With the Delta variant spreading is China’s ‘zero tolerance’ Covid approach over?

As the highly transmissible Delta variant continues to spread across at least 17 provinces, China is facing a new dilemma: is its once-successful “zero tolerance” approach to containing the spread of the virus over, and what comes next?

Unlike Britain and Singapore, where officials have explicitly encouraged people to “learn to live with the virus”, China has yet to officially shift its messaging.

But experts are asking what next for the country’s strategy, now that it’s clear the virus is not going away any time soon. Last week, the Chinese virologist Zhang Wenhong – widely known as “China’s Dr Fauci” – wrote in an essay about the need for the “wisdom” of long-term coexistence with the virus.

Zhang said the recent outbreak in the eastern Chinese city of Nanjing should serve as “food for thought for the future of our pandemic response”. “The data tell us that even if each of us were to be vaccinated in the future, Covid-19 would still be endemic, but at a lower level with a lower fatality rate. After the liberalisation of vaccines, there will still be infections in the future,” he wrote.

Less than a week after Zhang’s opinion piece was published, the Delta variant has now spread to more than half of China’s 31 provinces, shutting down transport routes. On Wednesday, China reported 96 new cases, 71 of them locally transmitted. Residential areas, including those home to more than 10,000 people in the capital, Beijing, have been sealed off for mass testing. In Wuhan, where the virus was first reported in late 2019, authorities have begun testing all 11 million residents.

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The debate over the merit of China’s zero-tolerance strategy has, in fact, been around for some time. Last year, Wang Liming, a professor at Zhejiang University urged the government to adjust the wartime thinking of “elimination” as the red line.

“We need to accept the fact that Covid is going to be around for a long time and that it will coexist with humans, [therefore we need to] abandon unrealistic KPIs [key performance indicators] such as short-term elimination,” Wang wrote.

In the last 12 months, as countries around the world struggled to control the spread of the virus, China’s approach led to its citizens living a largely virus-free life. There were sporadic cases in parts of the country, but they were swiftly contained by the government.

China’s success – including its economic growth as most nations recorded sharp downturns – also fed into a narrative that its system is more superior to its counterparts in the west. “Judging from how this pandemic is being handled by different leaderships and [political] systems around the world, [we can] clearly see who has done better,” the president, Xi Jinping, told a meeting at the central party school early this year.

In practice, this strategy is closely linked to local officials’ performance. On Saturday, Fu Guirong, the director of the local health commission in Zhengzhou, central Henan province, was sacked after the city reported a few positive cases. Last year, Fu was given a national award for her contribution to the country’s anti-virus effort.

Residents line up for Covid-19 tests near a banner with the words ‘Epidemic is the order’ in Wuhan in central China’s Hubei province Photograph: AP

Beijing’s thinking, according to experts, was to keep new infections to as low as possible while rolling out its nationwide mass vaccination programme, which Reuters calculated should have covered about 61.1% of the population.

However, “China’s ‘zero-tolerance’ policy is seeing its diminishing return, and the cost of implementing it is becoming higher and higher,” said Huang Yanzhong, a prominent Chinese public health expert at the Council on Foreign Relations in New York.

“You can sustain this policy for a year, but since the virus is going to linger for a long time, can you do it for more than two years? Three years? Or four years? And at what cost?” Huang questioned.

Part of the problem, according to Huang, is also to do with China’s homemade vaccines. “The efficacy of the Chinese vaccines is still uncertain given the data we have seen so far. And on top of that the virus is continuing to mutate into new variants from elsewhere,” he added.

Residents register before getting inoculated against Covid-19 at a vaccination site in a stadium in Nanjing, the capital of Jiangsu province in eastern China. Photograph: Xinhua/Rex/Shutterstock

But despite the apparent shortcomings of China’s current strategy, others argue that it’s unrealistic to see Beijing officially change tack overnight. “China is too big for a swift turn,” said Jin Dong-Yan, a professor at Hong Kong University’s school of biomedical sciences. “It takes time to educate the political leaders and any change has to be gradual and one small step at a time.”

The health blogger A’bao wrote: “Many people are voicing their opinions that we are paying too high a price with a ‘zero-tolerance policy’ and we should give it up and learn to coexist with it. I think the answer is no. We humans will coexist with Covid for the long term for sure … But not every country has the courage, determination, execution, and sacrificial spirit that China has … Though China paid a high price for a ‘zero tolerance policy’, it also minimised the influence of Covid on our lives.”

Contrary to the alarm shared by many scientists, Jin thinks that, at the moment, the spread of the Delta variant in China is “very limited” and “should be under control soon”. Yet Beijing’s mentality has implications for a much bigger question: even if the authorities contained the current situation, when will China reopen its borders?

“It may take them forever to reopen the border. They have no self-confidence and they don’t trust others. They know that their vaccines are not doing a good job in preventing infection,” Jin said. “They should have opened the border to Hong Kong [a long time ago] … However, they did not do anything even when we had zero cases for 50 days.”