China rolled back its longstanding pandemic strategy “zero Covid,” which had protected the country for nearly three years, in early December. This reversal came after historic public protests calling for an ease in restrictions but amid concern that there was not enough immunity to adequately protect the population.
The timing could not have been worse. A few weeks into a post-zero-Covid reality, the nation’s largest annual migration for the Lunar New Year, which ends in February, has begun. After years of restrictions, travel for 2023 is anticipated to be enormous as urban employees travel home to celebrate with family and friends. The combination of densely packed public transit systems, winter conditions and multigenerational gatherings is so ideal for the study of disease transmission that the Lunar New Year is a common tabletop simulation for training public health officials. This year we’ll actually see any fallout.
The challenge will be made harder by the arrival of the coronavirus’s most infectious subvariant to date, XBB1.5. In the United States, which has high vaccination rates using highly protective vaccines, XBB1.5 accounts for nearly half of all Covid cases. If the U.S. experience is any indication, XBB1.5 could be devastating if it spreads widely in China. Domestically made Chinese vaccines — Beijing has so far refused to import American mRNA vaccines — may provide less lasting protection against the virus and its variants. This is something the world will watch unfold in the weeks ahead.
What can the United States do, presuming our government is motivated to do anything? Given Beijing’s threats to Taiwan, its oppression of Uighurs and efforts to block the investigation into the origins of the coronavirus, Congress may be inclined to take a hard line on China or not do anything for the Chinese government at all. And the newly seated Congress is even more hawkish.
But doing nothing is a dangerous game. A refusal to help could not only cause incalculable suffering and deaths; it risks harming our own hard-earned gains to end the pandemic.
Given the current politics on both sides, direct government agreements seem unlikely. Over the past few years, decades-old U.S.-Chinese research collaborations, including my own research on emerging disease, have decreased. Beijing has also dragged its feet on transparent virus surveillance. However, some U.S.- Chinese academic and commercial partnerships have continued throughout the pandemic in areas such as clinical trials and vaccine research and development. With imagination, several of these collaborations could be quickly redirected to assist China in the coming weeks.
For example, in 2021, the U.S. National Academy of Engineering, the Chinese Academy of Engineering and the Royal Academy of Engineering in Britain issued a joint statement affirming their commitment to facilitate global action to respond to the pandemic through engineering approaches, including sharing public health information. In December, at least one online pharmacy in China began selling the Covid drug Paxlovid, made by the American pharmaceutical company Pfizer, directly to patients. The pharmacy shipped Paxlovid to any Chinese person with a positive coronavirus test. If the Beijing government were to tie the government’s home test result reporting system to the commercial Paxlovid home delivery providers, many lives could be saved.
What can the U.S. government do to help? Although the Chinese government has refused lifesaving assistance from the United States, Chinese physicians, patients and families devastated by Covid have not. U.S. agencies might save more lives and prevent more disruption of the Chinese economy — and our own — by bypassing Beijing and leaning on longstanding academic and commercial partnerships to go directly to the provinces, communities, companies, hospitals and individuals that have the most to lose.
Some potential solutions include the exportation of successful strategies from the United States’ Operation Warp Speed playbook, which accelerated the delivery of mRNA vaccines from the manufacturer into people’s arms. This huge logistical challenge can be revised for the rapid deployment of a new Chinese-made mRNA vaccine. Other possible initiatives include sharing disaster medicine protocols that extend hospital drug stockpiles to treat many more patients and sharing pandemic-proven strategies to help protect Chinese health care workers during Covid surges. These include prioritizing the protection of bedside nurses, using telemedicine consultants to increase available physicians and grouping clinical workers to reduce workplace infection and absenteeism. One high-impact technology approach would be to share U.S. taxpayer-funded intellectual property that could make average Chinese vaccines more potent.
Those who think the Chinese government is unlikely to cooperate need to do their homework. Though it’s still early, Pfizer was able to secure a deal with China to sell Paxlovid through a state-owned company. In September, Merck & Co. also made a deal with the Chinese state-owned drugmaker Sinopharm to import and market the antiviral medication molnupiravir in China.
Any solution that saves lives, avoids the collapse of the Chinese health care system and reduces the chance of a pandemic reboot is in our national interest. A pandemic catastrophe in China will reverberate around the world, making it a hugely crucial outbreak to contain. Many low-cost solutions are based on hard lessons learned by U.S. health care, and many of these are readily transferable to sister hospitals in China. This will have a trivial cost for taxpayers. It is also in the interest of U.S. national health security — provided you believe pandemics are made far worse by apathy, small thinking and politics.
Michael Callahan is an infectious disease physician scientist at Massachusetts General Hospital. He is a former program manager for several Darpa programs and former special Covid adviser to the assistant secretary for public health preparedness and response at the U.S. Department of Health and Human Services. He has been working on viral disease outbreaks and biosecurity in Asia since 2002.
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