China’s zero-Covid goal is no longer sustainable

Is a zero-Covid policy still possible now the Omicron variant is loose? China seems determined to find out. After a few days of wavering, the authorities in Shanghai have begun a strict lockdown, half of the city at a time. For five days in each half, Shanghai residents will have to stay at home and undergo mass testing. Those who test positive will be quarantined, even if they are asymptomatic.

Whether this will work is an open question. The lockdowns will be relatively brief — and it only takes one missed case to renew the outbreak. They will also come at an economic and social cost. Shanghai is China’s most populous city and its financial capital. Offices and factories are moving their staff into on-site “bubbles”, isolated from the outside world, so they can keep working. The economy will suffer nonetheless. Succeed or fail, therefore, the Shanghai lockdowns show the utility of China’s zero-Covid strategy is coming to an end. It is time to prepare for an exit.

The fundamental challenge of seeking to suppress coronavirus altogether has been clear for some time but it deepened with the arrival of Omicron. The virus can only be eliminated in an isolated territory, with no reservoir of positive cases to seed new infections. With Covid now endemic across most of the world, it follows that China — or any other country — can only keep it out with the most rigid border controls. Since Omicron is highly infectious, only the strictest lockdowns will serve to eliminate it once cases occur, and unless such controls are maintained forever, they merely delay the moment when Covid will spread through the population.

Ultimately, China will need a strategy to exit zero-Covid and live with the virus. Thanks to its effective management of the disease so far, which has kept its population safe and life relatively normal, China has the luxury of choosing when and how to do that. It should plan actively and act soon. The alternative is to carry on with lockdowns until public fatigue becomes too much and the virus escapes control.

That is what happened in Hong Kong and it is a cautionary tale for the mainland. After two years of keeping Covid close to zero via draconian border restrictions, the virus swept through the city this month, causing some of the highest short-term death rates anywhere in the world. The biggest reason for the high death toll was low rates of vaccination among the elderly.

Mainland China also has patchy vaccine cover: more than 130mn Chinese aged 60 and above are not fully vaccinated, according to FT analysis of Chinese vaccination data. Fixing that is essential if China is to live with the virus. A first necessary step is for China to announce that it will end the Covid-zero policy at a future date, so there is motivation to get vaccinated.

It also needs to take account of the lower effectiveness of domestic vaccines. Hong Kong experienced higher death rates among those who had received one or two doses of China’s Sinovac vaccine, compared with those who received internationally-developed versions based on mRNA technology. A third dose of Sinovac appeared to provide adequate protection, but it would make sense to approve mRNA vaccines for top-up inoculations.

As the world slowly returns to business as usual, the zero-Covid policy will come at a higher and higher cost to China. The Hong Kong and now Shanghai outbreaks of the Omicron variant have caused trauma and turmoil. But if they show once and for all that the only choice is to live with the virus, they can also mark the beginning of the end for the acute phase of the pandemic.