Full Text & Analysis: China's 20 measures to optimize COVID controls
A turning point? Beijing insists it is NOT "relaxing" COVID controls or "opening up."
China’s National Health Commission on Friday, November 11, published a notice (CHN) that includes the much anticipated 进一步优化防控工作的二十条措施 20 measures to further optimize COVID prevention and control work.
The formulation of the 20 measures was announced on Thursday via the readout (ENG) of a Politburo Standing Committee meeting:
The Standing Committee of the Political Bureau of the Communist Party of China (CPC) Central Committee met on Thursday to hear a report on COVID response, discuss and arrange 20 measures to further optimize epidemic prevention and control work.
Xi Jinping, general secretary of the CPC Central Committee, presided over the meeting and delivered an important speech.
It was stressed at the meeting that the decisions and plans of the CPC Central Committee ought to be carried out in full, accurately, and comprehensively.
So the 20 measures, published the next day, are from the highest echelon of power. The Friday notice also underlined that
The Party Central Committee has made important arrangements and made clear requirements for further optimizing the 20 measures for prevention and control work. All localities and departments should implement the various optimization measures to the letter.
Why formulate the 20 measures? The notice says
Currently, SARS-CoV-2 is still mutating. Globally, it is still a pandemic. New domestic outbreaks continue to emerge. China is a large country with a large population, a large number of vulnerable people, unbalanced regional development, and insufficient total medical resources. There is still a certain scale of the COVID spread in some regions.
Affected by virus mutations and climate factors in winter and spring, the scope and scale of the spread of the epidemic are likely to expand further. The prevention and control are still serious and complex. We must maintain strategic determination, and be scientific and precise to do the work of prevention and control of the pandemic.
We must adapt to the characteristics of the rapid spread of the virus, be quicker in our actions to respond to the quick spread, take more resolute and decisive measures to curb the spread of the pandemic as soon as possible, and focus on the war to wipe out the virus in key areas. All departments should firmly unify their thoughts and actions to the decision and deployment of the Party Central Committee, completely, accurately, and comprehensively implement the decision and deployment of the Party Central Committee, unswervingly adhere to the people first, life first, unswervingly implement the "guarding against imported cases and a rebound in indigenous cases" general strategy, unswervingly implement the "dynamic zero-COVID” general policy, in accordance with the requirements of containing the epidemic, stabilizing the economy and keeping development secure, prevention and control and economic and social development should be efficiently coordinated.
We must further improve the political stance and fully understand that the optimal adjustment of prevention and control measures is not to 放松 relax prevention and control, not to 放开 open up, 躺平 "lying flat," but to adapt to the new situation of prevention and control and the new characteristics of the SARS-CoV-2 mutant, adhere to the established prevention and control strategies and guidelines, to further enhance the scientific and precise prevention and control, to maximize the protection of people's lives, safety, and physical health, minimize the impact of the pandemic on economic and social development, and implement the spirit of the 20th Party Congress with practical actions.
So, in Beijing’s own words:
COVID is likely to spread further in China in the coming months;
Beijing is sticking with its grand strategies on COVID; it is not “relaxing” COVID controls or “opening up.” It is merely making “optimizations.”
To make sure that the Chinese population do not 误读 misinterpret Beijing’s latest 20 measures, the notice repeats, in its final part,
Strengthen publicity guidance and policy interpretation. Strengthen the interpretation of the optimization and adjustment policy, emphasizing that we continue to adhere to the general strategy and general policy of prevention and control of the epidemic in China, guide the whole society to fully understand the importance of adhering to the people first, life first, adhering to "guarding against imported cases and a rebound in indigenous cases" general strategy and the "dynamic zero-COVID” general policy.
Guide the whole society to fully understand that further optimization of prevention and control measures is to prevent and control more scientifically and precisely. We must not cause misinterpretations such as a relaxation of prevention and control or even 放开 opening up or 躺平 "lying flat."
So, what are the 20 measures? Pekingnology provides a full translation done hastily.
Before the text, here are a few summaries, followed by some personal observations
International travel to China will be easier:
the “circuit breaker” of flights is now canceled, which will enable more flights;
just one pre-entry RCP testing is required;
the quarantine upon entry is reduced from “7+3” to 5 days at a hotel and 3 days at home;
special treatment for sporting events or business travelers who won’t have to undergo quarantine but they won’t be able to leave the “bubble.”
More importantly, a series of measures that will domestic life easier:
China will no longer trace secondary contacts - a close contact of a close contact -of a confirmed infection;
The scope of lockdowns will shrink considerably, limiting largely to single buildings or just part of them rather than a whole residential compound;
No more whole-of-district RCP testing typically involving long lines unless in extraordinary circumstances.
Preparations for a potential relaxation and opening-up, which Beijing insists it is not doing right now and has published no timetable or roadmap for:
Planning for a hierarchical diagnosis and treatment system, which theoretically is for infected persons with different severities of syndromes;
Speed up drugs for COVID infections;
Speed up vaccinations, in particular for old people;
Mapping out vulnerable people and their concentrations.
On the one hand, mobilize local actors to act as early as possible to get ahead of the massive spread in a certain region and warn local officials not to “wait and see”; on the other, ask local governments not to “arbitrarily” expand controls.
Take care of people in quarantine and those affected by COVID controls to ensure medical care and basic livelihoods.
Emphasize pandemic controls in schools.
Ensure factories must be running and the supply chain is not disrupted.
The cost of time and money in international travel to China will likely decline substantially. The appetite of foreign travelers is perhaps another matter, given the remaining cost, the long-time closure, and the uncertainties in domestic COVID restrictions. (Also, have you heard of the CT value?)
Domestic life, including travel, is supposed to get easier, as the most strict controls - many of which Beijing apparently maintains are not of its making but due to problematic local implementation - have been lifted.
Beijing apparently believes if local governments move fast enough, they can forestall broad lockdowns and hence huge costs in society. But presumably the rapid first response should involve some “hard” measures like targeted controls in the first place.
The 20 measures provide much more clarity and certainty by limiting local governments’ discretion. But some measures remain, arguably, open to interpretations. For example, there are quite some 不准随意 don’t arbitrarily in the text, such as 严禁随意封控 no arbitrary lockdowns. But what constitutes arbitrary lockdowns? Who is to decide which lockdown is arbitrary? The upside is, if I were to be optimistic, with the way the wind is blowing now, the local officials now would probably likely err on the opposite side of caution.
Fundamentally, Beijing believes it can control COVID spread and ensure some normality in life at the same time, despite the dominant Omicron variant being characterized by, in Beijing’s own words, 病毒快速传播特点 fast transmission. The best case scenario is certainly that the 既要又要 “not only-but also” approach in balancing competing demands is achievable.
The numerous sad tales across China’s social media on people under COVID control could not get timely medical care clearly have struck a nerve in Beijing, which has now (again) again ordered that medical care must be guaranteed.
Schools are for children and young people who have the least to fear from COVID. But the 20 measures dedicate one entire measure to schools, perhaps out of the meticulous care for the future generation and the need to alleviate their frustration for their education and life being tremendously disrupted for the 2nd year in a row.
Beijing hasn’t published a timeline or roadmap to a complete return to normality. To me, who writes with no inside info, that indicates such a thing doesn’t exist. Many apparently believe - or need to believe - such a timeline exists, but even if it - a huge if - does, presumably it can be adjusted as Beijing sees fit. I caution against believing in a certain date.
To return to life as it once was, vaccination is key. Beijing didn’t mention any foreign vaccines, despite German Chancellor Olaf Scholz announcing an agreement last week to let expatriates in China use the COVID-19 vaccine from BioNTech. Beijing is speeding up domestic R&D in vaccines.
Many people have been puzzled why China, with perceivably unparalleled state tools at its disposal, hasn’t been able to push and prod its senior citizens to pick up vaccinations. Whatever the answer, further vaccinating the old is back on the agenda, and local governments are expected to produce tangible results.
One of the biggest challenges will be to establish the 分级诊疗 hierarchical diagnosis and treatment system and make it work. That has one of the key goals of China’s reform of its medical care system long before COVID hits. The background is that ordinary citizens overwhelmingly prefer going to large hospitals, sometimes in provincial capitals and above, whatever their illnesses. Now, basically, Beijing asks for such a system - and an effective one - in a wartime scenario. If China can indeed get it up and running, which would forestall infected persons from overwhelming big hospitals, then it’s gonna be something huge and perhaps sustainable in the long run.
For that to happen, the key would be to educate the Chinese citizens that the vast majority of infections are not worth a visit to a big hospital and perhaps not worth a visit to any medical facility at all. Chinese citizens still retain horrifying memories of the fatalities from the early days of COVID, when the dominant virus was considerably more virulent and deadly. It would help a lot if an education campaign based on science and new facts could be rolled out.
Beijing tackles the problems arising from excessive COVID controls by adding a new layer - the 专班 task forces, such as requiring the establishment of the:
整治层层加码问题工作专班 task forces dedicated to tackling the problem of excessive steps at all levels.
生活物资保障工作专班 task forces dedicated to ensuring providing the necessities of life
教育部和各省级、地市级教育部门牵头成立工作专班，逐一排查校园 task forces to investigate and supervise the rectification of outstanding problems such as arbitrary campus closure and control
各地联防联控机制要成立专班，摸清辖区包括民营企业在内的企业和工业园区底数 task forces to find out the number of enterprises (including private enterprises) and industrial parks in their respective jurisdictions.
They are gonna have a very busy time. And the rise of 专班 task forces may be a worthwhile subject in studying recent Chinese politics.
Beijing insists that traditional Chinese medicine (TCM) shall play a role in treating COVID, in line with China’s general belief that TCM works. China, or at least the authorities and a huge part of the population, genuinely believes in TCM.
That promotion of TCM has been characterized by the European External Action Service as a part of a disinformation campaign.
There is a view in some quarters that COVID restrictions, especially the restrictions on international travel, exist not for COVID but to facilitate and sustain authoritarian control, power politics, and China’s intentional drifting away from the world. I see no evidence to back up that view and believe it is based on a drastic misunderstanding of Chinese policymaking and political realities.
Allow me to reiterate: at the end of the day, the implementation of Beijing’s desired 既要又要 “not only-but also” approach will be tested all across China, as the notice underlines at the end:
Both to oppose the irresponsible attitude and the ineffective implementation which will result in larger risks in terms of COVID prevention and control, AND to oppose and overcome formalism, bureaucracy, and resolutely correct simplistic, "one-size-fits-all,” excessive steps, and other (bad) practices.
And finally, as Beijing put it, twice in the notice
We must further improve the political stance and fully understand that the optimal adjustment of prevention and control measures is not to 放松 relax prevention and control, not to 放开 open up, 躺平 "lying flat"…
We must not cause misinterpretations such as a relaxation of prevention and control or even 放开 opening up or 躺平 "lying flat."
20 measures to further optimize COVID prevention and control work.
(1) For close contacts (of a confirmed infection), the measure of "7-day centralized quarantine + 3-day home health monitoring" is adjusted to "5-day centralized quarantine + 3-day home quarantine," during which the quarantined person is assigned a suitable health code and not allowed to go out.
One nucleic acid test is conducted on Days 1, 2, 3, and 5 during centralized quarantine, and one nucleic acid test is conducted on Days 1 and 3 during home quarantine.
(2) Timely and accurately determine the close contacts of a confirmed infection. No longer determine the secondary contacts (of a confirmed infection).
(3) The "7-day centralized quarantine" of people from high-risk areas is adjusted to "7-day home quarantine", during which they are assigned a suitable health code and are not allowed to go out. The nucleic acid test is conducted once on Day 1, 3, 5, and 7 of home quarantine.
(4) The classification of a region of "high, medium, or low" risk is adjusted to "high or low" risk to minimize the number of affected people.
In principle, these are the high-risk areas: the infected person's residence, the workplaces where they were involved in frequent activities and where the risk of COVID spread is high, and the locations where they were involved in frequent activities and where the risk of COVID spread is high.
High-risk areas generally refer to a part of the building or a building and shall not be arbitrarily expanded.
Other areas of the 县 county (including the county-level city and county-level district) where the high-risk area is located are designated as low-risk areas.
The high-risk area is re-classified to a low-risk area when no new infection emerges for five consecutive days. High-risk areas will be “unlocked” quickly when they meet the conditions.
(5) “7 days of centralized quarantine or 7 days of home quarantine" for people who work in high-risk professions and leave the “closed-loop” environment are now required to conduct "5 days of home-based health monitoring." They are assigned suitable health codes. Nucleic acid testing is carried out on Day 1, 3, and 5 respectively. They should not go out unless necessary. If it’s necessary for them to go out, they shall not go to crowded public places or take public transport.
(6) For places where there is no COVID case, the scope of nucleic acid testing on people who work in risky posts or who are key (infection-vulnerable) personnel should be determined in strict accordance with the country’s ninth edition of the prevention and control plan. The scope shall not be expanded.
Generally, there shall be no universal nucleic acid testing based on administrative regions. Universal nucleic acid testing should only be conducted when the picture of the spread is unclear, such as when the source of infection or the chain of transmission is unclear, or when there has been a community spread for a relatively long time.
We will formulate specific measures for the implementation of the specification of nucleic acid testing, reiterate and refine the relevant requirements, and correct the unscientific practices, including "two testings a day" and "three testings a day."
(7) Cancelling the “circuit-breaker” mechanism for inbound flights. Adjust the two negative nucleic acid tests within 48 hours before boarding to one negative nucleic acid test within 48 hours before boarding.
(8) For important business personnel and sports teams entering China, they will be transferred "point-to-point" to the quarantine-free closed-loop management area ("Closed-loop Bubble") for conducting business, training, competitions, and other activities.
During this period, they will be assigned suitable code management and cannot leave the area. The Chinese personnel shall complete the intensive vaccination of the COVID vaccine before entering the area and take corresponding quarantine or health monitoring measures according to the risk level after completing the work.
(9) For inbound personnel, it is clarified that the standard of determining a COVID case is that their CT value is below 35. When the quarantine period for inbound people is up, a risk assessment is conducted for those whose CT values are between 35 and 40. If the person is concluded to have been infected before, the person shall undergo "two tests for three days," be assigned a suitable health code, and not go out during home quarantine.
(10) For inbound personnel, the "7-day centralized quarantine + 3-day home health monitoring" is adjusted to "5-day centralized quarantine +3-day home quarantine," during which they are assigned suitable codes and are not allowed to go out.
The inbound personnel, after having completed quarantines at their first entry point, shall not be subject to a repeated quarantine at their destination.
One nucleic acid test is conducted on Days 1, 2, 3, and 5 during the centralized quarantine, and one nucleic acid test is conducted on Days 1 and 3 of the home quarantine.
(11) Strengthen building medical resources. We shall develop diagnosis and treatment plans based on the classification of the syndromes and the hospitals, the admission criteria for hospitalizing patients based on the different clinical severity of infection, and the different plans for infections within different categories of medical institutions and medical personnel. Do a good job in the training of medical staff. Prepare hospital beds and critical care beds, and increase treatment resources.
(12) Promote vaccination for COVID in an orderly fashion. We will formulate programs to speed up the coverage of booster shots, especially among the elderly. We will accelerate the research and development of monovalent or multivalent vaccines that have a broad-spectrum protective effect and promote the examination and approval following the laws and regulations.
(13) Speed up the COVID treatment-related drug reserves. Stock up supply reserves to meet patients' needs, especially the treatment needs of severely high-risk and elderly patients. Pay attention to enabling traditional Chinese medicine to play its unique advantages, and do a good job in the reserve of effective traditional Chinese medicine. Strengthen the reserve of emergency medicine and medical equipment.
(14) Strengthen the protection of key institutions and key populations. Find out the numbers of the elderly, patients with underlying medical conditions, pregnant women, patients with hemodialysis, and other groups, and develop programs to ensure health and safety. Optimize the management of nursing homes, psychiatric hospitals, welfare homes, and other places where vulnerable people are concentrated.
(15) Implement the "four early" requirements and reduce the scale of COVID spread and time for disposal. All localities should further improve the multi-channel monitoring, early warning, and multi-point trigger mechanism for COVID. For inter-provincial travelers, carry out testing upon their landing (at the destination). Find the infected persons and report them following the law promptly. Do a good job in contact tracing and the management and control of people with COVID risks. Strictly conduct early detection, early reporting, early quarantine, and early treatment to avoid the spread of the infections or the delay in response. Everyone must not “wait and see” or deviate from the national policy.
(16) Crackdown on the "one-size-fits-all" or the “various levels of local governments each taking excessive policy steps” approach. Local party committees and governments should shoulder the responsibilities, strictly implement the national, unified prevention and control policies, strictly forbid arbitrary closure of schools and classes, suspension of work and production, traffic blocks without (upper-level) approval, arbitrary lockdowns, arbitrarily sealing and controlling, indefinite lockdowns for a long time, arbitrary close of hospitals and other excessive steps. We will increase inter-governmental notification and public exposure (of such excessive steps) and severely hold those responsible for causing serious consequences by laws and regulations.
We will give full play to the role of the 整治层层加码问题工作专班 task forces dedicated to tackling the problem of excessive steps at all levels, where they will do a good job in collecting and transferring tip-offs and urge local authorities to rectify the situation promptly.
The National Health Commission, the China CDC, the Ministry of Education, the Ministry of Transportation, and other departments in charge of respective sectors shall strengthen the supervision and guidance of the sectors, increase the public exposure of typical “excessive steps,” and effectively play a deterrent effect.
(17) Strengthen the services and protection for those quarantined. All localities should establish task forces dedicated to ensuring providing the necessities of life. Develop and improve the plans for the market supply of necessities of life, distribution in lockdown regions, and joint supply of necessities between different regions. Do a good job in stocking the necessities of life.
Comprehensively survey the basic information of the resident population in communities, gather the information of elderly people living alone, children in distress, pregnant women, patients with underlying medical conditions, and other key (vulnerable) people. Establish a key personnel list, a list for their essential needs. Optimize the terminal distribution of necessities for lockdown areas.
Specify the task forces for the supply of household goods, set out fixed receiving points in the district, and streamline the distribution at the "last meter." Guide the community and medical institutions, pharmacies, etc., to establish a direct hotline, equip the community is equipped with dedicated vehicles, and do a good job of service connection.
Those at the hospitals who first take care of a patient must take responsibility. The system for critical care in emergencies must be implemented. There is no excuse for not giving treatment. Ensure the residents can receive medical care and medication.
Do a good job of providing psychological help to quarantined people. Increase the care of the elderly, the sick and disabled, and other special groups to help people to solve their practical difficulties.
(18) Optimize on-campus prevention and control measures. Improve the school-region coordination mechanism. Use joint prevention and control to strengthen the on-campus emergency response to COVID infections. Prioritize transits and quarantines from campuses, nucleic acid testing, contact tracing, disinfection, and providence of necessities. Enhance the emergency response capacity of schools to support schools to fastly respond to infections to get ahead of further spread.
All localities and schools should strictly implement the central government’s and education department's prevention and control measures and resolutely implement the scientific and precise prevention and control requirements without additional controls.
The Ministry of Education and the provincial- and prefectural-level education departments take the lead in setting up task forces to investigate and supervise the rectification of outstanding problems such as arbitrary campus closure and control, excessively long closure and control time, long periods without offline teaching, failure to keep up with life necessities, and inconsistent control requirements for the teachers, students, employees, and their families (who typically live in the same campus).
Rectify the problems of ineffective prevention and control and excessive prevention and control. Education departments at all levels set up complaint platforms and hotlines and conduct timely acceptance, referral, and response. Establish a system of timely tackling received complaints, improve the rapid response to problems and enhance feedback, and timely promote the resolution of the urgent problems facing teachers and students.
(19) Implement prevention and control measures at enterprises and industrial parks. All local joint prevention and control (of COVID) mechanisms in each place set up task forces to find out the number of enterprises (including private enterprises) and industrial parks in their respective jurisdictions. Develop COVID prevention and control plans in line with "one policy for one enterprise" and “one policy for one industrial park”
Enterprises and industrial parks must fulfill their respective responsibility in COVID prevention and control, establish a full accountability system for COVID prevention and control from the management of enterprises and parks to workshop teams and front-line workers, and refine the whole link and the whole process of COVID prevention and control accounts.
Strictly verify the risk of COVID-related personnel returning to work and confirm their health before returning to work. Strengthen the guarantee of life, COVID prevention, and rotation preparation for employees in key positions and processes, improve the management methods of third-party outsourced/contracted workers, and strictly manage the access to the enterprises and industrial parks.
During infections, we should make every effort to ensure the smooth flow of logistics. We should not require key enterprises that are related to the overall situation of the industrial chain and the people's livelihood to stop work and production without authorization (from upper levels), and implement the "white list" system.
(20) Facilitate the orderly travels of stranded people based on their situations. The regions where COVID spreads should accurately delineate the risk area promptly and allow the people who are currently in the region but from other places and are not in the high-risk area to leave after risk assessments to avoid them being stranded. They should take precautions on the way back.
In places where more people are stranded, special travel programs should be developed, and the places of departure and destination should strengthen information communication and collaboration to make proper arrangements under the premise of effectively preventing the spillover of COVID. Transportation, civil aviation, and national railway units should actively facilitate transportation capacity. The destination should enhance the sense of the overall situation, shall not refuse to accept the return of the stranded people, and implement preventive and control measures for returned people in accordance with requirements, both to avoid the spillover of COVID, and not to take excessive steps.
Wang Zichen, this is extremely well done; congratulations on fine work.
It strikes me that if all of these instructions are put into effect, one result will be a significant impact on China's current high rate of unemployment, especially of younger people. If they can somehow be responsibly and effectively implemented by administrative organs at all levels, they will require a very large number of "workers" to maintain the system for the foreseeable future. Could these Instructions have been conceived as a response to the unemployment situation in the PRC?
The implementation of vaccine rollout to the elderly will be key. It is far more important than any of the other announced measures.
What concerns me about the COVID measures in China is the disconnect between expert scientific opinion and the government’s implementation of anti-COVID measures. Chinese scientists are quite clear: it is imperative to vaccinate the elderly, particularly the over 80s. Let me repeat that. Vaccinate the elderly. A fantastic paper (https://www.nature.com/articles/s41591-022-01855-7), published back in May promoted such a campaign, stating that if China were to relax zero-COVID, over a million Chinese (mostly elderly and unvaccinated) would die within the first few months. However, this paper has been largely ignored at the policy level. Since then, there have been several more publications (e.g., https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2022.172, https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2022.173) that have stressed vaccination of the elderly. The original vaccine rollout was extremely tepid, failing to prioritize vaccination for over 60s. In some sense, this was understandable. The original trials of Chinese vaccines excluded over 60s. However, over the last few months, there has been significant evidence, based on outbreaks in Hong Kong and Shanghai (https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00345-0/fulltext, https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-022-02606-8), showing that the inactivated vaccines in use in China are exceptionally effective even in the elderly. China must follow the broad scientific consensus and vaccinate the elderly.
At this time, if pandemic restrictions are relaxed before this happens, omicron will spread and kill over a million people. The government restrictions cannot and should not relax until a proper vaccination campaign (primary vaccination series and booster dose) nears completion, which would likely take at least 6 months. Until then, I expect no change in messaging, as this would encourage spread.
The other option is to hope for a silver bullet that can prevent transmission: a new vaccine, for example. This is a bad strategy. Firstly, there is little evidence that any vaccine at this time, whether mRNA or otherwise can do this. Furthermore, while stage III trials can evaluate odds reduction of catching COVID following vaccination, they typically do not evaluate the effects of a vaccine on transmission. Secondly, many of the second-generation vaccines are being trialed as booster doses (e.g., https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00087-X/fulltext), rather than as primary vaccination series. By now, it is already near impossible to perform a phase III trial for a primary series vaccine. There are not enough cases in China to run these trials and abroad, most people have either been infected with COVID already, vaccinated, or both. Therefore, a new generation of vaccines may not help China deviate from zero-COVID since a significant number of elderly will not have received their primary series and so will not be eligible for a booster with a second generation vaccine. Furthermore, there may not be evidence that any of the vaccines prevent COVID transmission. Hence, even new vaccines cannot fully mitigate the risk needed to justify relaxing zero-COVID. The new vaccines may not offer proof that they halt transmission to the unvaccinated elderly.
In summary, there are only a few broad categories of strategy to exit the pandemic moving forward:
1) Begin to relax COVID restrictions before an appropriate vaccination campaign of the elderly. This will likely result in more than a million deaths and undo all the good work up until now. Therefore, this first approach is unlikely.
2) Hold tight until a new generation of treatments is available. The evidence that these new treatments work well on the immunologically naïve elderly in China will not be certain. The studies in which this new generation is tested will likely not be able to rule out transmission with complete certainty. They will also be unlikely to have been tested in large number of individuals who have not already been vaccinated with a primary series or already infected with COVID. Therefore, using such vaccines as part of a primary dose series will not have been rigorously tested. I think this strategy is possible, but unnecessarily risky.
3) Vaccinate the elderly now with current vaccines. This will take at least 6 months during which zero-COVID can be used to prevent spread. Re-evaluate the situation close to the end of the vaccination campaign. This is by far the best option, in my opinion. It provides the maximum amount of policy flexibility in the future. The downside is that vaccination of the elderly in large numbers may not be possible without mandates. But the pay-off would be significant. If, next year better medications and vaccines are available, these can still be used.