes have broken out in several locations, most prominently at Foxconn’s massive factory in central China, which makes half the world’s iPhones. The scene there turned violent this week as thousands of workers protested the company’s failure to isolate those who tested positive and honor the terms of employment contracts.

Containment of the outbreak is again a priority. Shijiazhuang, a city of 11 million about 185 miles from the capital, on Monday suspended its relaxed requirements for mass testing and announced five days of citywide screening.

The first deaths reported since May – albeit only one or two a day – have fueled concerns that hospitals are ill-prepared to deal with a sharp increase in cases. Bloomberg Data estimated that full control of the coronavirus could leave 5.8 million Chinese in need of intensive care in a system with just four beds per 100,000 people.

At a news conference Wednesday, Chinese health officials said more than 100 critical cases meant more hospital beds and treatment facilities were “absolutely necessary” given the health risks for the elderly and people with pre-existing conditions. They added that the spread of infection is increasing in several places, with some provinces facing their worst outbreaks in three years.

Major cities including Beijing, Guangzhou and Chongqing have ordered residents in certain neighborhoods to stay at home. Shopping malls, museums and schools are closed again. Large conference centers are being turned into temporary quarantine centers, mirroring the approach taken in Wuhan at the start of the pandemic. Some of the strictest restrictions are for nursing homes, with 571 such facilities in Beijing implementing the strictest control measures, barring all but essential entry and exit.

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Officials worry that opening up to a world already living mostly with the virus will trigger a wave of deaths. China’s vaccines were initially limited to adults aged 19 to 60, a policy that continues to affect vaccination rates. Only 40 percent of Chinese over 80 have received a booster shot, despite months of campaigning and giveaways to encourage uptake. (Among those older than 60, two-thirds received a booster.)

Since the beginning of the pandemic, China has relied solely on domestic vaccine manufacturers. It approved nine locally developed options, more than any other country, with the first and most widely used vaccines from state-owned Sinopharm and privately owned Sinovac. Both received World Health Organization approval early last year after they were found to significantly reduce deaths and hospital admissions.

Sinopharm and Sinovac distributed their products widely around the world as part of the Chinese effort to become the leading global public goods provider and improve China’s image. However, in late 2021, demand for Chinese vaccines began to decline as Pfizer and Moderna ramped up production and distribution.

China has yet to approve any foreign vaccines or explain its decision to avoid what could be an effective way to close its own immunity gap. German Chancellor Olaf Schulz’s visit to Beijing in early November ended with an agreement for the Pfizer-BioNTech vaccine to be made available to foreigners living in China through the company’s Chinese partner, Shanghai Fosun Pharmaceutical.

BioNTech has a development and distribution agreement with Fosun that gives the Chinese company exclusive rights to supply the country. But Chinese regulators have repeatedly delayed signing off on the vaccine, despite it being available in Hong Kong, Macau and Taiwan.

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When asked last week whether the government would approve BioNTech for public use, the director of China’s Centers for Disease Control and Prevention said officials were working on a new vaccination plan that would be released soon.

Without access to the most effective mRNA-based candidates from Pfizer-BioNTech and Moderna that have been updated to fight the omicron strain, the world’s most populous country remains dependent on vaccines made using the original strain of the virus.

Some health experts find Beijing’s lack of justification difficult. Jin Dongyan, a virologist at the University of Hong Kong, said China should approve the BioNTech and Moderna vaccines for the Chinese public as soon as possible. It is ridiculous that they only allow foreigners in China to receive the BioNTech vaccine. It’s as if they think Chinese are inferior to foreigners.”

China is instead trying to develop its own 10 mRNA candidates. the furthest from Abogen Biosciences Biotechnology Group and the State Academy of Military Medical Sciences. Indonesia approved it for emergency use in September, but has not received approval from Chinese regulators and may not until data from phase 3 clinical trials in Indonesia and Mexico are available. These trials are expected to end in May.

Other options in China include an inhalable vaccine developed by CanSino, which has been available since October in Beijing, Shanghai and Hangzhou. A Chinese-made antiviral drug called Azvudine, originally used for HIV patients, was approved in July to treat Covid. Traditional Chinese medicine is widely used.

But new and more effective vaccines are still a priority and the country’s leading pharmaceutical companies are ready to mass produce them. CanSino is completing a manufacturing facility in Shanghai capable of producing 100 million doses per year – subject to approval.

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