‘It Doesn’t Hurt at All’: In China’s New Covid Strategy, Vaccines Matter

The Chinese government is on a mission: to convince older citizens that its latest Covid-19 vaccines are easy to take and effective.

In state-run media, a woman at a clinic in Tianjin said “there was no discomfort” with a new inhaled vaccine, while a woman in Shanghai quipped that getting her booster was “a bit like drinking milk tea.” A man in Wenzhou reassured the hesitant, “it doesn’t hurt at all, and it’s a little sweet.”

Such state-sponsored messaging is critical as the Chinese government drops its onerous Covid restrictions and braces for a surge in cases that could overwhelm its medical resources. It not only needs to convince people that the virus is nothing to fear, but also that vaccines are essential to protect against the most severe outcomes of the disease. The outbreaks in the coming weeks and months — and how deadly they will be — depend in part on whether older adults are willing to be inoculated.

Since its dramatic about-face to dismantle its “zero Covid” strategy last week, China has been downplaying the severity of the Omicron variant rippling through cities, essentially encouraging the country to learn to live with Covid. A top epidemiologist noted on Sunday that the death rate is similar to the common flu. Another health expert said authorities were prepared for the strain on the country’s medical system.

A resident receiving a Covid-19 vaccine in Hangzhou, China, in December.Credit…CNS, via Agence France-Presse — Getty Images

On Monday, China reported 8,561 new local cases, compared to around 30,000 before the strategy shifted. The figures have become increasingly unreliable as officials have all but stopped regular mass testing in recent days and made reporting of home testing voluntary.

Uncertainties over the new approach, and the rushed rollback of the rules, are mounting.

Within China’s oldest segment of the population, 40 percent have not received a booster; the World Health Organization has said such doses are especially vital with Chinese vaccines, which use inactivated virus and are usually less effective than foreign counterparts that use newer mRNA technology. And many families are still hesitant about the safety of vaccines for their elder relatives, even as new inhalable vaccines are being portrayed as less scary than those that require a needle.

Health experts warn that the vaccination campaign may be too late to defend against the current wave of cases. Singapore, where officials lifted strict measures late last year, spent months communicating and preparing before easing measures.

The authorities in Hong Kong neglected to encourage its older population to get vaccinated until it was in the middle of a major outbreak earlier this year. Without a high level of inoculation at the time, the virus killed people at a rate that exceeded nearly every country since the start of the pandemic.

“Ideally, you would be prepared before you open the gates,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations. “This is really not a recipe for a smooth transition — it’s going to be a bumpy ride.”

Funeral home staff loading a body into a vehicle outside a Hong Kong hospital in March.Credit…Billy H.C. Kwok for The New York Times

As China’s authoritarian government faced angry and rare protests against its Covid restrictions, policymakers two weeks ago launched a new vaccination drive targeting older citizens, a tacit recognition that in order to ease the rules, they needed to do more to protect the most vulnerable.

Officials pledged to bring vaccines to nursing homes, go door-to-door and use mobile stations. They swiftly rolled out one newly approved inhaled vaccine, touting it in a steady stream of television reports, newspaper articles and local health fact sheets as “easy,” “convenient,” and “like breathing fresh air.”

Understand What Is Happening in China

  • A Victory for Protesters: Beijing’s costly policy of lockdowns pummeled China’s economy and set off mass public protests that were a rare challenge to its leader, Xi Jinping.
  • A Messy Pivot: The Communist Party cast aside many Covid rules after the protests, while playing down the threat of the virus. The move could prove dangerous.
  • A ‘Tipping Point’: For the protesters, public dissent was unimaginable until recently. We asked young Chinese about what led them to take the risk.
  • Tracking Protesters: The authorities in China used the country’s all-seeing surveillance apparatus to track, intimidate and detain those who marched in the protests.

Officials have to overcome a deeply ingrained skepticism that they helped instill.

In early 2021, when China introduced its domestic vaccine, regulators restricted use to people between the ages of 18 to 59, inadvertently fueling misinformation and hesitancy within one of the most vulnerable segments of the population.

“That led to a firestorm of people saying it’s not safe for the elderly,” said Siddharth Sridhar, a virologist at the University of Hong Kong. “They are quite keen to avoid that narrative right now.”

Fences, signs and other equipment once used at a large Covid testing site now sit dismantled and unused at Hongqiao Railway Station in Shanghai.Credit…Qilai Shen for The New York Times

Many families urged their older relatives to stay home, thinking the inoculations might complicate chronic health conditions. Temporary vaccination clinics were reluctant to give older people a shot, since the facilities didn’t have their health records on hand. Neighborhood health workers and family members alike asked whether it was worth risking potential side effects when cases were essentially nonexistent in many cities.

Nicolas Tian, 24, urged his grandparents not to get vaccinated, citing concern over authorities restricting the doses to younger populations.

“In the beginning, people generally thought that people older than 60 years old were not suitable candidates for vaccination,” said Mr. Tian, who lives in the northeastern province of Shandong. He got vaccinated, but only because his government job required it.

Many public-sector workers were among the first groups to get vaccinated at a time when doses were still limited. While his employer called it a perk, Mr. Tian wasn’t convinced.

“We all knew it was treating us like lab rats, or at least I personally took it that way,” he said.

When his workplace later recommended that each employee find five people to get inoculated, he felt authorities had changed the requirements in a rush to boost the vaccination rate. He strongly discouraged family members from getting the shot.

“Although authorities said there was no harm in getting vaccinated, the popular thinking was that, ‘it is better not to have elderly people vaccinated.’”

Since approving Chinese vaccines, officials have provided little information other than to assure the public that they are safe.

People passing by a poster encouraging elderly people to get vaccinated against the coronavirus near a residential compound in Beijing in March.Credit…Tingshu Wang/Reuters

Authorities have recently approved six domestic vaccines, four of them in the past week. Two of the vaccines do not require a needle and are instead administered through a nasal spray or inhaled through a nebulizer, technology considered the frontier for the future prevention of Covid.

Health experts and doctors quoted in state media have embraced the inhaled vaccines, saying they are effective, safe and suitable for older populations, without providing detailed data.

“The most obvious advantage of inhaled vaccine is that it reduces the fear of injection,” Zhang Xin, a medical worker, said in the state-run news outlet Xinhua of Convidecia Air, a Covid vaccine developed by CanSino Biologics that was approved in September.

Scientists hope that by inducing an immune response in the nasal cavities and the lungs, an inhaled vaccine could offer significant protection, particularly against transmission. In reality, little is known about the real-world effectiveness of the new inhaled vaccines, which are being studied around the world but have not been broadly put to the test.

Early studies point to their potential power in fighting off severe illness. A nasal spray developed by Hong Kong University, together with Xiamen University and Beijing Wantai Biological Pharmacy, has proved in phase III trials to be 80 percent effective against Omicron as a booster following two doses of inactivated vaccines and 55 percent effective in unvaccinated people.

Even without complete information, the prospect of a coming tsunami of cases has been enough to prompt action.

Mary Ma’s grandmother is nearly 90 years old and has already received two shots. Ms. Ma, who lives with her grandmother and mother in Wuhan, where the virus first emerged in 2019, has worried about the adverse effects on seniors. She is also worried about inadvertently exposing her grandmother to Covid by taking her to get vaccinated, because she said the designated hospitals for vaccinations are the same as those that treat Covid patients.

But Ms. Ma, 24, said she recognizes that being up-to-date on vaccinations is more important than ever now that pandemic restrictions have been lifted.

“Even though my grandmother stays at home most of the time, I am still worried about the risk that our young family members may bring the virus back home,” Ms. Ma said.

“I think she should get vaccinated,” she said.

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