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Experts have been pushing China's government to ramp up vaccinations

A MARTÍNEZ, HOST:

As China weighs potentially easing its strict zero-COVID policies, we're going to hear about how we got here and what's to come with the University of Michigan's director of the Center for Chinese Studies, Mary Gallagher. Mary, much of China's struggle with COVID is linked to low vaccination rates. The country is going to stick with its own vaccines, which experts say are less effective than the ones being used in the U.S. and other countries. So how is this affecting vaccine hesitancy in China?

MARY GALLAGHER: Yeah, that's a great question. So China's vaccine hesitancy is mainly among older people, and it's been very difficult for the government to get particularly elderly vaccinated. They have hesitancy around side effects, and they have often been told by their own doctors that they don't need or that they shouldn't get the vaccines. So the advice on getting vaccines in China is actually the opposite, which is that older people maybe shouldn't get it, or if they have health conditions, that they shouldn't get the vaccines.

MARTÍNEZ: So doctors in China are saying for them not to get the vaccine that the government is providing.

GALLAGHER: That's been the case previously. I think with this new drive that they're going to have to change their tune because there's going to be a really big push in the next few weeks to get - what? - 90, 95% of the population vaccinated and boosted.

MARTÍNEZ: How big of a push, you think? How far is the Chinese government willing to go to get people vaccinated?

GALLAGHER: You know, they've been pretty careful. They don't have these really strict vaccine mandates that you've seen in other countries. They're trying a lot of enticements, you know, getting and giving people gifts or money. But I think what they'll have to do is starting to use, you know, not being able to travel and not being able to get certain types of benefits if they're not vaccinated.

MARTÍNEZ: I'm kind of surprised to hear that because your fear with an authoritarian country, that they wouldn't try to entice people. They would just say, this is what you're going to do.

GALLAGHER: Well, I think it puts them in a tough position. I mean, elderly people, you know, they're not - you don't want to be seen pushing elderly people around and poking them with needles when they don't want to be. So I think it's going to be really difficult to get that population vaccinated. They're going to have to use their children. And, you know, just trying to - not coerce, but, like, get people to think about, you know, getting China out of the pandemic requires that this elderly population gets vaccinated.

MARTÍNEZ: Why do you think China just didn't do a mass vaccination campaign a lot earlier in the pandemic?

GALLAGHER: Well, I mean, they did have - their vaccination rate has never been bad. It's always been high and certainly higher than the United States. But at the same time, they have been trying to develop their own mRNA vaccine for quite some time. So I think they've been waiting for better vaccines and maybe waiting for the big push to come with better vaccines. They're running out of time, obviously, because the protests have accelerated the need to reopen.

MARTÍNEZ: Now, China's zero-COVID policy has kept virus-related deaths low - remarkably low actually. Virus, though, has become more transmissible. And there are signs that the strategy is starting to fail. And lifting restrictions now, we're hearing, might lead to a huge surge in cases. Has China essentially wasted the past two years, Mary?

GALLAGHER: I feel like zero-COVID became a very successful policy. It was very associated with Xi Jinping, the leader himself. And I think it caused a big delay in thinking through what's the next stage in their COVID policies. And so they've, you know, they've basically sat on this policy that initially in 2021 looked great. And in 2023 and going into - 2022 and then going into 2023, it really doesn't look like the best policy. So they've wasted a lot of time, and now they're being pushed to reopen, I think, faster than they should be, given where they are right now with vaccinations.

MARTÍNEZ: Considering how closely associated, as you mentioned, zero-COVID has been to Xi Jinping, I mean, is this - how big of a crisis is this for him?

GALLAGHER: Well, if you look at what happened to Taiwan, for example, which, you know, also had a big surge in elderly deaths when they reopened, that's the fear that China has now, which is that reopening quicker, local governments are going to have to do this and experiment with, you know, moving away from zero-COVID. There'll probably be a lot of variation across the country. But they're at a risk of a big surge in elderly deaths if they do this too quickly. But at the same time, the economy is stagnating. And young people, as we've seen in the last couple of weeks, are really fed up with zero-COVID.

MARTÍNEZ: What do you think the chances are that Xi Jinping will kind of evaluate what's been going on lately and maybe rethink things or take a different track? Or is that just something that he just doesn't do?

GALLAGHER: Well, I think it all depends on what type of advice he's getting. And I think the big question that a lot of us have is, what type of advice is he getting? Is he getting good information? Do people have enough confidence to say to him, look, zero-COVID is no longer working, we need to try something new? Because that looks bad for him if it's so associated with him as the leader.

MARTÍNEZ: He just re-upped himself for another five years when traditionally that doesn't happen in China. Is this an opportunity for someone maybe in China, to talk about - maybe challenge his leadership at some point?

GALLAGHER: I think in the short term, no. I think he's pretty secure. He's put a lot of his own people into the top leadership. So I don't think I'm expecting anything to happen in the next couple of years at least. But, you know, Xi Jinping is a mortal man, and he will eventually have to pass on. So what's going to happen in the next five years is his people will now also be jockeying for, you know, the next leadership in five years. So I don't think he's out of the woods. And I think this has taken a big hit on his reputation, because as we move out of zero-COVID, we're going to see a lot of, you know, a lot of uncertainty about what's going to happen in China's health care system.

MARTÍNEZ: That's Mary Gallagher, director of the Center for Chinese Studies at the University of Michigan. Mary, thanks.

GALLAGHER: Thank you. Transcript provided by NPR, Copyright NPR.