(NEW YORK) -- Over the past several days, protests have erupted in cities across China, as citizens push back against the country's so-called "zero COVID" policy.
Since the virus began spreading across the world in January 2020, China has enforced harsh restrictions, including lockdowns and mass testing in an attempt to prevent outbreaks.
As most countries ease mitigation measures and focus on the importance of vaccination and boosting, China has kept the strict policy in place.
But public resentment over the disruption to daily life is growing, posing a problem for leader Xi Jinping and the ruling Chinese Communist Party.
"The Chinese government does not have a plan B or has not prepared for a way out of this zero COVID policy, and all these lockdowns," Dr. Ali Mokdad, an epidemiologist with the University of Washington's Institute for Health Metrics and Evaluation in Seattle, told ABC News.
"You cannot keep a country locked down. Why? Because right now what's happening in China is the economy has been impacted, the livelihood has been impacted and as a result, lives are being impacted meaning more mental health [crises], quality of life is really bad, more chronic conditions," Mokdad said.
China implements its zero COVID policy
After the first cluster of patients were discovered in Wuhan in December 2019, a public notice was released on Dec. 31 and, about a week later, Chinese officials announced they had discovered a novel coronavirus.
Lockdowns were implemented in Wuhan, then in the larger Hubei Province -- where Wuhan is located -- and lastly in most of China. Travel was banned and those who tested positive for COVID with mild or moderate symptoms were removed from their homes to prevent household transmission.
COVID-19 cases peaked in China in early February 2020 before declining to low levels by the end of summer 2020.
At the end of the first wave, the Chinese Centers for Disease Control and Prevention published an article arguing for a zero COVID strategy over more lax mitigation measures.
"The successful containment effort builds confidence in China, based on experience and knowledge gained, that future waves of COVID-19 can be stopped, if not prevented," the authors wrote. "Case identification and management, coupled with identification and quarantine of close contacts, is a strategy that works."
Only about 5,000 deaths have been reported in mainland China since the start of the pandemic, fewer than most countries with large populations including the U.S. and the U.K.
"The COVID policies were very effective in preventing people in China from getting the infection and dying, and that was a real achievement for the Chinese government," Robert Sutter, a professor of practice of international affairs at George Washington University -- with expertise in U.S.-China relations and China's domestic and foreign affairs -- told ABC News. "In 2020, they looked really good compared to the United States in particular, and they were handling it just fine and it was working well."
"With the severe lockdown in Wuhan, they bought us time, all of us to be prepared and the Chinese health officials early on were really open about what they are seeing shared information, which really helped everybody's response," Mokdad added. "So, we need to give them that credit."
Following the first outbreak, similar strict measures were enforced to control outbreaks happening elsewhere in China. But cases are now on the rise and the country reported its first COVID-19 deaths since May.
"Right now, the Chinese government, the policy that they have implemented, as successful as it was in the past first year, is a failure right now quite honestly," Mokdad said.
Less effective vaccines
In July 2020, the Chinese government allowed the Sinovac COVID-19 vaccine to be administered under emergency use authorization. More than 90% of the population has been vaccinated, according to the government.
However, research has shown the Sinovac vaccine is just 60% effective at preventing severe disease compared to 90% for the Pfizer vaccine and 97% for the Moderna vaccine.
What's more, when it comes to booster shots, only 69% of those aged 60 and older and 40% of those aged 80 and older have gotten boosted.
A combination of low vaccination rates and people not being exposed to the virus due to lockdowns has led to low immunity coverage.
"So, here you have a country that started a policy of locking down, but it resulted in less immunity," Mokdad said. "The country, at the same time, has low vaccination coverage, a vaccine that is not effective or has low effectiveness against Omicron and all the variants that came after."
He added, "So now if they open up, what will happen is they'll have more cases, more mortality. They'll overwhelm their hospitals."
Sutter said it's not clear why the Chinese government has rejected the Pfizer or Moderna vaccines, but it may be due to rejecting medicine from the traditional West in favor of their own vaccines or trying to convince the rest of the world they have the situation under control.
"On the one hand, they don't want to bring in the U.S. vaccines given the state of their attitude toward the United States," Sutter said. "And on the other hand, they don't want to acknowledge that they mishandled the situation."
During the early days of the lockdown, Sutter said there was support among the Chinese public for the stringent measures.
However, tensions have been rising and protests have rung out in cities across China, including Shanghai, Guangzhou and the capital Beijing, after a fire in a high-rise building in Urumqi, a city that was under lockdown, led to the deaths of 10 people.
People have questioned whether COVID restrictions prevented residents from fleeing the burning building and first responders from helping.
In addition, the Draconian measures have also led to food shortages and have prevented people from visiting doctors' offices for non-COVID-related visits.
"The zero COVID policy, it's very disruptive for people's lives and it leads to a lot of frustration," Sutter said. "This has been going on now for three years and so I think there's just a fatigue factor with it all. And people are fed up with the policy, particularly, as they learn more about other countries in the world, they're all opening up."
The government has tried to appease protesters, with Beijing announcing gates will no longer be erected around apartment complexes where COVID-19 cases are detected.
Sutter said he believes local officials may be worried about lifting restrictions because they will get blamed for any deaths.
"The local officials seem to be under the impression that they're going to be held responsible if there are deaths in their area," he said. "So, it leads to a very confused situation with a lot of local officials being cautious and therefore not changing the zero COVID policies because if they have a lot of deaths, they will be held responsible, and they will suffer the consequences."
Meanwhile, over the last week, China has been reporting a record number of COVID-19 infections, mainly due to more transmissible variants.
Mokdad said if China is ever to exit from the zero COVID strategy, officials need to convince the government to accept more effective vaccines and to ease restrictions slowly.
"That's the key message for the Chinese government, that the virus is not going anywhere," he said. "It's mutating, and we have more deadly or more infectious variants. And unless you have immunity, you're not going to be able to avoid getting infected. And the only way to get immunity is either through infection, which we don't want, or through vaccination."
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