Public-health experts agree with protestors that China's zero-COVID strategy must end. Leaders could have used lockdowns to vaccinate older people with Western vaccines, but didn't.

• Protests are erupting across China over the country's restrictive zero-COVID policies.
• Public-health experts say the policies are unsustainable, ineffective, and unnecessarily severe.

Protestors are flooding streets across China — the largest protests since 1989's Tiananmen Square demonstrations — demanding relief from the country's restrictive zero-COVID lockdowns, and public-health experts agree with them.

"There really are no benefits to this type of irrational policy except to feed the naked power lust of the leaders of China," Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, told Insider in an email.

China's zero-COVID measures are among the strictest in the world, and include frequent mass testing, closures of businesses and schools, and quarantining entire factories and stores on-site, according to the BBC. Public anger boiled over on Thursday after a fire in the locked-down city of Urumqi killed 10 people, reports The New York Times.

There is no easy way forward for China, but constant 2020-style lockdowns are not the solution, according to public-health experts, who called the policies unsustainable, ineffective, and irrational. Eradicating COVID-19 is impossible, they say.

"Zero COVID is about elimination rather than mitigation of this virus. It's too late to eliminate. The cat is out of the bag. COVID is here to stay," Maureen Miller, an infectious-disease epidemiologist at Columbia University, told Insider via email.

In reality, lockdowns are "pause buttons," Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health, told Insider. "They're supposed to buy time to build up immunity in the population through vaccines," she said.

China is buying time and then squandering it, experts say, with the potential for a devastating wave of infections looming on the horizon. In the meantime, people across China have grown tired of restrictions.

China may be primed for a catastrophic wave

Stringent restrictions had "severely detrimental consequences for China," Monica Gandhi, a professor of medicine and infectious disease expert at the University of California, San Francisco, told Insider via email. The rules kept workers home from their jobs, kids out of school, and limited people's access to medical care for non-COVID conditions. There was also a mental health toll, Gandhi added.

There may be even harsher consequences for China's most vulnerable people — aged 80 years and older — who are not well-vaccinated.

"If you look at the prevalence of vaccinations among the elderly, that it was almost counterproductive, the people you really needed to protect were not getting protected," Dr. Anthony Fauci, President Biden's chief medical adviser, said about China on NBC's Meet the Press on Sunday.

In China, 59% of people age 80 and older have received one dose of the vaccine, according to data from the Chinese National Health Commission reported by BBC. Roughly half of that age group received two vaccine doses and 20% have gotten two shots plus a booster.

Vaccination rates among 60- to 69-year-olds in China are higher than among the 80 and older set, with 89% having received one dose of the vaccine, and 87% having gotten two doses, according to the National Health Commission data.

In the US, 95% of adults 65 and older have received at least a first vaccine dose, according to the Centers for Disease Control and Prevention, and 92% are fully vaccinated.

As a result, some experts fear an unchecked wave of Omicron infections could easily rip through China's cities, overwhelm healthcare systems, and cause mass death.

"Even if it is slightly less lethal than earlier waves of the virus, you can just imagine a virus ripping through a densely populated, largely older population in a short period of time. And while we've learned a lot about how to care for COVID, it's impossible to deliver that care when there's just too many people needing it all at once," Nuzzo said.

What's more, research has shown the CoronaVac and Sinopharm vaccines, which China has been using, are less effective than the mRNA vaccines many Americans received. So it's possible that even China's fully vaccinated residents have lower immunity than those in the US.

"On the one hand, the [zero-COVID] policy is clearly heavy-handed, and certainly the Chinese people are reacting to that," Neil Sehgal, an assistant professor of health policy at the University of Maryland School of Public Health, told Insider, adding, "But on the other hand, it's not clear that in the immediacy there is a good alternative."

Not everyone agrees that lifting lockdowns would be catastrophic.

"I'm still not so sure whether policy relaxations are going to be immediately followed by mass die off in the country," Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations, where he specializes in China, told Insider.

He argues the incoming COVID wave could bring fewer hospitalizations than some experts fear — low enough for the healthcare system to handle it.

As a result, Huang thinks the zero-COVID lockdowns are completely unwarranted. "If you really don't have that many severe cases, why do you need this?" he said.

Lockdowns buy time, but China hasn't used it to ramp up vaccination

The key to avoiding a potentially catastrophic surge is increasing vaccinations among the most vulnerable.

China could use the time its lockdowns have bought to conduct fresh vaccine campaigns focused on people aged 80 years and older — but it hasn't. The government could also approve and distribute a foreign-made mRNA vaccine — but it still hasn't. Instead of using the Western mRNA vaccines that are already available, China's government is trying to develop its own, according to The Washington Post.

That may be about to change. On Tuesday, Chinese health officials announced a new campaign to boost vaccination rates among those older than 80 years of age, reports The Guardian.

"It's a really vulnerable situation for China to be in," Nuzzo said, adding, "Unless they really use this time to protect the population through vaccination, I just don't understand how this is going to end well."