China’s rulers are accusing “hostile forces,” including foreigners, of inciting street demonstrations in more than three dozen Chinese cities and many more universities in the biggest domestic political challenge for Beijing since 1989’s Tiananmen Square protests.

At stake is the legitimacy of the ruling Chinese Communist Party as protesters question its management of the COVID-19 pandemic. The government has used repressive methods such as repetitive mass testing, quarantines, and lockdowns resulting in large-scale unemployment and economic loss.

Jolted, the government is handling the new situation cautiously. Though several instances of police violence have taken place, state repression has not reached the magnitude initially feared. The government is depending more on propaganda to evoke nationalistic sentiments and using politically divisive methods to address some of the problems highlighted by protesters, according to analysts.

“We must resolutely crack down on infiltration and sabotage activities by hostile forces in accordance with the law, resolutely crack down on illegal and criminal acts that disrupt social order and effectively maintain overall social stability,” the CCP’s Central Political and Legal Affairs Commission (CPLAC) said in a statement released Tuesday.

Bucknell University political scientist Zhiqun Zhu said the statement is a direct reference to foreign forces attempting to fan the flames of political unrest.

“The definitions of ‘infiltration’ and ‘sabotage activities’ are very broad. Even a foreign journalist reporting on site is viewed with suspicion,” Zhu told VOA. “Social media postings and commentaries on the protests are also considered adding fuel to the fire.

“In this context, foreigners offering critical comments about the protests or making contacts with protesters are easily blamed for instigating, shaping and guiding the demonstrations,” he said.

By blaming unrest on foreigners and foreign governments, analysts said, Beijing can whip up nationalist sentiments that weaken the protest movement.

An estimated 43 protests across 22 Chinese cities unfolded between Saturday and Monday, according to the Canberra-based Australian Strategic Policy Institute, and some analysts say the protests have since spread to more cities and towns.

China’s leadership is trying to meet some protest demands to lift COVID-19 requirements such as lockdowns, mass testing and quarantines, and several locked-down areas and restaurants in the southern Chinese city of Guangzhou — a manufacturing hub hit hard by the latest COVID-19 outbreaks — reopened Wednesday.

“I believe that in the next few days most of the locked-down areas across China will be reopened,” Hu Xijin, former editor in chief of the Global Times and a strong Communist Party voice, said in a video statement on the paper’s website.

Hu indicated this would likely be done to maintain social stability. “As lockdowns are coming to an end, the biggest factor for public discontent will be eliminated. It will have a very positive effect on maintaining social stability,” he said.

Instead of using batons to keep protesters in line — a normal strategy for Chinese riot officers — police are busy identifying possible rebels and troublemakers and checking phones to find out whether they have been circulating protest images on virtual private networks and accessing banned sites such as Facebook and Twitter.

Tuesday’s statement by CPLAC said agency officials had emphasized that “political and legal organs must take effective measures to … resolutely safeguard national security and social stability.”

Will protests persist?

Analysts differ on whether the protests — which are demanding democratic freedoms and an end to censorship — are likely to continue.

“It is unlikely that there will be more large-scale protests in the near future,” Zhu said. “New policies are being rolled out to loosen COVID-19 controls. It is also expected that the ‘zero-COVID’ policy will be replaced by more scientific and pragmatic measures,” he said.

Others disagree.

“More protests will emerge in different parts of China in the coming days, although the authorities may try to suppress them,” said Jagannath Panda, head of the Stockholm Center for South Asian and Indo-Pacific affairs at the Institute for Security and Development Policy in Sweden. “The Communist Party’s image has taken a severe beating because of widespread unemployment and the government’s repression.”

Salih Hudayar, an activist leader of the Uyghur Muslims of Xinjiang, said China might even use the military to suppress the protest movement. The suppression of Uyghurs has drawn the attention of human rights activists and several foreign governments.

“The Chinese government has already started to crack down on the protests by intimidating protesters and arresting many of them,” said Hudayar, prime minister of the self-styled East Turkistan Government in Exile.

“Because there is not any meaningful political support from the international community, it’s highly likely that the Chinese government will use military force to suppress the protests in the coming weeks, if not days,” he said.
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In the highly conservative country of Pakistan, AIDS patients often face discrimination that keeps them from disclosing their diagnosis. Hundreds of HIV cases reported in Sindh Province in 2019 included children. That region was recently devastated by floods, making access to health care for HIV patients even more difficult. VOA’s Sidra Dar reports from Sindh Province, in this report narrated by Asadullah Khalid.
Camera: Muhammad Khalil
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As much of the world returned to some kind of new normal in 2022, China remains the only country sticking to a strict “zero-COVID” policy to control the spread of a global pandemic. While credited with saving lives, the policy slowed the economy, exacerbated supply-chain disruptions, cost millions of jobs, forced a large portion of Chinese residents into some form of lockdown for months, and is now, experts say, forcing Beijing’s leadership to seek a way out of a problem they don’t admit having.

Over the last weekend in November, protests against the zero-COVID policy erupted across China, the country where the virus was first identified in humans in late 2019 and where authorities in Wuhan, site of the initial outbreak, locked down millions of residents for most of the first four months of 2020.

That draconian step saved thousands of lives, according to Chinese figures, and since then many Chinese have compared the 6.6 million deaths worldwide to Beijing’s official count of just 15,986 deaths. The U.S. alone has lost more than 1.08 million people. Beijing’s policy emphasized “always putting the people and their lives above everything else,” according to a November 25 analysis in the official Xinhua news outlet.

‘We want freedom!’

But three years into zero-COVID, people fed up with being locked down are in the streets chanting “No PCR test, we want freedom!” “End the lockdowns!” “Step down, Communist Party!” Protests of this scale are rare because the Chinese Communist Party limits freedom of speech and association.

Under President Xi Jinping, whose increasingly authoritarian rule was extended for a historic third term in October, many citizens vent on social media, trying to stay ahead of censors.

“China at one point was one of the world leaders in COVID response, and now it’s the only country in the world that hasn’t gotten back to a near normal,” said Lawrence Gostin, a professor of global health law at Washington’s Georgetown University and director of the World Health Organization Collaborating Center on National and Global Health Law.

“I think part of the reason for that is literally the stubbornness of Chinese leadership, and particularly Xi Jinping,” he told VOA Mandarin via phone.

Xi Chen, an associate professor of health policy and economics at the Yale School of Public Health, told VOA Mandarin in a phone interview that public outrage and economic impact indicate that China needs to make “a big adjustment in its public health policy.”

Medical experts inside China are making similar arguments. Dr. Zhang Wenhong, who heads Shanghai’s expert panel on COVID, said in a recent video circulating on the Chinese app WeChat that Beijing should consider relaxing its zero-COVID strategy soon.

“Look at the U.S., their cases are several times higher than us, yet their people are living their lives to the fullest. It’s time for us to adjust our policy, people should be able to relax and live a normal life, we as medical workers are the ones that should be prepared to face a rise in severe cases,” he said in the video, which China’s censors deleted soon after it appeared.

Georgetown’s Gostin said that through conversations with top epidemiologists in Hong Kong who advise Beijing on its COVID strategy, he believes that Xi understands that China needs to end its zero-COVID policy.

“But China is running out of time,” Gostin added.

Authorities commit to policy

Officially, Chinese leadership had shown little interest in ending zero-COVID before the end of last month.

On November 29, during the regular daily press briefing, a Reuters reporter in Beijing asked Chinese Foreign Ministry spokesperson Zhao Lijian, “Given the widespread display of anger and frustration at the zero-COVID policy in recent days across China, is China thinking about ending it and if so, when?”

Zhao, usually quick with an answer, looked at the papers on his podium for almost 20 seconds before asking the reporter to repeat his question. Zhao then paused for another 15 seconds before saying that China is following a “dynamic zero-COVID policy” and there is no public anger. 

His silence came after Xinhua issued commentaries on November 28, saying that while Beijing will do its best to accommodate the needs or desires of the people, it will stick to a “dynamic zero-COVID policy.”

“From newborn babies to centenarians, we won’t miss one infected case, we won’t give up on one patient,” one commentary said.

A day later, Vice Premier Sun Chunlan, who oversees China’s COVID containment efforts, urged further “optimization” of testing, treatment and quarantine policies, according to Reuters. The agency cited other officials saying that current restrictions, such as forcing people from their homes into quarantine centers if they test positive for the virus, would be implemented more flexibly to reflect local conditions.

Zero-COVID above all

Xi has staked his political reputation on the fight against COVID, and that continues to mean mass testing, snap lockdowns and extensive quarantines.

According to estimates by the Japanese investment bank Nomura, about 412 million people in China were in some kind of lockdown as of November 23. That accounts for almost a third of China’s total population and was up from 340 million the week before.

Shanghai, China’s most populous city and financial hub, experienced two months of strict lockdowns this spring, bringing business to a halt and severing key links in already disrupted regional and global supply chains. 

In November, with the number of cases increasing in Beijing, many residents in the country’s capital feared a similar lockdown as residents of other cities blamed the zero-COVID policy for tragedies.

Father says policy ‘indirectly killed’ his son

In the western city of Lanzhou, a 3-year-old boy died of carbon monoxide poisoning after COVID restrictions kept him from receiving medical care. His father told Reuters that the strict COVID-19 policies “indirectly killed” his son.

In China’s northern city of Hohhot, a 55-year-old woman committed suicide by jumping from the 12th floor, where she had been quarantined for two weeks. The woman was reported to have suffered from anxiety and was on anti-depression medication, sparking discussion about the impact on mental health from strict zero-COVID lockdowns.

The last straw was a fire in Urumqi on November 24 that killed at least 10 people and injured nine in a building with stringent lockdown protocols that that may have prevented victims from fleeing the flames. In a news briefing after the fire, Li Wensheng, head of the Urumqi City Fire Rescue department, said “the residents lacked the ability to rescue themselves.” 

“I think China’s zero-COVID strategy has been disastrous for the country in so many different ways,” said Gostin of Georgetown. “Most importantly it’s really been a huge violation of human rights: not just the lockdowns, but also the intrusive surveillance that we’ve seen of the entire population on their mobile phones.”

To enter any public space, all residents of China rely on a color-coded smart phone app that tracks exposure to infection. In June, media reports surfaced that authorities in Zhengzhou, the capital of central Henan province, were using the codes to restrict the movement of people heading to protest at local banks that had frozen their deposits.

An economy upended

Although the zero-COVID policy had nothing to do with the Zhengzhou bank run, it has slowed the country’s economic growth.

Previous official estimates said China’s economy would grow 5.5% in 2022. Now, the International Monetary Fund has lowered China’s economic growth projection for this year to 3.3%. The difference equals about $400 billion in lost GDP. 

“International trade and tourism have ground to a halt. Supply chains have been severely disrupted,” Gostin said. “And all in all, I think it’s actually reduced public trust in Xi Jinping, and it burst the bubble of so-called Chinese efficiency and effectiveness in policy.” 

Dr. Anthony Fauci, U.S. President Joe Biden’s chief medical adviser, said that he thinks China’s zero-COVID strategy “doesn’t make public health sense” on NBC’s “Meet the Press” on November 27.

“They went into a prolonged lockdown without any seeming purpose or endgame to it,” Fauci said.

Exit strategy

Unlike almost all other countries, a large percentage of China’s population lacks immunity because most people have not been infected with COVID. Without this so-called herd immunity, it may be difficult for China to extricate itself from its zero-COVID position.

The elderly are among the most vulnerable, but according to new statistics released by the Chinese Center for Disease Control and Prevention on November 29, only 65.8% of people over the age of 80 have received booster shots, up from 40% as of November 11.

Chen of the Yale School of Public Health said there’s real concern among international experts about China’s ability to treat severe cases.

“There is no shortage of hospital beds in China. The number of hospital beds per 100,000 people is basically the same as that of the United States. But for intensive care unit beds, it’s a completely different story,” he said.

According to government statistics, there are 3.6 intensive care (ICU) beds per 100,000 people in China, compared to 11 in Singapore and 29.4 in the United States.

“This is China’s weakest point,” Chen said. “Once the country relaxes the zero-COVID strategy, there will inevitably be a proportion of severe cases. And there will be deaths considering the current ICU beds level.”

He added that as the country pours all its medical resources to COVID testing, there are few resources available for making these long-term preparations.

Shin-Ru Shih, director of the Research Center for Emerging Viral Infections at Taiwan’s Chang Gung University in Taiwan, said that even though the omicron variant has become less virulent, it is still a threat to Chinese people who have not been infected or vaccinated.

“The best way for China to fight against COVID and to reduce economic impact is vaccination by next-generation vaccines,” she said.

Gostin stressed that it’s particularly important to make sure that a large percentage of the vulnerable populations gets jabbed with effective vaccines and boosters, saying “that is the only way China can emerge from zero-COVID … without a considerable loss of life.”
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Cameroonian health workers and people with HIV marched for World AIDS Day on December 1, calling for access to treatment for patients in conflict areas.

About half a million Cameroonians have HIV, and at least 1,000 live in troubled western regions and the border with Nigeria. The protesters urged Cameroon’s military, separatists, and militants to allow all HIV patients access to needed treatment.

Marie Chantal Awoulbe, who belongs to the Cameroon Network of Adolescents and Positive Youths, which encourages those with AIDS to get regular treatment, took part in the protest and World AIDS Day activities at Chantal Biya International Research Centre in Yaounde. The center carries out research on AIDS, and supports programs to treat and support vulnerable people with HIV.

Awoulbe said her network is asking both armed groups and government troops to stop deaths among people with AIDS where there are armed conflicts by allowing the patients access to regular treatment.

Cameroon’s public health ministry says similar protests and activities to encourage free screening took place in 70 hospitals, with at least 30 hospital workers and people with AIDS taking part at each of the hospitals.

The Cameroon government accuses separatists in the country’s west of attacking hospitals and abducting health care workers. Activists also accuse government troops of attacking and arresting hospital staff suspected of treating civilians the military believes are either fighters or sympathize with separatists.

In April, medical aid group Doctors Without Borders suspended work in Cameroon’s troubled Southwest region to protest the rearrest of four of its staff members. Authorities accused the staffers of cooperating with regional separatists, but the organization denied it.

Medical staff members say intimidation and abduction of health workers, and ceaseless battles between government troops and separatist fighters make it impossible for medical supplies to reach the troubled English-speaking regions.

Twenty-eight-year-old Betrand Lemfon said he and several dozen people with AIDS moved from Jakiri, an English-speaking northwestern town, to Bafoussam, a French-speaking commercial city. He said he and others with the disease were afraid of dying in Jakiri because they did not have access to regular treatment.

“There are a lot of persons out there who are in need of medications, so if we could have the opportunity and chance for medications to always reach every interior part of the North-West region, South-West region who are hit by the crisis, it will help the adolescents, young persons and children living with HIV to take their ARVs [antiretroviral medicines] and stay healthy,” he said.

Lemfon spoke via the messaging app WhatsApp from Bafoussam.

Cameroon’s military says it will protect all health workers and civilians in the troubled regions.

The government says the number of people with the disease in Cameroon has decreased from about 970,000 in 2010 to 500,000 in 2021.

Health officials say the decline is due to increasing awareness of the disease and its consequences. The government says sexual behavior is changing, with the number of people using condoms or abstaining from sex increasing.

Honorine Tatah, a government official in charge of AIDS control in Cameroon, said unlike in 2020 when there was resistance due to lack of awareness, many more civilians now accept systematic screening for HIV.

“During antenatal care, a woman is screened for a number of diseases including hepatitis B, HIV and if you are tested positive, you are eligible for treatment and that treatment will reduce the chances of a child getting infected with HIV. The treatment is free of charge,” Tatah said.

World AIDS Day was the first international day for global health, starting in 1988. It allows people all over the world to join in the battle against HIV, to support those with HIV, and to remember those who have died from an AIDS-related illness.
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In October, Zimbabwe became to first African country to approve the use of the injectable HIV prevention drug known as cabotegravir. As Columbus Mavhunga reports from Harare, Zimbabwe, many are eager for the drug to become available. Videography by Blessing Chigwenhembe.
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A new, long-lasting drug could be a game-changer for preventing HIV infections, experts say.

Advocates are hopeful that those who need it most in low- and middle-income countries will not have to wait for it as long as they have for previous HIV drugs. But questions remain about access and price.

The drug is called cabotegravir and is delivered as a shot once every other month. In clinical trials, it did a better job at preventing infection than another option — a pill taken once a day.

The bimonthly injection seems to be an easier treatment regimen to stick to than daily pills, according to Mitchell Warren, executive director of AVAC, an HIV prevention advocacy organization.

“If you can take a pill every day, that’s great. But if you can’t, we see a lot of people who start [taking the pills] who don’t continue,” he said.

Aside from the inconvenience, there can be a stigma attached to taking the pills, Warren said. The drugs for prevention, called pre-exposure prophylaxis, or PrEP, are the same as the drugs used to treat HIV infection.

“If you’re a young person and your parents find your pill bottle, they say, ‘Why are you taking this pill? Are you HIV infected?’ And the young person may say, ‘No, I’m protecting myself,'” Warren said. “And they say, ‘Well, why are you having sex?'”

Long-lasting drugs like cabotegravir or another new product, a once-a-month vaginal ring, offer patients more choices, he added.

About 1.5 million people were newly infected with HIV in 2021, according to the World Health Organization, about 60% of them in Africa.

Uganda and Zimbabwe approved cabotegravir for PrEP earlier this year. They are the first countries in sub-Saharan Africa to do so.

These approvals come less than a year after the U.S. Food and Drug Administration authorized it.

That’s progress, Warren said. FDA approved PrEP pills in 2012, but “it took three years before any African regulatory agency approved it. So, we’ve already seen a condensing of that timeline.”

Cabotegravir costs $22,000 per year in the United States. ViiV Healthcare, the company that makes the drug, has not officially announced what it will cost in low- and middle-income countries, but it is expected to be much lower. Some aid groups have indicated that ViiV will offer the drug at $250 per year.

“The problem is that actually that won’t be really affordable for countries who need to roll it out and scale up,” said Jessica Burry, a pharmacist with humanitarian group Doctors without Borders.

PrEP pills cost about $54 per year, Warren said.

“The hope is that early in 2023, we can see a price point that is much closer to that 54 [dollars] than to the 250 [dollars],” he said. “Hopefully, in the $100 range per year.”

ViiV said it is working with the U.N.-backed Medicines Patent Pool to allow generic manufacturers to produce cabotegravir at a lower price for low- and middle-income countries.

ViiV said cabotegravir is more complicated to manufacture than most HIV drugs. No generic manufacturers have been selected yet. Once they are, it will take about three to five years before a generic version is on the market.

The company has filed for regulatory approval in 11 countries so far. Burry says there should be more.

“If they’re going to be the only supplier for the next four or five years until generics are available, then they really need to step up to the plate and actually file, register and get that drug available,” she said.

Demand for the drug is unclear. PrEP pills have been slow to catch on.

About 845,000 people in more than 50 countries took them in 2020, but the United Nations was aiming for 3 million by that time.

“We don’t have a ton of PrEP users, so if you’re ViiV, you’re looking at a very small market,” Warren said.

Warren said providers and advocates need to help grow that market. They need to do a better job connecting people at risk with programs that offer PrEP, he added.

“Some of the early PrEP programs began with us thinking that if you just bought the product, people would magically show up,” he said.

Warren hopes to change that as part of a coalition that includes ViiV, the Bill and Melinda Gates Foundation, the World Health Organization and others.

“There’s a huge effort in this coalition to bring in civil society from day one, and the communities that this product is meant to help and support,” he said.

The slow uptake means PrEP has not yet shown that it can make much of a real-world impact, Warren noted. He hopes to see research programs launch next year to find the best ways to reach the communities most at risk and lower infection rates.

“If we can’t show that in the next three years, then we don’t necessarily need all these generic manufacturers, because there will not be a market for this product,” he said.
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