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Protests raise questions about why China is still relying on COVID restrictions


These recent protests in China have cast a spotlight on its tough zero COVID policy, a policy that is clearly unpopular with a lot of people in China. Right now, the country is going through its biggest COVID surge yet, around 39,000 cases daily. In response, the government has yet again ramped up strict monitoring and surveillance, mass testing, quarantines, large-scale lockdowns. Three years into the pandemic, one question is, why is China still relying on all these restrictions when the rest of the world has mostly moved on?

Well, to help us explore this, I want to bring in colleagues from NPR's Science and International Desks. We're joined by China affairs correspondent John Ruwitch and science correspondent Michaeleen Doucleff. Hey to both of you.


JOHN RUWITCH, BYLINE: Good afternoon.

KELLY: Michaeleen, you start. And just help me understand why cases might be exploding in China, because China has COVID vaccines. It has more than one. They were actually among the first to be developed back in 2021, right?

DOUCLEFF: That's right. The Chinese government has approved eight vaccines for use there, including one vaccine that's inhaled through the mouth, so it doesn't require an injection. But really, there are two main shots used in China, Coronavac and Sinopharm. These are not mRNA vaccines like Pfizer and Moderna have made. These vaccines use an older but well-proven technology. They're made with a killed form of the SARS-CoV-2 virus. And both of these vaccines have been approved by the World Health Organization, and both have been used all over the world.

KELLY: And do they work? Compared to the mRNA vaccines, Moderna and Pfizer that we're using here, are they effective?

DOUCLEFF: Yeah. So these Chinese vaccines don't offer much protection against a COVID infection. So with them, you'll still see a lot of mild or asymptomatic cases of COVID. They are definitely worse than the mRNA vaccines on that front. But, you know, the mRNA vaccines also don't protect against infection over time either. On the other hand, the Chinese vaccines do a good job of protecting against death and hospitalization, even an excellent job if you receive three doses of them. One study from Hong Kong published back in March found that three doses of a Chinese vaccine offered the same protection against severe disease as three doses of the Pfizer mRNA vaccine, particularly in older people. But right now in China, only about 56% of the population has received three doses, and only about two-thirds of people over age 80 have received three doses. So that leaves at least 12 million people in China at high risk for hospitalization and death if they become infected.

KELLY: Well, that's interesting. John, as our resident China watcher, jump in here. Why is uptake not higher?

RUWITCH: Yeah. Well, there's a few things going on here. For one, vaccine uptake by adults in China even before the pandemic was quite low. There's also the issue of vaccine hesitancy, like in the U.S. and elsewhere. There's just a swath of the population that's hesitant about vaccines. And there's a sort of Chinese version of this which relates to made-in-China vaccines. There's been a string of product quality scandals over the years, some involving tainted vaccines. People are wary. I have friends in China who, for instance, refuse to get their kids made-in-China vaccine shots. They just don't trust them.

Another thing that relates to the elderly is that in China, you know, vaccines are often administered by doctors who aren't familiar with or may not have access to a patient's health records. And a suspicion among some experts is that that has given doctors less of an incentive, made doctors more wary about taking the risk of giving shots to elderly patients. And also, frankly, there just hasn't been a whole lot of COVID going around in a population that's as large as China's. Right? They've contained it fairly well with zero COVID policy, of course, at a cost, as we're seeing. So there are people who simply don't feel any sense of urgency or need to get a shot.

KELLY: But the thing I'm still trying to get my head around is China is an authoritarian country. They can force people into lockdown. They can snuff out protests when they want. Why can't they force people to get the shots?

RUWITCH: The state has the capacity to run a vaccination campaign. And after these protests, we may very well see it happen. The National Health Commission just yesterday ordered the further acceleration of vaccinations of the elderly. You know, they've had vaccination campaigns in the past, though, and they've fizzled. Some people speculate the authorities might have concerns about pushback from the populace or they're getting pressure from companies that are making money off of all the mass testing that's happening in China. Many believe, though, that it has more to do with politics in China. I talked to Roy Truex about this. He's an expert on Chinese politics at Princeton University.

ROY TRUEX: So Xi Jinping famously declared a people's war on COVID. And the narrative for many months was that China was outperforming the West in this war, and that became a source of regime legitimacy. And I think that led to perhaps a degree of arrogance and overconfidence about what they could accomplish with respect to COVID and difficulties in changing course.

RUWITCH: Yeah. So critics say the messaging led to complacency, and it wasted critical time - right? - and political capital when they could have been, you know, vaccinating the population, preparing for the eventual reopening of China.

KELLY: Michaeleen, let me get the science layered back in here with the politics, because I want - I'm interested in the vaccines and the development by China of an mRNA vaccine like we have in the West. They're making a push to do that. Would that help them fight this surge?

DOUCLEFF: Yeah. So, you know, China is working on its own mRNA vaccine. There's at least six versions in the pipeline. And there is this sense that if China can get an mRNA vaccine, it would help them handle a big omicron surge better. You know, as they loosen up restrictions, you know, an mRNA vaccine would better protect the hospitals from getting overwhelmed. But really, the vaccines they have now should be able to do this too if - and this is key - people at high risk like the elderly receive the vaccines and really receive three doses of them.

KELLY: The three doses. OK. John, I'm going to give you the last word. And I want you to speak to what feels like you're telling me is a fundamental tension here. China's leaders seem to be feeling the pressure from these mass protests. A handful of Chinese cities are trying to ease restrictions, but that also must feel like a risky proposition in a country that's seeing - what was it? - 39,000 new cases a day.

RUWITCH: Yes. The coming months will be challenging for them. I mean, zero COVID is unpopular. The protests have shown that it's a political liability to a certain extent. But if they drop the policy quickly, they have medical and political risks as well. I mean, cases will soar. It's just simple math. When omicron hit Hong Kong in the spring, vaccination rates were roughly similar, maybe a little lower than in China now. More than 6,000 people died within just a few months. Most of them were elderly. China's population is almost 200 times the size of Hong Kong. So you're talking about potentially over a million deaths. And remember, Hong Kong's hospital system is superior to that on the mainland, and it has twice as many critical care beds per capita as China does. The United States, by comparison, has four times as many per capita.

KELLY: That is NPR China affairs correspondent John Ruwitch and science correspondent Michaeleen Doucleff. Thanks to you both.

DOUCLEFF: You're welcome.

RUWITCH: You bet. Transcript provided by NPR, Copyright NPR.

Michaeleen Doucleff, PhD, is a correspondent for NPR's Science Desk. For nearly a decade, she has been reporting for the radio and the web for NPR's global health outlet, Goats and Soda. Doucleff focuses on disease outbreaks, cross-cultural parenting, and women and children's health.
John Ruwitch is a correspondent with NPR's international desk. He covers Chinese affairs.