Covid-19 may have gotten its start in China, but the country seemed to be the first to contain it. Whether China can maintain that edge, though, is another question.

After months of successfully controlling the spread of Covid-19 in China, the virus has suddenly resurfaced in the northern part of the country — in Hebei, Heilongjiang, Jilin, and even in Beijing, necessitating a complete lockdown in nearby Shijiazhuang. Given the ongoing success of Chinese quarantine policies, these outbreaks will likely come under control in the coming weeks. But as the rest of the world inoculates against Covid-19, China faces a difficult choice between launching a mandatory inoculation campaign and continuing its quarantine from the world. Both scenarios will lead to heightened risks of limited outbreaks in China for months or even years to come even as other major economies obtain herd immunity from vaccination. 

It’s a surprising turnabout. For much of the past year, as the world has succumbed to Covid-19, China seemed to have successfully contained the spread of the disease after an initial phase of uncontrolled spread. The China model of adopting harsh quarantine tactics, testing at the grassroots level and mobilization of state resources across sectors led to the suppression of Covid-19 on mainland China for much of 2020 after March. One key to its success was the draconian quarantine policy for overseas travelers, including returning Chinese citizens, who had been required to quarantine in designated facilities for 14 days upon arrival from other countries. As Covid cases multiplied around the world, China largely prevented the round-tripping of the pandemic until December, when a major cluster broke out in Hebei, necessitating a city-wide lockdown and an additional 7-day quarantine for international travelers. 

Now, as Covid vaccinations ramp up in the rest of the world, China faces two unpalatable choices. First, the Chinese government can maintain the current policy of quarantine and containment. But, as the rest of the world obtains immunity, especially the key economies of the U.S., Europe, Korea and Japan, will China be comfortable with allowing travelers with proof of vaccination into its border? Given the political pressure on Chinese officials to prevent outbreaks, those in charge of immigration policies will likely continue to insist on 14- or even 21-day quarantines for international travelers, including returning Chinese citizens. Such a burden will deter most international businesspeople, academics, and visitors from going to China, which will, in turn, impose both absolute and relative costs on China as commerce and tourism into and out of China will continue to be hampered. As long as Covid remains prevalent in some parts of the world, China likely will not relax its policies, thus imposing economic costs on the country for months or even years to come. In the meantime, it is probable that the economies of the U.S., Europe and Northeast Asia will return to normalcy by the fall of 2021. Without additional policy interventions to provide the Chinese population herd immunity, this state of affairs might continue indefinitely. 

As the rest of the world inoculates against Covid-19, China faces a difficult choice between launching a mandatory inoculation campaign and continuing its quarantine from the world.

An alternative scenario might have China launching its own mass vaccination campaign so that the population achieves herd immunity. But here too, the trajectory is far from clear. The latest data from the Butantan Institute in Brazil suggest that the Sinovac vaccine — the first Chinese vaccine approved by the Chinese government — had efficacy as low as 50.4 percent, which is far lower than the efficacy of leading Western vaccines. Thus, even if sufficient supply can be secured, which is an enormous hurdle in its own right, the Chinese government will still face two issues. 

First, even if China can give the Sinovac vaccine to 700 million Chinese — roughly half the population — before the end of 2021, it would only protect roughly a quarter of the population based on the latest efficacy ratio, which falls far short of the threshold for herd immunity. If China insists on relying on the Sinovac vaccine, herd immunity through inoculation may not come until well into 2022 or even 2023. 

Second, given the relatively low efficacy and the opaqueness of the testing process, many Chinese citizens may not want to receive the Sinovac vaccine even with government encouragement. Mandatory vaccination has already commenced for some front-line workers in China, but mandatory shots for China’s health-conscious upper-middle class may lead to an across-the-board backlash both online and even on the streets, which would be highly unpalatable to the government. More likely, the upper-middle class will go on “holidays” overseas en mass in order to seek vaccination elsewhere. Not only would this be embarrassing to the Chinese government, it would lead to hundreds of thousands more travelers being placed in quarantine upon their return, taxing the current quarantine capacity in major cities. Moreover, will these citizens be content with following the government’s draconian quarantine and contact tracing policies after they themselves have obtained immunity? In any event, imposing the Sinovac vaccine on China’s increasingly savvy population likely will delay herd immunity much longer than is necessary. 

Unless a more effective Chinese vaccine emerges, China’s best course of action may be to import or license the leading vaccines developed overseas, such as the Pfizer-BioNTech and Moderna vaccines. These vaccines have been widely tested on a large number of subjects, and the data have been scrutinized by regulators in the U.S. and Europe, as well as by global experts. Chinese citizens, if given accurate information about these vaccines, should be willing to receive them. China has already secured 100 million doses of the BioNTech vaccine through a deal between Chinese pharmaceutical giant Fosun and BioNTech. Given the enormous fiscal capacity and a healthy trade surplus, China can afford to expend tens of billions to secure sufficient vaccines for the majority of its population before the end of 2021, followed by full population vaccination in 2022. If a licensing arrangement can be worked out, China would contribute its considerable pharmaceutical production capacity toward producing proven vaccines for China and for the world. Although the trade surplus might be compressed for a few quarters, importing proven vaccines may pave the surest route toward herd immunity for China. 

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