Yanzhong Huang on China’s Zero-Covid Campaign

Yanzhong Huang is a senior fellow for global health at the Council on Foreign Relations. He is also professor and director of global health studies at Seton Hall University's School of Diplomacy and International Relations, where he developed the first academic concentration among U.S. professional schools of international affairs that explicitly addresses the security and foreign policy aspects of health issues. He is the founding editor of Global Health Governance: The Scholarly Journal for the New Health Security Paradigm. Huang has written extensively on global health and China. He has published numerous reports, journal articles, and book chapters, including articles in Survival, Foreign Affairs, New York Times, Foreign Policy, and Washington Post. In 2006, he coauthored the first scholarly article that systematically examined China’s soft power. He is the author of Governing Health in Contemporary China (2013), Toxic Politics: China’s Environmental Health Crisis and its Challenge to the Chinese State (2020), and The COVID-19 Pandemic and China’s Global Health Leadership (2022). He has testified many times before congressional committees and is regularly consulted by major media outlets, the private sector, and governmental and nongovernmental organizations on global health issues and China. He serves on the expert board of the Washington-based CSIS Commission on Strengthening America’s Health Security and cochairs the commission’s China working group. He is a life member of the Council on Foreign Relations, a member of the National Committee on United States-China Relations, a board member of the Institute of Global Health (Georgia), and an Academic Advisor of the Center for China and Globalization. In 2012, he was listed by InsideJersey magazine as one of the “20 Brainiest People in New Jersey.” He was a research associate at the National Asia Research Program, a public intellectuals fellow at the National Committee on U.S.-China Relations, an associate fellow at the Asia Society, a visiting senior research fellow at the National University of Singapore, and a visiting fellow at the Center for Strategic and International Studies. He has taught at Barnard College, Columbia University and Tsinghua University. He obtained his B.A. and M.A. degrees in international politics from Fudan University and his Ph.D. degree in political science from the University of Chicago.
Ningqi (Carina) Zhao '24 interviewed Dr. Yanzhong Huang on on October 7, 2022.
Photograph and biography courtesy of Dr. Yanzhong Huang.


Despite the relatively low Covid cases rate in the country, China persists with its zero-tolerance approach to Covid. Why does the Chinese government continue the strict enforcement of the “Zero-Covid” policy, when the rest of the world has already moved on?

Several factors have contributed to the stickiness of the “Zero-Covid” policy in China. The first is the Chinese government’s obsession with the worse-case scenario. That is, if China relaxed its policy toward Covid, it would lead to an upsurge of Covid cases that would have serious consequences, such as the death of millions of people and an overwhelmed health system.

Right now, the Omicron variant is the most prevailing virus in the country. The case fatality rate of the original virus strain is around 3.5%, but it has now dropped to the level of the seasonal influenza. For instance, there were 585 total deaths among 625,000 people who were infected in the spring, which led to a 0.09% fatality rate. However, the government continues to highlight the danger of the disease and the vulnerability of Chinese population, especially the elderly. Therefore, as long as the top leaders don’t change their perception on the severity of the disease, they will continue enforcing this type of response to Covid.

The second factor is the immunity gap between China and the rest of the world. There is only a small fraction of Chinese people who obtained natural immunity, as only a few people get infected by the virus in the country. Therefore, there's no natural immunity, but only vaccine-induced immunity in China.

By March 2022, China already had 90% of the population vaccinated with two doses of non-mRNA vaccines.  The problem is that after six months, the antibody level drops to a level that is considered very low or even undetectable. So China has largely an immunologically naive population.

Another concern is that, despite the 90% vaccination rate, there is a large elderly population that is not fully vaccinated or get a booster shot. Only around half of the people over 80 took the booster shot. Even the Chinese government admits that the vaccination rate among the elderly is lower than in the United States. This is very unusual for a country that has strong mobilization capacity to get things done. 

Right now, you cannot expect the virus to go away anytime soon, so the immunity gap will always be there. As long as the gap exists, and as long as the Chinese government is reluctant to launch an aggressive national vaccination campaign to narrow the gap, the only choice is to continue using Zero-Covid policy to shield the population against the virus. 

The third factor is that the Covid response is tied to the stability of the CCP. As the 20th Party Congress is coming, President Xi doesn’t want to have any risk of instability in the country. The Chinese government continues to highlight that it really cares about people's health and well-being. If China reopens, the rapid increase of cases and deaths would lead people to question this claim. 

Why doesn’t the Chinese government just force old people to take the vaccine? 

The main reason is that old people have safety and effectiveness concerns with the vaccines. For instance, if an 80-year-old person with a high blood pressure goes to a doctor and asks whether he can get the vaccine, he probably won’t get a clear answer from the doctor. This makes him reluctant to take the vaccine, since he is unsure about the potential adverse effects, even the risk of not taking the vaccine might be even higher. 

In addition, it is also related to China's vaccination strategy. When China launched the vaccination campaign, the government prioritized the health care workers and other essential workers, in part because they didn’t have data proving the effectiveness of the vaccines on elderly people. This is so because in the phase three clinical trial, they had only recruited a very small number of elderly people into vaccine studies. The uncertainty prevents them from pushing further the vaccine campaign.

The Chinese government has relied heavily on propaganda to justify the strict policies. It came up with new terms, replacing “lock-down” with “static management” to not irritate the public. What do you think the psychological effect of propaganda is on the Chinese people? Is it still effective?

Chinese leaders often highlight that China's approach is the most successful in the world. The low cases and death rate easily leave people with the false impression that the “Zero-Covid” policy is the most effective way. This leads to an interesting phenomenon in China: Many citizens who have parents aged over 80 might complain a lot about the local government’s mis-handing of the crisis. But if you ask them whether they support the policy or not, they might still give a positive answer. In addition, in the countryside, people don't have access to alternative information. Therefore, they're more likely to be convinced that the Zero-Covid policy is the right option for them. 

With the endless Covid testing and lockdowns, resentment is rising against China’s “Zero-Covid” approach. There is a decline in public support for heavy-handed enforcement. What is the impact of these negative attitudes on government policy? What are the long-term implications of public support for the party?

First, there is a rising social discontent with the government’s effort to implement the Zero-Covid policy. However, a significant proportion of the population still supports the policy, because they think the policy shielded them from the virus which they consider dangerous. 

Right now, an increasing consensus is forging among the middle class in large cities that zero-Covid is not sustainable and should be abandoned. The dissatisfaction and discontent though have not reached the level that threatens the CCP’s rule or legitimacy. However, if that policy continues, more people will be hurt by the policy, and this may lead to an increase in public pressure for policy change. When more people find out that their East Asian neighbors, such as Korea and Japan, have all abandoned this approach, they may naturally ask the question: Why we are still clinging to this policy? 

Another group that has apparently paid a heavy price is local officials. They must work extra hard to implement the Zero-Covid policy.  Do we have any signs of fatigue among this group?  How has the policy affected the functioning of local governments?

The fatigue is increasingly a problem. Zero-Covid has been in effect for more than two and a half years, and many regions have experienced multiple rounds of Covid attacks. When there is an outbreak of Covid, the local governments are more likely to rely on the heavy-handed nonpharmaceutical interventions to bring the situation under control as quick as possible. Because they are held accountable for the Covid situation in their jurisdiction, local government officials are often implementing the policy with fear and trepidation. The longer they are put in this situation, the more likely they will be fed up with the policy. 

In China, there is a sense of hope that, after the 20th National Party Congress ends, China will start to loosen its enforcement of Covid policies. Will China adjust its restriction on Covid in the foreseeable future? What might follow the relaxation or even abandonment of the Zero-Covid policy in terms of infections, hospitalization, and death in China?

First, a shift in Zero-Covid policy is inevitable. Even the strongest supporters of the Zero-Covid policy will admit that this policy will not be pursued in the long run. However, it is unrealistic to expect an immediate and significant policy pivot after the 20th Party Congress. In part this is because President Xi’s personal stature is so closely tied to the Zero-Covid policy. A policy U-turn would be tantamount to admitting a policy failure, which is not politically acceptable. 

In the meantime, President Xi is expected to secure a third term and it would be a victory for him and his followers. Therefore, he may be in a more politically secure position to pursue his favored policy agenda. This includes redefining the narrative and introducing the necessary measures to mitigate the impact that may be caused by a surge of cases after policy relaxation. But most importantly, to have a change in policy, the top leadership’s mindset toward Zero-Covid should be changed. If they still believe that it is possible to contain the spread of the virus without incurring unbearable social and economic costs, then there would not be any fundamental policy shift.


Ningqi (Carina) Zhao CMC '24Student Journalist

N509FZ, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

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