6/18/2021 China’s zero-tolerance approach helped control Covid-19, but is it time for an exit strategy? | South China Morning Post

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This is the third in a series about China’s plans to reopen its borders to the world amid the Covid-19 pandemic. Here,Josephine Ma explores whether China’s zero-tolerance prevention and control strategy can hold.

Within days of about 100 new Covid-19 cases being discovered in Guangdong, most cities in the southernChinese province had tested their entire populations, some more than once.

Although the number of infections was relatively low compared to elsewhere in the world, o�cials said drasticmeasures were needed to make sure the outbreak did not spread further since the province was an entry pointto the country and served as its �rst line of defence.

The message was clear: the province of 126 million people would not take any chances when it came topossible transmission of the coronavirus, even if they had to test millions of people and send tens ofthousands to hotels for quarantine.

Beijing has touted its zero-tolerance approach to Covid-19, enabled by stringent social control measures andlarge-scale screening, as a model for containing the pandemic. The approach has gained strong public supportand turned around an initial outpouring of grief and anger in the early stage of the crisis. 

China/ Science

China’s zero-tolerance approach helped control Covid-19, but is it time for an exitstrategy?

Beijing may have no choice but to reopen its borders and face the risk of outbreaks even if most peopleare vaccinated, experts sayThere may be more pressure to do so as other countries open up, but it could come at a political cost

Josephine Ma

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Beijing has touted its strict measures as a model for containing the virus, but morethan a year after it closed the borders it is facing a dilemma over whether to reopen.Illustration: Perry Tse

Published: 1:00pm, 17 Jun, 2021

6/18/2021 China’s zero-tolerance approach helped control Covid-19, but is it time for an exit strategy? | South China Morning Post

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But more than a year after it �rst closed its borders, China is facing a dilemma between remaining shut at theexpense of international business and trade, or opening up and risking public anger over potential virustransmission from international travellers after locals made sacri�ces to contain the pandemic at home.

Residents get tested in Guangzhou during the latest outbreak.Mass screening is part of a zero-tolerance approach. Photo:AP Photo

Hard-won achievement

At the start of the pandemic, China’s zero-tolerance approach kept its casualties low and propelled itseconomic recovery compared with other countries.

This was only possible because the Chinese public complied with pandemic control measures that requiredpersonal sacri�ces, such as having their movement restricted and daily lives disrupted, for the sake of cuttingo� local transmissions. 

The government has hailed its ability to mandate mass testing and contact tracing and impose lockdowns as astrength of its authoritarian administration and highly centralised decision-making process. President XiJinping attributes the country’s containment of Covid-19 to the “superiority of the Chinese political system”.

Covid-19 is very unlikely to be eradicated globally, so allcountries will remain at risk, probably for years to comeand perhaps inde�nitelyChristopher Dye, University of Oxford

Success in extinguishing outbreaks – such as the initial large-scale outbreak in Wuhan and smaller ones inBeijing, Liaoning and Xinjiang – has won the government support.

Months into the pandemic, in April last year, Chinese people expressed more trust in the government afterthey compared pandemic control measures at home with those of the United States, according to a survey ledby York University in Canada.

But strong support for the zero-tolerance policy combined with the sacri�ces made to comply withrestrictions also means any relaxation of the measures could come at a political cost for Beijing, making ithard to deviate from its current approach.

6/18/2021 China’s zero-tolerance approach helped control Covid-19, but is it time for an exit strategy? | South China Morning Post

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“The policy creates its own forces that are resistant to change because they are associated with a lot ofepidemiological, political, economic, psychological and foreign policy bene�ts,” said Huang Yanzhong, asenior fellow for global health at the Council on Foreign Relations in the US. “So there’s a strong incentive tosustain what they call hard-won achievement.”

But Nicholas Thomas, an associate professor at City University of Hong Kong specialising in health security,said changes to the policy would come down to political will.

“Is the state itself willing to take the hit? Because up until this point, many states pursued a zero-caseapproach that justi�ed their restrictions on keeping the people safe, but now it’s opening up and basicallysaying, ‘Well, people are going to become unsafe’. So that’s a challenge for any state,” he said.

‘Breathing space’ for vaccinations

Beijing may not have a choice but to eventually reopen its borders and risk some Covid-19 cases, experts say.

“Covid-19 is very unlikely to be eradicated globally, so all countries will remain at risk, probably for years tocome and perhaps inde�nitely,” said Christopher Dye, an epidemiology professor at the University of Oxford.“Although sealing national borders has been understandable during the acute phase of the pandemic, I doubtthat any country can keep out the virus inde�nitely; it will be too costly.” 

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Thomas said zero-tolerance policies should only be taken as a means to create “breathing space” for acountry to vaccinate its population, instead of a long-term measure. 

“Most of the countries that do this actually do have a pressing need to open up their borders,” he said.“Because without it, they’re not going to be able to … have sustained economic growth.”

Like other major economies, China has embarked on a mass vaccination programme in hopes of reaching herdimmunity. As of Tuesday, the country had administered 924 million coronavirus vaccine doses. 

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Some major economies, such as the European Union, have already relaxed travel restrictions for vaccinatedforeigners. Huang said there could be more pressure for China to change its zero-tolerance approach ifbusinesses and trade sectors in other countries were bene�ting from reopened borders elsewhere –particularly in the US.

“Why are you proud of your policy? Because of US failures. But through a successful vaccine roll-out, theUnited States could be able to contain the spread of the virus and life will go back to normal,” he said. “But ifChina continues to stick to the zero-tolerance policy and continues to close its border, you are going to see thecontrast between the two. People will then question China’s pandemic control strategy.”

Even when the majority of the population is vaccinated,outbreaks can still occurMark Jit, London School of Hygiene and TropicalMedicine

Mary-Louise McLaws, an epidemiology professor with the University of New South Wales, agreed that a zero-tolerance approach made sense for countries initially as there was little known about the impact of the novelcoronavirus.

But as the virus continues to mutate, McLaws said infections would be inevitable when borders eventuallyreopened.

“Herd immunity levels may change as the virus mutates until the majority globally have been vaccinated,” shesaid. “Then we will inevitably still see infection until the rate of mutation slows due to a high enough level ofvaccination so mutations occur less rapidly and this can be dealt with fast via booster shots.”

Even vaccinating the majority of the population does not mean a country can be completely free of Covid-19,particularly with the emergence of new variants.

“Covid-19 vaccines give very good protection against severe disease and death due to Covid-19. However, theydon’t work so well against mild infections, so even when the majority of the population of a country isvaccinated, outbreaks can still occur,” said Mark Jit, a professor of vaccine epidemiology at the London Schoolof Hygiene and Tropical Medicine.

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6/18/2021 China’s zero-tolerance approach helped control Covid-19, but is it time for an exit strategy? | South China Morning Post

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For China, there are not enough active cases to analyse how well its vaccines would fare in the real world,according to Feng Zijian, deputy director of the Chinese Centre for Disease Prevention and Control. Speakingat a conference in Qingdao earlier this month, he said even if 60 to 80 per cent of the population wasvaccinated, there might still be a severe outbreak if China reopened its borders now.

Scientists said a more realistic goal for low-incidence countries was to avoid serious cases and hospitalisationthrough mass vaccination, while accepting a certain level of Covid-19 in the country – an approach manyWestern countries are now adopting.

“Countries will likely make di�erent policy decisions based on their level of risk tolerance and economicresilience,” Jit said. “However, in the long term, countries probably will have to accept some level of Covid-19activity.”

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Dye from the University of Oxford said he saw the idea of zero tolerance “applying not so much to infection,but rather to minimising severe illness and deaths, protecting older and more vulnerable people”.

“If widespread immunity can be maintained in populations, mainly by vaccination, spikes in infection will bemore easily controllable; there will be fewer patients in hospitals and fewer deaths,” he said.

A disrupted new normal?

For now, there is no sign China will relax its zero-tolerance policy any time soon: its handling of theGuangdong outbreak suggests Beijing is doubling down on measures to ensure the highly transmissible Deltavariant, �rst identi�ed in India, does not circulate in China. Feng also said at the Qingdao conference thatChina was unlikely to reopen its borders before the middle of next year.

Given the new strains, especially Delta, the pace of reopening should be carefully managed, Thomas said.

“A gradual opening with limited travel to similarly low-incidence countries is going to be essential. Theycannot simply open up their borders, even to their closest partners, as the Delta variant is now endemic in allregional countries.”

China also had to see how e�ective its vaccines were against the new variants, he added.

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6/18/2021 China’s zero-tolerance approach helped control Covid-19, but is it time for an exit strategy? | South China Morning Post

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Steve Tsang, director of the China Institute at SOAS University of London, said Beijing was likely to avoidtaking any political risks.

“The pressure may get stronger for some elements of opening for the Winter Olympics in the new year. Buteven then, Beijing can have a limited opening of the borders, particularly if Japan cannot fully reopen for theSummer Olympics,” he said. “I expect Beijing to play safe in the reopening of borders.”

But experts said it was time for China to work on an exit strategy.

“The public has to also recognise that the trade-o� for greater return to economic normality is going to besporadic outbreaks of the virus,” Thomas from CityU said. “So we really are looking now at … planning for adisrupted new normal, which also requires greater resilience in our institutions and in our society – and thatconversation really hasn’t started yet.”

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