Should China continue on its “zero-Covid” route, or shift to “living with the virus”? This question has been much debated recently.
On 5 August, the China Health Economics Association posted on its website an article attributed to former health minister Gao Qiang, titled “Will living with the virus work?” (“与病毒共存”可行吗？). It emphasised that we cannot live with the virus, but have to fight to eliminate it. Without naming names, the article is seen as criticising the view for “living with the virus” as put forward on Weibo by Zhang Wenhong, head of the Center for Infectious Disease at Huashan Hospital under Fudan University.
While each government sets their own long-term pandemic strategies in line with what is appropriate for its country, pandemic control measures involve the opening of borders and the flow of goods and people, and the choice of each country would eventually affect others. This applies especially to countries with greater international influence, and hence there has been much attention on the pandemic policies of big countries.
Living with the virus
On 29 July, Zhang published a Weibo post titled “Nanjing outbreak a pressure test for China; provides food for thought for future pandemic control” (南京疫情促使全国经受压力测试，为未来疫情防控提供更多思考). It noted that most virologists around the world now agree that the virus is endemic and the world needs to learn to live with it, and the outbreak in Nanjing is another example of how the virus is always there.
He also said that China will definitely choose a strategy that would ensure a “community with a shared future for mankind” and connectivity with the world for a return to normalcy, while making sure that the Chinese people will have no need to fear the virus.
Zhang also mentioned that vaccination is a prerequisite for living with the virus. He cited the examples of the UK and Israel, where vaccination rates are nearly 70% — while there has been a clear uptick in the number of infections after their recent opening up, it has not led to a strain on healthcare resources; and death rates have gone down from a high of 18% last year to the current 0.1%, which is close to the death rate of the common flu.
He [Gao] countered Zhang by saying that even with a death rate of 0.1%, that would mean 10,000 deaths in 10 million cases, 100,000 deaths in 100 million cases, and 1 million deaths in 1 billion cases.
Zero-Covid
However, Gao’s article on the China Health Economics Association website questioned Zhang’s views. It was also shared on the People’s Daily healthcare page on 7 August.
Gao hit out at the UK, US and other countries for shifting the blame for their governments’ incompetence in pandemic control to virus variants, stressing that China has to stick to strict controls and drop the idea of living with the virus.
Gao said pointedly: “It is surprising that some of our experts are also talking about the shocking power of the Delta variant, and suggesting that China considers living with the virus.” He countered Zhang by saying that even with a death rate of 0.1%, that would mean 10,000 deaths in 10 million cases, 100,000 deaths in 100 million cases, and 1 million deaths in 1 billion cases.
Gao said whether China can resume normal interaction with the world does not depend on domestic control of the virus, but the international situation. Given the strong global rebound, China has to hold firm to pandemic measures such as quarantines and strict checks on border entries. “This is not cutting ourselves off from the world, but a highly responsible move for the people’s health and the safety of the country.”
Living with the virus would shake the country
Opinions are divided among China’s internet community. Netizens supporting the zero-Covid strategy say: “If China had followed Europe and the US, how many out of 1.4 billion people would have died? As for socioeconomic factors, if we have not controlled the spread of the virus, our economy will be destroyed! Can we still say no to the US?”
This group also feels that the strategy of living with the virus would shake China’s very foundations. They ask: Our system has been constantly improving. Why not lead a glorious revolution of fighting the virus?
Those who feel otherwise argue that living with the virus does not mean surrendering to it, and while Europe and the US have opened up, they have not abandoned vaccination. They ask: “How long can lockdowns last?” These netizens also advocate listening to the doctors, as they note that Gao is an economist and most of his other articles are about politics.
According to open sources, Gao graduated from the School of Economics at the Renmin University of China. He had taken on various economic roles in the local and central government. In July 2001, Gao became the assistant secretary to the State Council of the People's Republic of China and the director of an office in charge of technology and education. In 2003, when SARS broke out, then Vice Premier Wu Yi simultaneously took on the role of health minister, and Gao became the party secretary for the Ministry of Health, as well as the deputy minister of its standing committee. In April 2005, Gao became health minister after Wu Yi stepped down. Gao is currently the chief consultant for the China Health Economics Association.
Tussle of systems between China and the US/UK?
Gao wrote at some length criticising the political lapses leading to errors in pandemic policy in the UK, US, and other countries, remarking that it was the “inevitable consequence of individualism”.
From another perspective, Gao’s article is highlighting the institutional superiority of China’s anti-epidemic strategy, elevating the debate between “zero-Covid” and “living with the virus” to the level of a tussle between political systems. On 9 August, the Global Times ran an article by Zhang Yiwu of the Chinese Department at Peking University (PKU) titled “Do not fall for the schemes of the West; continue the overall fight against the pandemic” (继续全面防控，不要中了西方的连环计), which strengthened this impression.
Zhang Yiwu said Western media like the BBC, as well as some Western experts, have recently made policy suggestions to China, as they feel that China’s zero-tolerance policy towards the virus is not sustainable and it should relax its measures and learn to live with the virus. That way, “the US and the UK would become China’s new model for fighting the pandemic”.
The article also said these countries have not gotten any socioeconomic benefits from living with the virus, yet they feel that their efforts are more advanced and effective than China’s. Zhang said China has done far better in controlling the virus than the UK, US, and other countries, while its socioeconomic development during the pandemic has also fared far better amid strict controls.
The article also stated that such a proposal to live with the virus is akin to China’s traditional “interlocked stratagem (连环计)” where one does not engage in a direct confrontation when the opponent already has an obvious advantage but instead prompts them to make mistakes and self-destruct. The article claimed that Western media were anxious when China’s Covid-19 cases were once down to zero, and when society is back to normal and the economy and other sectors are quickly recovering. Thus, they offered the stratagem of living with the virus in hopes that “the Delta variant could continue to wreak havoc here”.
Global Times editor-in-chief Hu Xijin also said on 9 August that China is “unlikely to abandon its dynamic approach of vigorously clearing new Covid-19 cases” in the short term and “embrace the loose approach used in the West” to achieve herd immunity.
He listed three reasons for this: one, achieving herd immunity has not been proven a “positive experience” and the World Health Organization has not approved such an approach; two, China’s way has helped achieve excellent economic performance but that of the US and Europe not only caused more loss of life, but also demonstrated a lack of economic competitiveness; and three, “the West's barbaric route of disregarding human lives will eventually compete with China’s dynamic approach of clearing Covid-19 cases, and economic growth will be the peak of the competition between the two routes” in the long term.
Hu also asserted, “I don't feel that this is really a serious divergence with the anti-epidemic approach in Chinese society.”
Approach of China and the UK at two extremes
Putting aside political factors, both approaches each have their own pros and cons. In a China News Weekly article, professor Jin Dong-Yan of the Department of Biochemistry at the University of Hong Kong’s Li Ka Shing Faculty of Medicine said that all countries should just manage their own affairs according to their characteristics.
The UK is making bolder moves in lifting lockdown measures. In the second week of July, it confirmed that the plan to lift lockdown rules including mask mandates will go ahead on 19 July despite the fact that there are still 289 infections per 10,000 people in the country.
The world is watching to see if the UK will succeed in its management of the Covid-19 pandemic. Lu Mengji, a German-Chinese virologist and professor at the Institute of Virology of the University Hospital of Essen, said in a China News Weekly article that lockdown measures can be lifted as long as the medical system can provide adequate treatment to patients. He explained that the present number of daily new confirmed cases in the UK stands at around 50,000 and the number of critically ill patients is at a low level of roughly 500. If the latter number does not increase significantly, the pressure on the medical system would not be too great.
A BBC report pointed out that China and the UK are at two extremes when it comes to containing the pandemic. The US, on the other hand, swayed a little in its anti-epidemic policy, having eased restrictions earlier on before tightening them again due to the fast-spreading mutant strain.
Based on a New York Times article, the situation within the US is very varied as well. While California and New York report high vaccination rates, unvaccinated people are still required to wear masks indoors. On the other hand, while Alabama and Idaho see lower vaccination rates, they do not have mask mandates. Some schools and university programs require students to be vaccinated, but most states have banned public institutions from implementing such measures.
In response to the transmission of the Delta variant, the US’s Centers for Disease Control and Prevention adjusted its guidelines on 27 July, recommending that fully vaccinated people should still wear masks indoors in places with high Covid-19 transmission rates.
Various signs point to the fact that the approach of living with the virus will not become China’s mainstream anti-epidemic policy in the short term.
The dilemma between life and livelihood
Deciding on an anti-epidemic strategy also involves the dilemma between life and livelihood.
Huang Yanzhong, senior fellow for global health at the Council on Foreign Relations and professor and director of global health studies at Seton Hall University’s School of Diplomacy and International Relations, pointed out that a good public health policy is in finding a dynamic balance between upholding public health and maintaining social and economic order.
The Economist Intelligence Unit (EIU) also said that the zero-Covid strategy is “not economically sustainable” and economies that rely heavily on international trade, commerce, and tourism such as Hong Kong and Singapore will feel the most pressure. It added that China is not as pressured by this strategy and may hence maintain it for the longest period of time because the Chinese economy has greater self-sufficiency and is most cautious about when border restrictions can be lifted.
Officials punished as country strives for zero infections
Various signs point to the fact that the approach of living with the virus will not become China’s mainstream anti-epidemic policy in the short term.
Two of the clearest observations are: one, the outside world considers Gao’s article as the Chinese government’s informal response to the opinion of living with the virus; and two, this resurgence of Covid-19 cases that began in Nanjing has implicated many regions and over forty people have been held accountable for their lax response in dealing with the flare-up. Eighteen officials and public post holders from Zhangjiajie have been held accountable, as well as 15 from Nanjing, eight from Yangzhou, and some others from Zhengzhou and Yantai.
According to a BBC report, epidemiology professor Chen Zhengming of the University of Oxford thinks that the dismissal of Chinese officials and the arrest of disobedient people send a strong signal that the government not only has zero tolerance for Covid-19 cases but also demands that officials at all levels of responsibility be held accountable.
Professor Jin thinks that the crux of the issue mainly lies with the political leaders and it would be difficult to change the anti-epidemic policy immediately. He explained, “The problem with China is once you let go, you see chaos, and once you tighten up, you hurt development. So you can’t just change anti-epidemic policy.”
On the other hand, the EIU pointed out, considering the fact that the Chinese Communist Party (CCP) will hold its 20th National Party Congress next autumn and the Politburo Standing Committee will be reshuffled then, China’s border restrictions may be in place for even longer.
The Financial Times published an article by Cao Xin on 9 August introducing an interesting concept: the two approaches of “living with the virus” and “dynamic clearance of Covid-19 cases” are premised on the fact that for a populous country like China, the result of nationwide serum antibody testing should be a deciding factor for implementing the zero-Covid policy, that is, the implementation of the zero-Covid policy should be dependent on the population’s serum antibody level.
The article asked, “China is said to have administered over 1.7 billion doses of Covid-19 vaccines. But it has yet to conduct a national sampling and monitoring of serum antibody tests. Can today’s China build a collective immune barrier?”
Related: China's top infectious diseases expert Zhang Wenhong: Division stands in the way of defeating the pandemic | Why the Chinese are not motivated to get vaccinated | Chinese academic: Why China's 'harsh' counter-pandemic measures are valid | War of words over efficacy and safety of vaccines: Will China win?
