China Covid: Why is it struggling to vaccinate the elderly?
China Covid: How is it tackling the latest surge in cases?
(15 days later)
China says it plans to ramp up Covid-19 vaccinations among its elderly population.
Hospitals in China are reported to be filling up with Covid patients after the country relaxed its lockdown rules.
The move follows widespread anti-lockdown protests and the abandonment of its controversial zero-Covid policy.
The government says it will now ramp up its vaccination programme, having immunised relatively few people until now.
The relatively low vaccination rate for older people in China has been a major obstacle in relaxing the country's strict controls on the spread of the virus.
What are China's new Covid rules?
How many older people are vaccinated?
Following mass protests over its controversial "zero Covid" policy, China has dropped mass testing in cities and regions where there have been outbreaks.
In April this year, official data showed that only about 20% of over-80s had received two jabs plus a booster, while under 50% of the 70-79 age group fell into this category.
People can now stay at home if they have mild Covid symptoms, rather than being sent to a quarantine centre.
China is now stressing the need to accelerate these vaccinations among the elderly, who are more likely to get seriously ill or die from the virus compared with younger age groups.
There were widespread protests against China's rigid Covid restrictions
"All localities should....focus on improving the vaccination rate of people aged 60-79, accelerating the vaccination rate of people aged 80 and above," the country's National Health Commission has said.
Officially, China is reporting relatively low numbers of Covid cases and a tiny number of deaths.
The latest figures from the Chinese authorities, released as lockdown protests erupted across the country at the start of December, suggest there's already been marked jump in these over-80s vaccination rates to about 40% fully vaccinated with a booster.
Because it has ended its mass testing programme, Chinese authorities no longer have reliable figures for the number of Covid infections.
However, these Chinese vaccination rates for the elderly are significantly lower than, for example, those in the US and UK.
However, there are anecdotal reports of hospitals filling up with patients.
Figures from the UK in November indicate that about 80% of people aged 80 or above (living in England) had received a booster jab in the previous three months.
The World Health Organization (WHO) has asked it to provide specific data on disease severity and hospital admissions.
China is now reported to have set a goal of getting 90% of the over-80s to either complete the initial two-dose vaccination course or get a booster jab by the end of January.
China's hospitals seem to be filling up - WHO
Why have more older people not been vaccinated?
'Everyone I know is getting a fever' - Covid hits China
The head of China's Covid expert panel, Prof Liang Wannian, has told the BBC that vaccine hesitancy among the elderly is one issue.
"Many old people have underlying diseases. They reckon it won't be safe to get vaccinated. But in fact, it is safe." he said.
How many people have been vaccinated in China?
Unlike in other countries which targeted the elderly first, China prioritised the working-age population when it started its vaccine rollout at the end of 2020.
Official figures for November suggest Chinese health authorities have now vaccinated 40% of over-80s with two jabs and a booster.
Lockdown in Beijing: Restrictions have become increasingly unpopular
People in this age range are the most vulnerable to the virus.
It also tested its vaccines outside China in countries with much younger populations - and initially told its own elderly population there was not enough data on the effectiveness and safety of the vaccines to recommend they receive them.
This is a big improvement on China's past performance.
Community health infrastructure is also vital to vaccine rollouts, says Prof George Liu, of La Trobe University in Melbourne. He says this is lacking for the elderly in China.
In April 2022, fewer than 50% of people aged between 70 and 79 age had received two jabs and a booster, and fewer than 20% of over-80s.
"Unlike planned immunisation for children, community health facilities don't have a full name list and schedules for the elderly, and they don't have an existing process to ensure proper vaccination coverage for them."
China is now reported to have set a goal for 90% of its over-80s to receive either the initial two vaccination jabs, or both plus a booster, by the end of January.
Faith in locally-made vaccines has also been dented by a series of health scandals in recent years. These include safety issues and production standards for rabies jabs, as well as for diphtheria and tetanus.
However, vaccinations alone may not be enough to halt the surge in Covid cases.
Are Chinese-made vaccines effective?
Experts believe that because the Chinese population has been locked down so much, many people have not picked up "hybrid immunity".
China has developed and produced its own vaccines, which use an inactivated form of the virus to train the body to fight the whole virus.
This means they haven't gained protection both from being vaccinated and from being exposed to the virus through other people.
While effective, these are not quite as good as the mRNA vaccines used elsewhere in the world, which home in on the key part of the virus which infects the body's cells.
Why have so few elderly people been vaccinated in China?
Research suggests that two doses of the Pfizer/BioNTech mRNA vaccine would give 90% protection against serious illness or death, but it is 70% for two doses of Sinovac, one of the most widely-used Chinese vaccines.
When China's government started rolling out vaccines in late 2020, it prioritised the working-age population.
And long periods of lockdown in China have meant that there has been far less mixing of people.
It did not test its vaccines on many elderly people, and told them it could not say whether they were safe for this age group.
This has meant that even for those who have been vaccinated, there has been less exposure to the virus, and so less benefit from "hybrid immunity" - that is protection through a combination of vaccination and coming into contact with the virus itself.
The head of China's Covid expert panel, Prof Liang Wannian, says that made some people reluctant to get their jabs.
"It's this wall of protection built up... through natural exposure and effective vaccines, that have made Covid something most of the rest of the world is now willing to live with," says BBC Health and Disinformation reporter Rachel Schraer.
"Many old people have underlying diseases," he says. "They reckon it won't be safe to get vaccinated."
Add to that the fact that new variants of Omicron have emerged, which spread even among the vaccinated, and it makes the prospect of eliminating the virus even more unlikely.
Are China's Covid vaccines effective?
China has only used domestically-produced vaccines on its citizens: CoronaVac, made by a company called Sinovac, and Sinopharm.
Both use parts of a dead coronavirus to expose the body to Covid and stimulate the immune system to produce virus antibodies.
A vaccine production plant in Shanghai
A vaccine production plant in Shanghai
Why has China not used Western vaccines?
A US study suggests that Sinovac - the more widely used of the two - is only 66% effective at protecting against Covid infection and 86.3% effective at preventing death.
In the early stages of vaccine rollout during the pandemic, China made great play about its own production efforts.
Both Sinovac and Sinopharm are less effective than the mRNA vaccines made by Pfizer and Moderna which have been widely used in western countries.
Last year, it claimed to have made half of the world's existing stock of Covid vaccines.
These train the immune system to attack the spike protein on the virus - the part of the virus which infects the body's cells.
So it is not surprising that it has been reluctant to use vaccines developed elsewhere.
They offer 90% protection against severe disease or death.
Germany has urged China to consider using Western-developed mRNA vaccines. These are currently difficult to obtain in China, and only made available to foreign residents.
What do we know about China's Covid-19 vaccines?
China is believed to be developing its own vaccine using mRNA vaccine technology, but it is not clear when this might be available.
Which countries use Chinese vaccines?
Additional reporting by Wanyuan Song
Since the start of the pandemic, 64 other countries have used Sinopharm and 34 have used Sinovac.
They have been especially popular in Asian countries such as Indonesia, Thailand, Malaysia, Vietnam and the Philippines.
The Chinese vaccines can be stored in a refrigerator between 2 and 8C, while Moderna's mRNA vaccine needs to be stored at -20C, and Pfizer's at -70C.
Many developing countries use China's vaccines because they do not have the facilities to store large amounts of vaccine at such low temperatures.
Why has China not used Western Covid vaccines?
China claims to have made about half of all the world's Covid vaccine stock.
The government has refused so far to approve Western mRNA vaccines for domestic use. Germany has sent doses of the Pfizer vaccine to China, but they will only be given to foreign residents.
China is believed to be developing its own mRNA vaccine, but has not said when this might be available.
It reportedly asked US company Moderna to give it the technology behind its mRNA vaccine, but the company declined to do so.
