China has abruptly abandoned public health measures controlling the spread of coronavirus disease (Covid-19). The ‘dynamic zero-Covid’ policy begun in August 2021, has been under growing pressure from the imperialists; from the Chinese business class, some of whom began rioting against lockdowns; capitalist pressure to permanently reopen the economy to boost economic growth; and ever more transmissible, imported, virus variants. Trying to ‘balance’ the needs of the economy against public health protection is akin to riding a tiger. After three years of success, the decision to abandon zero-Covid to boost economic growth is a momentous blunder. China’s focus is no longer on preventing infection but on preventing and treating critical cases, with officials downplaying the severity of Omicron. A death toll in 2023 of hundreds of thousands of people from the ‘not scary’, ‘mild’ virus is predicted. The victims will be mainly the elderly from poorer rural areas of China. Long Covid is rarely mentioned.
Despite a 60-year genocidal blockade by US imperialism, socialist Cuba shows that a zero-Covid policy can and does work. Cuba has brought the virus under control, is the most vaccinated country in the world and reopened its borders to 1.7 million tourists in 2022, without subjecting its population to mass infection.
Does zero-Covid work?
Zero-Covid does not mean having zero cases of Covid-19. It is a goal of bringing community transmission of infections as close to zero as possible. It does not mean lockdowns per se. Lockdowns are a sign of desperation, of failure to control transmission. According to epidemiologist Dr Deepti Gurdasani, ‘a zero-Covid strategy is the only strategy that can provide certainty over the long-term, and allow life to almost go back to normal. But it means we have to prioritise infection control over everything else for a short period of time’. Where zero-Covid has been implemented, it has saved lives, brought outbreaks under control and had the least damaging effects on economic growth.
Despite Wuhan being the global epicentre of the initial outbreak in 2019, subsequent seroprevalence (prevalence of Covid antibodies in blood) was <5% in Wuhan and <1% outside Wuhan in Hubei province – a remarkable achievement. Alongside a mass vaccination programme in 2021, which vaccinated over 93% of the population with two doses of homegrown vaccines, China was able by 7 December 2022 to keep total confirmed Covid-19 cases to 354,000 and experienced only 5,235 deaths, a rate of 3.7 deaths per million of the population. When asymptomatic cases are included, Johns Hopkins University estimated 4.53 million cases and 17,062 deaths, still a rate of just 12.2 deaths per million. In contrast, the Western capitalist governments have chosen the criminal ‘living with Covid’ policy, which in Britain has led to over 216,000 official deaths, a rate of 3,208 per million. Having ridiculed China’s zero-Covid policy for nearly three years, Western propaganda is exulting that China is adopting a murderous ‘living with Covid’ policy.
An outbreak of Omicron in Shanghai on 28 February 2022 is an illustration of the costs of not acting early. Shanghai’s dithering ‘pandemic task force’ on 26 March explicitly refused to follow zero-Covid protocols due to the ‘damage it would do to the economy’. A full lockdown was then implemented just days later on 4 April. By that time, it was too late, and cases peaked at about 30,000 daily. Numbers were eventually reduced to essentially zero after six weeks, and Shanghai reopened on 1 June – a clear example of the power of zero-Covid: mobilisation of public health measures, including universal masking, vaccination, mass testing, contact tracing, isolation and quarantine of infected persons, and temporary decisive lockdowns. Fewer than 600 people died, but the painful two-month lockdown would have been shorter and the deaths far fewer had the Shanghai capitalists acted quickly and put public health, not profits, first.
How socialist Cuba contained Covid-19
Omicron was first detected in Cuba in November 2021, and on 1 January 2023 Cuba reported 21 cases of Covid-19 and no deaths. The last recorded death due to Covid-19 was on 21 August 2021 and before that in May. It is possible that there has not been a single Omicron death in Cuba to date – an amazing feat. There have been 8,530 total deaths since March 2020 – a rate of 754 per million. Despite brutal economic hardships, Cuba developed and deployed its own vaccines, such as Abdala – shown to have over 98% efficacy in preventing severe disease and 99% efficacy in preventing death (Dickinson-Meneses et al. The Lancet Regional Health – Americas, 23 September 2022). Cuba has fully vaccinated over 90% of its population (including 97.5% of children over two years old) with three doses. Vaccination started with the most at risk – the elderly, then progressed to younger age groups. Schools were kept closed until 80% of all two to 18 year olds had received all three doses. Vaccines alone will not end the pandemic, but given the key role played by children in transmission, it is impossible to achieve herd immunity without vaccinating children, something the British government has refused to consider.
In addition, success requires an integrated public health system capable of rapid and organised action that can mobilise and educate the population. Cuba used its networks of mass organisations, primarily the local Committees for the Defence of the Revolution (CDRs) and the Women’s Federation (FMC), whose members go door to door informing people of the place and time of their appointment. Vaccinations are administered by local family doctors who, in the event of cancellations, quickly find willing replacements at short notice. Cuba has a highly educated and politically conscious population. 77% (8.66 million) have received their booster (4th) dose. There are no protests in Cuba against vaccines or masks or attacking testing booths or quarantine centres as we have seen in China and the imperialist countries. Cuba’s policy is one of ‘responsible coexistence’ with the virus, not the irresponsible living in denial of the imperialists.
China ‘adjusting’ zero-Covid
Having successfully contained Covid-19 for three years, China began to ‘adjust’ its Covid-19 response when the National Health Commission announced ‘20 measures to optimise Covid controls’ on 11 November 2022, and the State Council, a further ‘10 measures’ on 7 December. The new measures repeatedly claim that they are ‘not “relaxing” Covid controls or “opening up” or “lying flat”’ before the virus. The measures include no more mass testing or arbitrary or indefinite lockdowns, except in exceptional circumstances. Testing is now voluntary. Quarantine requirements and testing frequencies for close contacts will be eased from seven days to five days in dedicated centralised quarantine centres plus three days home monitoring (with PCR tests on alternate days). Secondary contacts (contacts of contacts) will no longer be traced. Those who are asymptomatic or with mild symptoms can quarantine at home. People will no longer need a negative PCR test to access public venues or domestic travel, except in schools, childcare facilities, nursing homes and medical centres, that is, where vulnerable groups frequent. For sporting events or business travellers, a closed-loop bubble will be maintained, but closed-loop management of airline crews, entry PCR testing, and mandatory quarantine for international travellers ended on 8 January 2023, despite this being one of the ‘20 measures’.
The new measures would prioritise vulnerable (elderly, immunocompromised) populations, especially in rural areas where the majority of the elderly population live, and where health systems are less resourced and can easily be overwhelmed. The emergence in November 2021 of the Omicron BA.1 variant made the second dose of a Covid-19 vaccine less effective in preventing infection or reducing transmission. It made a third (booster) dose vital, even before the emergence of further sublineages such as BA.2, BA.5 etc.
The majority of China’s population is vaccinated with inactivated vaccines made by Sinovac or Sinopharm. Studies comparing the performance of the Pfizer or Moderna mRNA vaccines and the Chinese vaccines found higher effectiveness for mRNA vaccines following two doses, but very similar performance after three doses (see Table). Deaths in China are not due to its ‘ineffective’ vaccines, contrary to imperialist propaganda, or any failure to buy western mRNA vaccines. In any case, the imperialist pharmaceutical companies have refused to share the mRNA vaccine technology with China or anyone else. Unfortunately for imperialist profits, China has developed its own mRNA vaccines, at least two already in clinical trials.
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Vaccine effectiveness against Omicron (BA.2) |
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| Severe disease | Deaths | |||||
| Vaccine | Doses | Under 60s | Over 60s | Under 60s | Over 60s | Over 80s |
| Pfizer | 2 doses | 96% | 90% | 97% | 88% | 90% |
| Sinovac | 2 doses | 92% | 74% | 93% | 74% | 63% |
| Pfizer | 3 doses | 99% | 99% | 99% | 99% | 98% |
| Sinovac | 3 doses | 99% | 96% | 99% | 97% | 98% |
However, by 28 November 2022, only 57% of China’s population had had a third dose, only 69% of over-60s and 40% of over-80s, precisely the populations most vulnerable to severe disease and deaths. In sharp contrast to Cuba, the mass vaccination campaign started with key workers to keep the Chinese economy open. It has now been reported that almost 60,000 people, 90% of them over 65, died of Covid-19 in China between 8 December 2022 and 12 January 2023 – a hardly surprising consequence.
The situation is not helped by high levels of vaccine hesitancy in China especially amongst the elderly. Studies show this is due to factors including lack of government and family support, lack of information and high levels of vaccine disinformation. The Chinese state had adopted the paternalistic attitude of simply ‘urging’ people to ‘come forward’ and be vaccinated rather than pro-actively engaging with populations and taking the vaccine into communities as is done in Cuba.
The weak messaging around Chinese vaccines, failure to vaccinate the most vulnerable, failure to tackle vaccine hesitancy and disinformation head-on, and removing public health protections in the middle of ongoing outbreaks are fatal and appalling blunders. China is belatedly ramping up booster vaccinations for elderly populations, but modelling studies suggest a fourth dose needs to be given 30-60 days before any reopening, to at least 85% of the population, and that this plus timely antiviral medication and ‘moderate’ public health measures (ie not including lockdowns) could at best still lead to an estimated 627,000 to 705,000 deaths in 2023. However, simultaneous reopening without a fourth dose, with status quo vaccination uptake, no antiviral use and no further public health measures – a worst-case scenario – could lead to as many as 1,078,000 people deaths.
On 30 December, China further announced that mass testing in schools and kindergartens will no longer be required, except under specific circumstances. Schools with no new infections for five days will resume in-person classes. Justifiably, the new measures blame local administrations for not correctly implementing zero-Covid, for ‘oversimplified, one-size-fits-all approaches and excessive formalism and bureaucratism’. What is unmentioned is a paternalistic top-down approach whereby measures are imposed without consultation or involvement of local communities, leading to frustration and fatigue. Local authorities have been blindsided by the speed of the unravelling of zero-Covid.
On 1 January 2023, authorities ended daily reporting of cases, and continue to exclude asymptomatic cases (up to 90% of cases) from official reports. Infections surveys show that infections levels are up to 80% of population, with only two of 21 provinces below a 50% infection rate. Millions of people are clearly being infected daily. Deaths not due to pneumonia or respiratory failure will no longer be classified as Covid deaths, a wretched attempt to hide the scale of this tragedy. China’s abandonment of a very effective zero-Covid policy shows that capitalism cannot meet the needs of humanity. Only under socialism, as evidenced by Cuba, can the control of a dangerous pathogen and a return to ‘normal life’, be ultimately achieved.
Charles Chinweizu
FIGHT RACISM! FIGHT IMPERIALISM! 292 February/March 2023
