China's pivot from zero-COVID strategy and the role of vaccines

Objective: This paper aims to examine China's vaccine policy within the context of broader policy interventions and evaluate their impact on both health and non-health outcomes. Method: We first utilize the categorizing Policy & Technology Interventions (CPTI) framework to assess the intensities of different policy responses during various stages of the COVID-19 pandemic. We adopt a process inspired by the Delphi method to evaluate the timelines and intensities of the policy measures comprehensively. Subsequently, we probe the results generated from this process to identify distinctive patterns in China's pandemic policy changes, particularly in relation to the country's reopening process. To explain this distinctive pattern, we employ the governmentality perspective, drawing on Foucault's theories, which focus on the power dynamics between techniques and governance. Results: The policy interventions in China during the COVID-19 pandemic significantly differ from those in the other countries in the four policy areas. Despite the massive vaccination efforts, vaccines did not play a decisive role in China's reopening in late 2022. Our analysis reveals that the vaccines are only used in China as part of a broader social governing system in conjunction with zero-COVID policy, such as lockdowns, travel restrictions, and mass tracking. Conclusions: China's approach to COVID vaccines and the policies governing their use are distinctive, shaped by a governmentality perspective that prioritizes the strengthening of governance.