For more than two years, the Chinese government has stamped out Covid-19 infections wherever they have appeared, even as it has meant shutting down megacities like Shanghai for months. To move away from this unsustainable policy, you will need to convince a wary population to get vaccinated
ROME – China’s urban populations have been enduring some of the most intense infection prevention measures of the Covid-19 pandemic. For 60 days in a row, the 27 million residents of Shanghai were forced into a strict lockdown, and they were not alone.
During the peak of the Omicron wave, in April and May, 45 cities, with a total population of 373 million, were under some form of lockdown. That’s more than the combined populations of the United States (329.5 million) and Canada (38 million), and 83% of the population of the European Union (447 million).
China’s “Covid zero” strategy has wreaked havoc on its economy and its people. But Omicron’s wave has also highlighted the continued vulnerability of its elderly population to the virus. As of June 2, 40% of people over the age of 60 (about 95 million people) had not received any dose of the Covid-19 vaccine, despite being at increased risk of severe illness and death because of the disease.
One of the reasons for the low vaccination rate is that the Chinese population has simply gotten used to the low rates of Covid-19 infections in the past two years. Now that the Omicron wave has come, the perceived increased risk of remaining unvaccinated should increase vaccination among somewhat older people.
Yet another reason for the low vaccination rate among the elderly is that many fear side effects. To counter this, the Chinese government recently introduced a Covid-19 vaccine insurance package for people over 60 years of age. Vaccine recipients who get really sick will receive $75,000, more than four times the nation’s median annual income ($15,950). This is a smart idea. But it won’t be enough, because the biggest hurdle is a lack of trust between the Chinese public and the medical establishment.
To be sure, all countries have faced difficulties in convincing interested populations that the benefits of vaccines outweigh the risks. In the United States, 15% of people remain unvaccinated against Covid-19, and 42% of this group say they don’t trust vaccines. Still, this is a big improvement from September 2020, when 49% of American adults said they wouldn’t get a vaccine if one were available. Within that cohort, 76% of respondents cited concerns about side effects.
Therefore, the fear of side effects is shared by the vaccine-resistant populations of China and the United States. But the Chinese and American medical establishments have responded to these concerns in very different ways.
In the United States, the medical establishment has sought to build trust by conducting independent and transparent medical trials, the results of which are reported in uncensored publications and subject to open deliberation at all levels: by experts, journalists, politicians and the public. This approach is based on two well-known public health maxims: trust in the medical establishment will increase acceptance of treatments; and that trust is built through transparency and open deliberation.
In contrast, China’s approach has been almost completely opaque. The government has released very limited data on vaccine trials and has censored any discussion of side effects, even common minor ones like injection pain. Chinese authorities have followed the maxim that information on controversial issues should be withheld to prevent the dissemination of views that may run counter to government goals.
This strategy has backfired, because it creates an information vacuum that can only be filled with rumours, speculation and conspiracy theories. The current failure contrasts sharply with China’s earlier success in making deliberative decisions on health policy issues. After the SARS outbreak of 2002-04, China allowed a constructive debate on the problems of its health system. As many pointed out, more than 80% of rural residents and 40% of urban dwellers did not have health insurance of any kind at the time.
In response, the government announced in 2009 that it would invest 850 billion renminbi ($127 billion at current exchange rates) to provide health coverage to 90% of the population. The next two years were characterized by intense debates between national and regional legislators, health experts, community leaders, journalists, and the public. The deliberations resulted in many amendments to the proposed policy. Although the final product was not perfect, it proved popular and led to the widespread adoption of health insurance. By 2021, 95% of Chinese had some form of coverage.
Of course, the deliberation on vaccines against Covid-19 will have to be faster and it will not be free. Chinese vaccines would draw criticism, and some people would still be put off by the common side effects (such as fever) that they cause in some. or rarer risks (such as allergic reactions). Others would criticize the government’s handling of the pandemic, given the chance. But these short-term costs are worth the long-term benefits of building trust in public health authorities and increasing vaccination rates over time. As other countries have discovered, disseminating negative information about vaccines might increase public reluctance in the short term, but it helps maintain trust and deters conspiracy theories.
Fighting Covid-19 effectively requires keeping in mind the long term, given the high probability of future waves and the need for additional rounds of vaccination. For China, even more than for other countries, building trust is essential, because it is a necessary step to move away from the “Covid Zero” strategy. That change will naturally lead to more infections and deaths. But open discussions about vaccines can increase their uptake, help moderate the spread of the disease, and offset the negative impact on public confidence.
China urgently needs to adopt transparency on this issue. The longer you wait, the harder it will be to abandon your economically destructive “Covid Zero” policy.
The author
Nancy Qian, professor of managerial economics and decision sciences at Northwestern University’s Kellogg School of Management, is founding director of the China Econ Lab and Northwestern’s China Laboratory and leads Kellogg’s development economics initiative.
Copyright: Project Syndicate, 2022