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China dropped its “zero-Covid” policy in early December, prompting the World Health Organization to warn on Wednesday that the world should be concerned about an accelerating wave of infections there.

“Zero Covid” had become untenable, given the contagiousness of the Omicron variant, as well as protests in late November that demonstrated growing anger about strict mitigation measures.

Disease modelers in Australia think the death toll from China’s reopening could run as high as 1 million people since China lacks drugs to treat the disease and at least a third of people over 60 aren’t fully vaccinated. Chinese-made vaccines, the only ones available in the country, also have lower efficacy rates than mRNA shots.

Yanzhong Huang, a China expert and senior fellow for global health at the Council on Foreign Relations, spoke to Carmen about why the Chinese government isn’t better prepared three years into a pandemic that started within its borders.

This interview has been edited for length and clarity.

Given how vigorously the Chinese government pursued “zero Covid,” requiring testing and quarantining, why didn’t it mandate vaccination?

The elderly people were protected by the “zero-Covid” policy. It reduced the incentive to take the vaccine.

For local governments, mass PCR testing and snap lockdowns were more efficient ways to stamp out those local flare-ups than vaccination, which takes time to have effect.

Chinese-made vaccines didn’t include people 60 or over when they were starting the Phase III clinical trial. So still today, some people think this vaccine may not be so safe for them.

Now the virus is spreading fast. I think the government is so overwhelmed by this demand for health care, hospitalizations. It’s made it difficult for them to prioritize vaccination.

Why is China not using foreign-made vaccines?

They imported 100 million doses of mRNA vaccines, but the government refused to authorize or approve the use of the vaccines.

To some people, this is an example of technological nationalism. They want to approve their own homegrown mRNA vaccines first.

After the German chancellor’s visit in November, they allowed foreigners to get mRNA vaccines.

Did the protests make the government panic?

The inside story of what happened in the couple of days between the student protest and the decision to move away from “zero Covid” remains untold.

I suspect we will never find out what happened, but clearly, in my opinion, the student protest is a trigger of the reopening process even though there were some other factors that led to this decision.

There was no preparation. There’s no roadmap.

Before the reopening, they could have adopted some measures to prepare health workers, to do some risk communication with the public, prepare a stockpile of anti-fever medication.

China approved the use of Paxlovid as early as spring this year, but they’re not importing much.

It may have something to do with national pride.

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Today on our Pulse Check podcast, Katherine Ellen Foley talks with Ruth about the state of artificial intelligence in health care and why it hasn’t reached its promise yet.

MEDICAID’S PANDEMIC RULES TO END: Despite the damage Covid-19 wrought on the economy, the number of people without health insurance declined between 2019 and 2021.

About 1.5 million people gained insurance coverage thanks largely to a change Congress made to Medicaid rules barring states from bumping people off their health insurance programs for low- and lower-middle-income people so long as the public health emergency remained in effect.

That benefit will end on April 1, per a new directive from Congress in its fiscal 2023 omnibus spending bill.

POLITICO’s Alice Miranda Ollstein explained that Democrats negotiated away the Medicaid coverage for other things on their wish list, including “a year of postpartum coverage for low-income moms in states that don’t already offer it and a year of continuous coverage provisions for children at risk of losing health insurance.”

Republicans argued that with the job market long recovered from the early pandemic shock, it no longer made sense to keep people on Medicaid who’d found well-paying work.

And, as Alice wrote, with Republicans set to take control of the House in January, Democrats saw the trade as possibly their “last chance to fund some of their top health priorities, including policies that address the country’s worsening rates of maternal mortality.”

NO BOOST FOR FAMILY PLANNING: Abortion-rights groups were dismayed that Democrats in charge of both Congress and the White House came up empty in their bid to increase funding for contraception in the year-end funding bill, Alice also reported.

Funding for the Title X family planning program will remain where it’s been for the last eight years: at $286.5 million.

Senate Health, Education, Labor and Pensions Chair Patty Murray (D-Wash.) said there was little Democrats could do, given Senate rules that require 60 votes to pass appropriations bills. The GOP was opposed to increasing funding for the Title X clinics that provide free and discounted contraception to millions of low-income people.

But abortion-rights groups said they expected more, considering the bill also maintains the Hyde Amendment, the decades-old rider banning federal funding for abortion, and several other longstanding restrictions on government health insurance covering the procedure.

“Congress had a clear directive, and they failed to deliver,” Planned Parenthood President Alexis McGill Johnson told POLITICO. “At a time when Roe v. Wade has been overturned and health care access is under increasing threat, this bill fails to meet the moment.”

DOMINO EFFECT CUTS LIFESPANS: A baby born in 2021 can expect to live 76.4 years, down from 78.8 in 2019, according to a new Centers for Disease Control and Prevention analysis of U.S. life expectancy.

As POLITICO’s Krista Mahr reported, the latest figures leave expected U.S. lifespans well below those in other large, wealthy nations and reflect the federal and local governments’ ongoing struggle to meet the demands of concurrent public health crises.

The drop in life expectancy in 2021 extended a downward trend that began in 2020 and brought the level to its lowest since 1996.

Both Covid-19 and fatal drug overdoes were to blame.

Nora Volkow, director of the National Institute on Drug Abuse, said the decline was the result of a domino effect set off by the pandemic. Americans died in large numbers from Covid-19, but the pandemic also “drove social changes that made people more vulnerable to taking drugs as a way of escaping.”

It also made it harder to get help. As a result, fatal drug overdoses have skyrocketed, rising nearly 16 percent in 2021 after a 30 percent increase in 2020.