The U.K., Netherlands, and Denmark recently announced that they will abandon most of their COVID-19 containment efforts, in a move that could mark the start of a turning point in the pandemic. These countries appear to view the virus as just another seasonal ailment that, while dangerous to a small segment of the population, is a mild to medium annoyance for most. The implicit acknowledgement is that the “greater good” of resuming normal social and economic life outweighs the risk of death and severe disease to a small minority – mainly the unvaccinated, elderly, and those with serious pre-existing conditions.
Taking an alternative approach, China is maintaining its strict zero-COVID policy posture in ways that are not very different from those in early 2020. The suppression measures may appear shocking to societies that are now calming their response to COVID-19: quarantine periods that can last a month or more, sudden lockdowns of residential blocks and neighborhoods, social restrictions that are forcing some businesses into heavy losses or bankruptcy, and the killing (let us call it what it is) of more than 2,200 pet hamsters. One must ask: What is the endgame?
To be sure, there are legitimate reasons for China to pursue strict zero-COVID measures. A rapid surge of infections has the potential to flood healthcare capacity, crowding out those who need unrelated treatment. China’s public hospitals were highly stressed even before the onset of the pandemic and have long lacked sufficient capacity to respond to public health emergencies. Older or immunocompromised individuals are at risk of severe disease or death – even though Omicron is a milder variant – while the longer-term effects of COVID-19 seem to weigh heavily on the minds of Chinese people.
Given these circumstances, a move away from zero-COVID – even a gradual one – to co-existence with COVID-19 would likely lead to many unfortunate deaths in China. These are losses that most of the world has been largely willing to accept, and consequently enduring, for the past two years – but that China has avoided. The question that now haunts China’s leadership is whether it can indefinitely avoid such losses.
If the endgame is the full elimination of COVID-19 within China’s borders, this is achievable with aggressive enough measures. China remains highly vigilant to outbreaks, and as long as the borders are sealed tightly and permanently, COVID-19 will probably be snuffed out. Then what? The rest of the world is moving en masse toward a living-with-COVID reality. If China is determined to remain isolated until the rest of the world eliminates COVID-19, it would be a long while before China can open its borders. If COVID-19 becomes endemic, as most epidemiologists expect, China’s closure would theoretically have to be indefinite.
Without the emergence of a tragically lethal strain of COVID-19, there is little political appetite in most of the world to return to the strict containment measures seen in 2020 – let alone the aggressive, zero-tolerance measures China has adopted. So, how will China keep COVID-19 out? One strategy is to maintain the current “dynamic zero-COVID” stance until nearly the entire population is vaccinated. However, this raises an additional concern: What about the relatively low effectiveness of China’s home-grown vaccines as compared to those developed elsewhere? If China relaxes its zero-COVID approach, the virus will meet the world’s largest immunologically naïve population. Two years of commitment to zero-COVID means that the only protection China’s population comes from the Sinovac and Sinopharm vaccines – unless China is willing to accept mRNA vaccines from the West or develops its own. China’s population has virtually zero of the natural immunity that prior infection provides, and thus enjoys no other backstop for break-through infections.
Of equal uncertainty are the socio-political dimensions of zero-COVID policy. China has predisposed its population to believe that a COVID-19 outbreak is the result of somebody’s failure. This narrative is plausible amidst tight restrictions. However, if China resumes normal life across the entire country (i.e., resisting city-level lockdowns) and connects again to the outside world, how will the government reframe this failure narrative?
One option is to wait for more home-grown mRNA vaccines and better treatments, or even a milder strain of COVID-19, that would allow the authorities to claim that the virus is now just as mild as the typical flu. Another option is to wait for an opportune time – like after the 20th Party Congress widely expected in October 2022 – to begin shifting its narrative to one that downplays the severity of COVID-19 (regardless of improvements to vaccines and treatments) and maintains that the sacrificed health of some people is worth the social and economic benefit of the majority.
Either approach is fraught with political risk. Zero-COVID was never only about the successful suppression of the virus; it was also meant to be living proof of a superior system of governance – one that values human life, unlike the supposedly callous and feckless ways of the so-called democratic West. The fashioning of an ideological battlefront out of the COVID-19 pandemic has raised the geopolitical stakes of zero-COVID considerably and unnecessarily. With each passing day that China clings to a zero-COVID strategy, the gap with countries adopting a living-with-COVID strategy grows wider. It appears unlikely that China would surrender this ideological stare-down by accepting COVID-19 as endemic.
As such, the principal dilemma facing China’s government concerns politics rather than public health: lose ideological face or suffer the adverse (economic) consequences of (self-imposed) isolation. At present, China seems to view the former as a bigger loss than the latter. Perhaps this is what playing the geopolitical long game looks like.
It is appropriate also to acknowledge the domestic politics of COVID-19. In countries like the U.S. and U.K., response measures became an immediate ideological fault line. Then-president Donald Trump in the United States offered up a veritable torrent of embarrassing gaffes and regretful moments, including insisting that the virus would disappear in a matter of months (in early 2020), suggesting that injecting bleach might cure it, and hawking other unproven and even dangerous treatments. To this day, resisting mandates to wear a mask or receiving a vaccine is seen by many on the political right as an ideological statement – even a declaration of personal freedom against an Orwellian government. The politicization of the virus and measures to contain it are by no means unique to any single country. At the global level, however, there seems to be China on one end of the COVID-19 response spectrum and most other countries moving towards the other end.
Finally, the challenge of China’s dilemma is further evident when reflecting on the concept of sunk cost. The sunk cost bias may lead officials to avoid “wasting” previous efforts by altering COVID-19 containment strategy; they are therefore more likely to persist with harsh measures to maintain zero infections than to squander their early success suppressing the virus. This bias can extend to individuals as well. Those who have personally sacrificed by avoiding travel for holidays or to see family, and in more severe instances by losing their jobs and businesses, may not enjoy seeing years of effort rendered meaningless if a living-with-COVID-19 posture is adopted. This domestic issue imposes a difficult extra layer on the aforementioned dilemma. How China handles this situation should provide important lessons for addressing future pandemics.