China’s zero-covid policy won’t work forever. But there’s no easy way out of it.

China’s frequent, large-scale lockdowns have halted outbreaks and saved lives — but they’ve also prevented widescale infections that would help build immunity in China’s population. Compounding the problem, Xi has relied on mediocre homegrown covid vaccines. And the virus has grown more infectious over time, raising doubts about how long the current approach will hold.

“China’s ‘Dynamic Zero-Covid’ strategy is unsustainable and will almost certainly fail over time,” said Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University. “SARS-CoV-2 is too infectious to be contained, especially with a population that has very little natural or vaccine-induced immunity. If China abruptly ends its zero-covid strategy, it would see an explosion of hospitalizations and deaths.”

But whatever loosening is coming may be too little, too late to hold off either more protests or the eventual overtaking of the pandemic throughout China, fear public health experts, with implications both for the Chinese economy and geopolitics.

“China is, frankly, between a rock and a hard place,” said Victoria Fan, a senior fellow in global health at the Center for Global Development. The country “is in a situation not too different from 2020. It’s almost like a pre-vaccine moment for China,” she said. Former zero-covid nations like Taiwan, Singapore and New Zealand have confronted difficult questions about how, whether and when to relax restrictions in the past year and a half, managing the transition with timely responses to outbreaks, backed up by hospital capacity lacking in China. “It’s hard to imagine they will vaccinate their way out now,” she added.

The risky option

All the same, it’s a mistake to think of China’s only choices as keeping zero-covid or a full-scale opening, said Fan. “It’s not an either-or — there are a lot of loosening measures they could pursue instead.” Strong masking policies, contact tracing, social distancing and border restrictions, and business closures, for example, are already the rule of the day in China and are not the subject of contention like lockdowns. “They need to get their elderly vaccinated first, though, before they do anything else,” she said.

Off-ramp

Regardless, mRNA vaccines look like the best options for shots that can most quickly change to address new covid variants in the future. “There is only one effective off-ramp for President Xi, which is to import more effective Western mRNA vaccines and to vastly increase vaccine uptake among its most vulnerable population, such as the elderly,” said Gostin. “The problem is that President Xi needs a face-saving way to end its zero-covid strategy. The current protests in China show that the population is deeply unhappy with the policy. It needs to change but change in a way that does not see massive loss of life.”

Protests and politics

The protests and zero-covid’s association with Xi led to a politicization of the strategy that necessitates that face-saving. Rather than becoming solely a medical question, the protests have elevated zero-covid’s continuation to a question of the strength and legitimacy of the national government, said Kirby.

And despite the demonstrations, not everyone in China wants to end zero-covid restrictions, said Carl Mitcham, a science and technology policy scholar at the Colorado School of Mines and Renmin University of China. From conversations with Chinese colleague, his sense is that some want more time to come to a consensus on ending the policy and that for others the protests are seen as more isolated to cities such as Beijing or Shanghai, rather than reflecting sentiment everywhere.

A cultural reluctance to force shots on the elderly may also have played a role in China not getting boosters out more widely to the aged, said Kirby: “It is a good value, to respect the elderly, but it is a problem now, and it is hard to understand how a government which can force severe conditions on the population, just consider the history of China, hasn’t acted more strongly until now.”

“The virus escaped from Wuhan [in 2020] because of the political system, which refused to acknowledge its existence until it was too late,” he added. Next, the zero-covid policy was erected, which undoubtedly saved hundreds of thousands of lives. “But it didn’t prepare them for a post-covid zero world. At the end of the day, that has to be a political decision, not a medical or scientific one.”