Covid immunity where does Hong Kong stand?

Despite Hong Kong’s triumph in containing COVID-19 local infection rates at a relatively low level in comparison with other regions of the world, the city has been struggling to drive up vaccine uptake among its citizens. The vaccination programme was rolled out in February 2021 but it took eight months to reach a 55% inoculation rate for the second dose of vaccine. That is still 15% short of the 70% threshold for herd immunity as suggested by government public health advisors. 1 2

As a global business hub, the Hong Kong’s current strategy of “zero-infection”, and the associated quarantine and social-distancing measures, are apparently unsustainable in the long term. If we are to meet the instated goal of a 70% vaccination rate by the end of 2021 and open ourselves to international business again3, we must focus on two questions. What are the major reasons behind the vaccine hesitancy of Hongkongers? More importantly, how can the vaccination drive be steered on course?

Vaccination hesitancy in Hong Kong

Whether to get vaccinated or not is a decision influenced by our judgement and the information we are exposed to, as in making any important decision. Information about the pandemic in this case includes the misinformation and conspiracy theories that have been identified by researchers as a major contributor to vaccine hesitancy worldwide.4 While members of the general public are not expected to understand all the medical technicalities, during the early stage of the vaccination roll-out, the relentless local media coverage of deaths and cases

63.8%

1st dose

55.1%

2nd dose

Source and updates covidvaccine.gov.hk/en/dashboard

1. HK Vaccination Dashboard: covidvaccine.gov.hk/en/dashboard

2. Vaccination rate in HK and herd immunity threshold: .scmp.com/news/hong-kong/health-environment/article/3145933/coronavirus-hong-kongs-zero-infection-policy?module=perpetual_scroll&pgtype=article&ca mpaign=3145933

3. Vaccination goal to reach by end of 2021: thestandard.com.hk/breaking-news/section/4/155363/Vaccine-to-cover-70-percent-of-population-by-end-of-2021--David-Hui

4. Rumours and conspiracy theories about COVID-19 vaccines: journals.plos.org/plosone/article?id=10.1371/journal.pone.0251605 of rare adverse reactions such as facial paralysis after receiving a jab, created hysteria over vaccine side effects. Nevertheless, there is no proof that such side effects have any connection with the Covid vaccine according to a report conducted by Hong Kong Baptist University.5,6

Concurrently, as more and more people use social media to acquire information about the disease and modes of prevention during the pandemic, social media platforms have also grown into notorious breeding grounds for misinformation and conspiracy theory. A Harvard Kennedy School review7 showed that individuals who were exposed to vaccine-related information on social media were more likely to be misinformed and become vaccine-hesitant than those who use traditional media. The heightened distrust of established authority among vaccine-hesitant individuals then evokes further emotional resistance to any message, including those emanating from traditional sources, and leads to an entrenchment of “anti-authority” beliefs.

All these factors constitute a negative feedback loop: as the number of people who are reluctant to get vaccinated rises because they are worried about vaccine safety and efficacy. As more people seek vaccine-related information on social media rather than conventional sources, the public becomes increasingly sceptical about the government and its vaccine programme. Compounded by local media headlines that amplify serious adverse reactions without giving important context, the number of individuals willing to get vaccinated becomes even fewer.

Steering the city’s vaccination drive

In view of the fact that such online health informationseeking behaviour on social media puts users at risk of exposure to misinformation, mitigation measures should be carried out to minimize the threat to public health. Monitoring social media data in real-time has been identified as one of the best measures to track and dispel misinformation. Regardless of debates over the possible infringement of digital privacy and freedom of speech, in this turbulent time of pandemic, many studies agree that such real-time tracking of COVID-19 vaccine misinformation and engagement

Sources

5. Deaths unrelated to vaccination: news.rthk.hk/rthk/en/component/k2/1583019-20210328.htm with social media can aid the dissemination of accurate information, help safeguard the public and, ultimately, restore their confidence in vaccination.

Nevertheless, progress is being made (see Figure 2)8,9. Incentives from the government and private businesses have proved effective in boosting vaccine uptake among Hongkongers. The recent spike in vaccination since June 2021 coincided with the rollout of lottery schemes run by many different private businesses that offered prizes – from new iPhones and a Tesla electric car, to even a million-dollar luxury flat – for citizens who have been fully vaccinated in Hong Kong.10 Apart from the lucky draws, the government’s imminent policy of making vaccines mandatory for certain workers, and the provision of additional incentives such as partial exemption from social distancing measures in restaurants, fueled an uptick in the vaccination rate in the summer.11

Looking forward

As of early to mid- September 2021, 4.28 million people had received their first COVID-19 jab, accounting for 63.8% of the eligible population. The uptake concentrated on those aged between 20 and 59, with

6. HKBU report on vaccine-related ‘fake-news’: research.hkbu.edu.hk/f/page/20480/21838/(EN)OVH_Report_No.9.pdf

7. Review on misinformation about vaccines: misinforeview.hks.harvard.edu/article/users-of-social-media-more-likely-to-be-misinformed-about-vaccines/

8. Daily vaccination doses administered figure in HK: fortune.com/2021/07/29/hong-kong-Covid-vaccination-rate-hesitancy-comeback-lottery/

9. HK Vaccination Dashboard: covidvaccine.gov.hk/en/dashboard

10. Vaccination lucky draws in Hong Kong: hongkongfp.com/2021/07/22/hkfp-guide-hong-kong-Covid-19-vaccination-lucky-draws-you-can-enter-now/ more than 70% vaccinated but dropped for people aged 60 to 69, with only 56% having had their first jab. It fell to 37% and 12% respectively for those in their seventies and eighties.12 While it is likely that the 70% inoculation rate will be achieved by the end of 2021, given current vaccination progress, what next?

Singapore has one of the highest vaccination rates worldwide with more than 80% of its population fully vaccinated by the end of August 2021.13 The city-state is now moving on to cautiously reopening its border with free-entry for vaccinated travellers from low-risk countries, a list of countries that is growing.14 Hong Kong, as a similar economy that relies on the flow of foreign talent and investment, should consider a likewise shift in its coronavirus strategy as soon as certain conditions are met. Professor Ivan Hung, one of the government’s public health advisors, stated in a television interview in mid-August 2021 that the city could further relax social-distancing rules once 80-90% of the population had been inoculated.15

Until then, we should expect loosening of border and social restrictions to be conducted in a cautious and calibrated manner to keep the pandemic in check. Young people aged 12 and above became eligible for walk-in vaccination at 24 of the city’s 29 vaccination centres in late August and perhaps they can lead the way in a trend. So far there has been comparatively low take-up in both the young and the elderly.

Source bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/

11. Government relaxation of social distancing measures in April 2021: info.gov.hk/gia/general/202104/28/P2021042800868.htm

12. scmp.com/news/hong-kong/health-environment/article/3148134/coronavirus-hong-kong-officials-announce-measures

13. straitstimes.com/multimedia/graphics/2021/06/singapore-covid-vaccination-tracker/index.html?shell

14. Singapore gradually reopens its border: scmp.com/week-asia/health-environment/article/3145833/singapore-trades-Covid-zero-Covid-resilience-how-will?module=perpetual_scroll&pgtype=article&campai gn=3145833

15. Prof. Ivan Hung’s call for vaccination: scmp.com/news/hong-kong/health-environment/article/3145933/coronavirus-hong-kongs-zero-infection-policy