China forces pace of vaccinations with persuasion … and some cash

Early in March, when the Covid vaccination rate in the UK had reached 30% of the population, China’s top respiratory expert Zhong Nanshan revealed in a webinar that the figure in China was barely 3.56%.

The low vaccination rate was worrying the country’s leaders, as new variants continued to emerge across the world. By the end of February, only slightly more than 52m doses of Covid vaccines had been administered in China – a country with more than 1.4 billion people.

But Zhong – also one of Beijing’s most trusted medical advisers – said that China would aim to inoculate 40% of its population by the end of June, while admitting it was going to be a challenging task ahead. “We don’t have much time, and we still have a large amount of work to do,” he said.

Without charting a path to achieving “herd immunity”, the current policy of zero-tolerance for cases meant, for example, that an entire neighbourhood in the southern city of Guangzhou was shut down for door-to-door testing yesterday, because of a handful of positive cases.

A national mass vaccination programme began roaring into action three weeks after Zhong’s pledge. Provinces and cities then came up with their own plans to meet the target, and to compete with each other.

Vaccination production was accelerated, too. On 1 February, only 1.5m doses were produced. But by 24 March, the capacity had been raised to around 5m doses daily. And on last Thursday alone, more than 20 million people were injected. Nearly 603m doses had been administered as of Saturday, according to the National Health Commission.

Some Chinese experts now say that the country is on its path to achieving “herd immunity”. George Gao, director of the Chinese centre for disease control and prevention, told Chinese media that he hoped between 900 million and 1 billion people can be vaccinated by the end of this year or early next year.

So how did China turn itself from laggard to leader in vaccinating its massive population in less than three months?

Persuading the nation

Although the pandemic was first identified in China, Beijing’s vaccination programme began unimpressively. “Just like a certain population in the United States, some Chinese people are also hesitant about the vaccine,” said Huang Yanzhong, an expert on public health in China at the Council on Foreign Relations in New York. In January, a survey of 1.8 million residents in Shanghai showed that only half said they would get vaccinated. A month later, another survey of health care and epidemic prevention workers in neighbouring Zhejiang province showed that highly educated people and medical workers were particularly unwilling to be vaccinated. Among them, nearly 58% worry about potential side-effects.

But then, the national government deployed a range of carrots and sticks to persuade the public. And like most nationwide campaigns in China, it started with a top-level speech.

On 22 March, vice premier Sun Chunlan, according to state news agency Xinhua, asked departments and localities to improve organisation and coordination.

“Sun’s speech also marked a shift in Beijing’s strategy from heavily exporting vaccines overseas to prioritising its domestic rollout,” noted Huang. “Inevitably, that meant a slowdown in shipment of Chinese vaccines to countries such as Brazil and Turkey – both have ordered Chinese vaccines.”

Vaccination centres were set up across the country – in hospitals, neighbourhoods and in electronics markets. Civil servants, girl bands and even NBA basketball star Yao Ming were seen persuading their neighbours to be vaccinated. Communist party members and employees at state-owned enterprises were urged to be role models.

Well-known public figures such as Dr Zhang Wenhong, a Shanghai infectious disease expert whom the New York Times called China’s Dr Fauci, went on television to warn of the danger of complacency. “Just as everyone thought there was no longer any problem, then the epidemic suddenly returned,” he said this month.

In Shanghai, some neighbourhoods rewarded each newly vaccinated person with 300 yuan (£33); others gave out milk, eggs and washing powder. In Sichuan province, its health commission has this month released a rap song called Get Jabbed Quick.

But perhaps the most powerful tool of persuasion was sporadic outbreaks across the country. In mid-May, four locally transmitted cases were recorded in a small city in east Anhui province – China’s first in 20 days. Local officials highlighted the fact that the infected had not been vaccinated.

The results? On 27 March, barely 100 million people had been vaccinated. By 21 April, an additional 100m doses had been administered. After this, according to Chinese media, it only took the authorities 16 days to inoculate a further 100 million people.

The momentum carried on through May. On 23 May the authorities reported that more than half a billion people had been vaccinated.

State media has praised the government’s efficiency, calling it the “China speed” vaccination. “The challenge of realising herd immunity for the world’s most populous country is obvious, but the ‘China speed’ of vaccination has lit the light at the end of the tunnel,” Xinhua gushed.

“It’s been fantastic news so far,” said Ben Cowling, head of Hong Kong University’s epidemiology and biostatistics division. He said that at the current pace, more than 50% or 60% of the population could be vaccinated by the end of the summer. “Once coverage goes above 60% to 70% it would be quite safe to start relaxing some of the Covid measures such as on-arrival quarantines,” Cowling added.

But Huang is not as confident. He pointed to countries that have been using Chinese vaccines and are still seeing outbreaks. “Seychelles, for example, has largely used Chinese vaccines, but we are still seeing high infection rates. That might have something to do with the relatively low efficacy rate of the vaccines.”

“The virus won’t go away, and perhaps it’s time to update our thinking on the so-called ‘herd immunity’. If China insists on its current policy of zero-tolerance for Covid cases, then it’s going to be a big challenge moving forward. Ultimately, we need to live with the virus.”

Additional reporting by Jason Lu