But instead of setting the stage for this scenario, China has reinforced its commitment to “zero Covid”, implementing emergency lockdowns and contact tracing. Meanwhile, daily vaccinations fell to record lows. Intensive care beds remained in short supply, even as workers built testing rooms and isolation facilities. Research on indigenous mRNA vaccines has failed to keep pace with the rapidly mutating virus. Now, the costs of that approach are piling up, putting China in a bind from which there appears to be no easy escape, scientists said in interviews. Even as new Covid cases have reached historic highs, residents have taken to the streets to protest the lockdowns that have halted daily life in many cities. Concerned, officials have begun to ease restrictions. Researchers worry that China may struggle to reopen the country and ease the strain on its economy without risking a wave of deaths. Such a destructive wave could pose a significant threat to political leadership. “We often pretend that China has a choice in terms of ‘zero Covid’ versus opening up,” said Dr. Siddharth Sridhar, a virologist at the University of Hong Kong. “There was never a choice. The simple fact is that China is not ready for a wave of this scale.” Nothing has delayed China’s preparations as extensively as its difficulty vaccinating the elderly. Two-thirds of people age 80 and older are vaccinated, but only 40 percent have received a booster dose, a critical shortfall because the Chinese-made vaccines offer weaker protection than the Pfizer-BioNTech and Moderna vaccines. In a study during the Omicron outbreak in Hong Kong, two doses of China’s main domestic vaccine, Sinovac, were only 58 percent effective against severe Covid or death in people aged 80 and over. Two doses of Pfizer-BioNTech, by contrast, were 87 percent effective in the same group. An earlier study in Brazil similarly found that two doses of Sinovac were only 61 percent effective in preventing deaths from Covid. These results have cemented the impression among scientists that Chinese vaccines, which rely on killed viruses to induce an immune response, are essentially a three-dose vaccine rather than a two-dose one.

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Long Covid: People who received the antiviral drug Paxlovid within days of being infected with the coronavirus were less likely to develop long Covid months later, according to a study. Updated boosters: New findings show that updated boosters from Pfizer and Moderna are better than their predecessors at raising antibody levels against the most common version of the virus now circulating. It calls for a new strategy: Covid boosters can help vulnerable Americans avoid serious illness or death, but some experts believe shots must be improved to avoid new waves. Future vaccines: Financial and bureaucratic hurdles in the United States mean the next generation of Covid vaccines may well be designed here but used elsewhere.

Making matters more difficult, China’s last major vaccination push was in the spring, eight months or more since the last dose for many recipients. This could put a dent in their immune defenses. A study in Malaysia found that while the Pfizer-BioNTech vaccine induced relatively stable protection against intensive care admissions three to five months later, the Sinovac vaccine’s effectiveness against intensive care admissions fell to 29 percent from 56 percent during that time. of the period. The Chinese vaccines stack up relatively well to the world’s other non-mRNA Covid vaccines, said Dr Paul Hunter, an infectious disease expert at the University of East Anglia in England. But reopening the country so long after the last vaccination campaign could be detrimental. “I think this is more of an issue than the quality” of China’s vaccines, Dr. Hunter said. Vaccination gaps in China’s elderly population are all the more apparent because the country has achieved relatively strong coverage overall. Nearly 90 percent of the population has received a series of primary vaccines, generally including two doses of Sinovac or Sinopharm, another Chinese-made vaccine. The disparity is partly due to an antiquated theory that as younger and more active Chinese were vaccinated, the country could build up a kind of immunity and protect the elderly, said Andy Chen, an analyst at Trivium, a Shanghai-based consultancy. . Older people in China often avoid health risks, Mr. Chen said, so the chances of even minor side effects from the vaccine may have seemed threatening to many. China’s reluctance to provide data on the effectiveness and side effects of its vaccines created a vacuum in which those concerns flourished, other experts said. Misinformation about side effects is spreading on Chinese social media. And while health officials have encouraged older people with chronic illnesses to get vaccines, vaccinators are often reluctant to give them without access to the medical histories of the most vulnerable recipients. The “zero Covid” strategy only complicated the vaccination effort. By reducing infections, it saved lives but also eroded many elderly people’s sense of urgency about the need for a vaccine. The emphasis on throat swabs instead of vaccinations drew attention away from the vaccination campaign. In the wake of a spring outbreak, China set up tens of thousands of testing chambers in cities such as Shanghai and Beijing and built massive facilities to isolate millions. The vaccination rate remained stagnant. “There is always a shortage of staff in the health care system,” said Xi Chen, an associate professor of public health at Yale University. “People told me at the time they were told to focus on mass testing.” China said this week it would renew efforts to vaccinate its older citizens, announcing measures to use mobile vaccination stations, bring shots to nursing homes and go door-to-door to reach the most vulnerable, according to statement of the National Health of the country. Commission. But some experts, such as Yanzhong Huang, a global health expert and senior fellow at the Council on Foreign Relations, expressed skepticism that the move was much more than talk. “It’s about aligning with the current approach,” he said. “But this approach essentially no longer makes sense from a public health policy perspective.” Authorities have not provided a detailed plan for the new efforts and are not mandating the vaccinations. However strong the country’s leadership, forcing seniors to take shots is considered a potential overreach, experts said, carrying with it the risk of a public backlash. “From the perspective of a local government official, if even one person dies from the adverse effects of vaccines, that’s blood on your hands,” said Mr. Chen, the Trivium analyst. “It’s really hard to recover from that.” If cases continue to rise, gaps in vaccine coverage could pile more pressure on hospitals that may also have to deal with a winter cold and flu season. China has fewer intensive care beds per capita than many other Asian countries. The country once faced shortages of doctors and nurses, especially in rural areas, by moving health workers from one province to another when the virus flared up. A nationwide deluge of contamination from Omicron would make that impossible. A study by Shanghai’s Fudan University in May warned of a “tsunami” of Covid cases and an estimated 1.6 million deaths if China abandons its “zero Covid” policy. Since then, China has gained more options for antiviral treatments. But hospital capacity is limited enough that a sudden lifting of “zero Covid” restrictions would still create a health crisis, said Ben Cowling, a professor of epidemiology at the University of Hong Kong. Given the inevitability that cases will rise whenever China reopens, Yang Yang, an associate professor of biostatistics at the University of Florida, said efforts to “prepare the medical system” were a priority. There are already some signs that the leadership is shifting focus from building quarantine facilities to fortifying its best hospitals, he added. China’s faltering retreat from the emergency phase of the pandemic contrasts with exits by places like New Zealand and Taiwan. There, lockdowns brought breathing space while the population was vaccinated. When the measures were lifted, deaths rose, but at much lower levels than in countries like the United States. China’s strategy so far has also limited Covid deaths, the scientists said, but without also mapping out a way out of the restrictions. “Restrictions and lockdowns can help buy time to take critical public health measures and save lives, but they are not in themselves an exit strategy,” said Jeremy Farrar, director of Wellcome, a global health foundation. China, which has rejected Pfizer and Moderna vaccines, appears to be banking on hopes for locally made alternative mRNAs. Government scientists conducted a one-on-one trial of more than a dozen new vaccine candidates, including some mRNA doses, experts said. Public data is sparse, but Indonesia recently approved China’s mRNA vaccine, and some vaccine makers appear to be moving closer to seeking approval from Chinese officials. “The formula for getting an mRNA vaccine right may have taken a few shots in the gun, but early data shows it’s headed in the right direction,” said James Bellush, medical science specialist at RTW Investments in New York. China’s top leadership has signaled recognition that its blanket approach to controlling the virus is coming at an increasing economic and social cost,…