Tanya Lewis: Hi, and welcome to COVID, Quickly, a Scientific American podcast series!

Josh Fischman: This is your fast-track update on the COVID pandemic. We bring you up to speed on the science behind the most urgent questions about the virus and the disease. We demystify the research, and help you understand what it really means.

Lewis: I’m Tanya Lewis.

Fischman: I’m Josh Fischman.

Lewis: And we’re Scientific American’s senior health editors. Today, we’re going to explain how vaccines helped the economy: we saved 10 dollars for every 1 dollar we spent on them, plus millions of lives… 

Fischman: And we’ll talk about the protests in China against extreme lockdowns, the harm that country’s zero-COVID policy is doing, and how it could affect the rest of the world.

—

Lewis: COVID vaccines cost billions to develop and deliver. But for at least one big city that used them, they had an incredible rate of financial return. 

Fischman: We usually talk about vaccines saving lives. But in New York City, hit hard by the pandemic early on, they saved the town from a gigantic economic hole too, Tanya. Vaccines saved the city about $28 BILLION dollars, which is what it would have lost without vaccines. Or, as you said, every dollar spent on shots saved ten dollars that would have been spent without shots.

Lewis: Where did the savings come from?

Fischman: A few different places. Long hospitalizations that weren’t needed, emergency room visits avoided, and workers who stayed healthy instead of calling in sick.

Lewis: Hmm. But how did they know about things that didn’t happen? And how can you count those things?

Fischman: I wondered about that too. It turns out scientists do know enough to build a model of events without vaccines. We know how effective the shots are at keeping people out of the hospital, and we have estimates of how many people in New York were infected. So from that scientists can figure out how many infected New Yorkers would have been hospitalized if vaccines didn’t exist. And there’s data on numbers of unvaccinated people who turn up in emergency rooms versus vaccinated people. 

Lewis: That makes sense. So what were the actual dollar figures?

Fischman: The direct costs of COVID-related healthcare—hospitals and suchlike—were about 7 and a half billion dollars with vaccines. Without them, the cost jumped to 33 billion.

Costs like the value of lost workdays came to almost 2 billion dollars with vaccination. Without it, the dollars lost due to lost productivity more than doubled, to over 4 billion, the researchers reported in a recent issue of the journal JAMA Network Open.

Lewis: But the vaccines themselves cost a lot for city and federal governments to get and distribute. To be fair, that has to be accounted for.

Fischman: It was almost 5 billion dollars, including money the feds gave to the city for running the vaccine campaign and buying the actual shots. 

The math of these calculations gets complicated, but at a basic level, New York spent that 5 billion and, as a result, kept at least 28 billion. Also business or school shutdowns would have been even longer, and cost even more money, if vaccines weren’t around. 

So yes, vaccines save millions of lives, which are hard to put a value on. But they are also an incredibly strong return on investment.

—

Fischman: A wave of protests broke out in China last week against the government’s strict zero-COVID policies. What do we know so far about what’s happening?

Lewis: The protests in China are some of the biggest in decades. They started last week after a fire in an apartment building in the Western Chinese city of Urumqi [Oo-room-chi].

The fire resulted in an official death toll of 10 people, although it may have been much higher. Some people have claimed that a COVID lockdown prevented people from escaping the building.

Fischman: What happened next? How did the protests spread? 

Lewis: People in other Chinese cities, including Shanghai and Beijing, organized vigils for the victims of the Urumqi fire that quickly evolved into protests against the Chinese Communist Party’s zero-COVID policy. Some people even called for Xi Jinping, the country’s president, to step down.

Fischman: That seems like a big deal for China, a country that suppresses dissent and strictly controls people’s speech. 

Lewis: It’s a huge deal. But let’s back up a minute and talk about how zero COVID started.

China began the policy when the outbreak first began in late 2019 in Wuhan. And it’s been very effective at stopping the virus’s spread—China has had far fewer COVID cases and deaths (at least officially) than many other countries, especially for a country its size.

Fischman: So in some ways, their policy seems like a good thing.

Lewis: Well, that’s how many Chinese people saw it, at least at first. But we’re almost three years into this pandemic, and almost every other country has returned to something close to normal.

Yet China has continued its draconian lockdowns and quarantine policies. These have taken a huge economic and social toll, and the Chinese people seem to have had enough.

Fischman: The Chinese government has reacted with arrests. But are they changing their policies in any way?

Lewis: Authorities have said they will relax some of their COVID policies, like no longer putting up gates to restrict access to apartment buildings where COVID cases have been detected and reducing the amount of mass testing. But it is still committed to the goal of zero COVID.

Fischman: Is that even a feasible goal anymore, given the costs?

Lewis: I think many people would say it’s not. The problem now is how to relax the restrictions without causing massive outbreaks and deaths. Because China has kept such a tight lid on COVID, relatively few people have immunity from infection. It’s true that about 90 percent of the country is vaccinated. But China’s Sinopharm and SinoVac vaccines are less effective than Pfizer’s and Moderna’s mRNA vaccines.

Plus, fewer people over 80 have gotten the shots, and only 40 percent of that age group has gotten a booster.

China is already reporting around 40,000 COVID cases per day. If it were to just let the virus rip, it could result in a million or more deaths.

Fischman: That sounds like a really terrible idea.

Lewis: It would be. And it’s not just risky for China. If the government lets the virus run through such a large population that could also lead to new variants that could circle the globe. And unchecked infections in China could also wreak havoc on the global economy.

But it doesn’t have to be all-or-nothing. Instead of lockdowns and mass testing, China could focus on vaccinating and boosting its elderly population—which it says it plans to do. It could give people mRNA vaccines for better protection. And it could ensure access to antiviral drugs like Paxlovid, which greatly lower the risk of death.

There’s no easy way out of this. But it doesn’t look like China will let go of zero COVID anytime soon.

—

Lewis: Now you’re up to speed. Thanks for joining us. Our show is produced and edited by Jeff DelViscio and Tulika Bose.

Fischman: It’s December, and we’re going to take a holiday break. We’ll be back in 2023 with our own new variant of the show.

Lewis: Good one, Josh. So come back with us. And check out sciam.com for updated and in-depth COVID news.