Thread by @SGriffin_Lab

OK, so China...
Do I agree with some of the draconian measures used to implement their COVID strategy? Of course not.
However, there are some laudable achievements at play. Their test/trace/isolate network is incredible. They have also kept deaths right down following the first

emergence of SARS2 back in 2019. No small feat in a country of 1.4 bn inhabitants. If they had the same deaths/100k as the UK we're talking an unprecedented humanitarian crisis. Sadly, we may be about to see a version of this.
Have they completely unlocked and r "living" with

the virus? Well, no. In fact, they retain a pretty good set of mitigations, the likes of which would be great to see here.

So, what's the problem? Well, China simply doesn't have the extent of vaccine/infection induced immunity that we have. They made their own killed virus vax,

which is less effective than our mRNA vaccines. Killed vaccines also tend to be better at inducing antibody responses than Tcell responses, but there's a spectrum. Could they have accessed our vaccines? Yes, but at huge cost I imagine, but worth it IMHO. I don't know enough on

the geopolitical stuff around acquiring them to comment further...@globalhlthtwit?

So, OK, the vaccines are less than ideal, but they also adopted a different policy in terms of their rollout, open to all ages, not necessarily prioritising older/vulnerable people. This is a real

issue in terms of susceptibility of their population to severe COVID. They have also yet to update their vax wrt circulating strains AFAIK.

So, yes, their vaccine programme is a major Achilles heel. But, they also would have been incredibly unwise to allow infection to run riot

in the way the UK and other countries have...not that this was wise at all!
A lot is made over how we're in a better position now in terms of our population immunity, but this has come at a price. >200k deaths, long COVID, other morbidity and predisposition to other sequelae are

nothing we can ignore. We are also immensely privileged by being able to boost frequently ahead of pandemic waves, which has certainly blunted their impact during 2022, but even so we have seen ~30k deaths from a so-called "mild" disease...💔🙄🤦‍♂️🤬, more than 2 million currently

"live" with long COVID, including 10s of 1000s of children.
We also retain a considerable proportion of our population that isn't protected by vaccination, mainly young children (don't get me started 🤬🤬🤬), but there are inequities by race, deprivation and even geography.
Now,

do some maths, imagine this scenario in a country with 1.4bn people...this is why antivax morons are exactly that.
So, yes, China is definitely at fault in terms of vaccines. But, their COVID policy had worked in terms of suppression, notwithstanding the human rights problems. So

why stop? They had spent most of the last few years actually living WITHOUT COVID. Yes, local restrictions were harsh, and I don't condone them at all, but just consider, this is the country where SARS2 emerged from, and they only now import cases...suppression impossible? Nope.

Sadly, we may now see a repeat of the BA2 outbreak in Hong Kong from spring 22, but upscaled to the nth degree 😢
China is over a barrel, it has made mistakes re vax, but the threat remains external from unlocking.
Should we impose travel restrictions, testing etc? Well, in

theory yes, but this seems futile and hypocritical given the remaining 6 bn people on the planet aren't similarly restricted...glass houses etc.
Is there concern re a new branch of viral evolution occurring in China? Well, yes, of course. However, this again applies across the

planet. Johnson did nothing to prevent delta being imported in 2021 despite his "roadmap"...why, I wonder?
The Chinese population will represent a very different mixing pot, so yes, we could see something different emerge,but the reduced immune pressure may also mean a China

variant is less able to thrive elsewhere...of course, evolutionary freedom could cause something else as well.
Viral diversity is never a good thing, but we seem to apply this principle unequally. Omicron subvariants are emerging relentlessly across the planet, we see multiple

and sequential waves of dominant strains in different parts of the globe...Hong Kong shows us that the Govt stance of tolerating such waves rests predominantly in our immunity, something China simply doesn't possess at present.
So, yes, virologically, test test test, limit

travel, etc, but if you do this in one place, do it for others. Omicron was from Africa, Delta from India, Alpha...from the UK!

Ultimately, what I think China and our approach show us is that in the vaccine era, which we MUST remember is SO fortuitous, neither suppression, nor

vaccines only work alone. Immunity and viral diversity remain in constant flux, we can't win the race unless we slow the virus down. However, this neither requires draconian measures, nor "restrictions" if we combine excellent vaccines with variant agnostic NPIs, with additional

benefits for other diseases, pollution etc. Please don't start immunity debting, we can do sooooo much better.
#VaccinesPlus