The Washington PostDemocracy Dies in Darkness

Hong Kong had a year to vaccinate its elderly. As omicron spreads, low uptake has left them vulnerable.

Residents wait at a rest area after receiving the Pfizer-BioNTech vaccine at a mobile station set up for elderly residents in Hong Kong on Jan. 9. (Anadolu Agency via Getty Images)

HONG KONG — For the first time since the initial rollout of coronavirus vaccines almost a year ago, Hong Kong’s vaccination centers are jam-packed.

With advance bookings at capacity, people assemble in lines each morning in the hope of snagging same-day appointments. Among the hopefuls are members of a demographic largely immunized everywhere else in the developed world: gray-haired seniors, many leaning on canes or using wheelchairs.

“I was afraid that the vaccines could harm my body, so I wasn’t vaccinated,” said Shek Wai-keung, 68, who expected to receive his first Sinovac shot this week. “I feel frustrated, but since I need to get into restaurants, I’m forced to get vaccinated.”

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Hong Kong had a year to protect its elderly, who have free access to Pfizer-BioNTech or Sinovac doses. But staggeringly low uptake among people over 80 — fewer than 1 in 5 have had two shots, and almost none have had three — has left this most vulnerable group starkly exposed as the omicron variant spreads.

The squandered opportunity has exposed flaws in Hong Kong’s pandemic strategy, which focused on achieving “zero covid” by keeping infections out rather than preparing for a world in which the virus is endemic.

Now, Hong Kong has responded to an outbreak of the highly transmissible new variant by halting flights from eight countries, including the United States and Britain, banning dining after 6 p.m., and closing gyms, beaches, playgrounds and some schools. (Malls, however, remain open.) Hong Kong carrier Cathay Pacific and other airlines have slashed cargo capacity, leading to shortages and a spike in prices of dairy, fruits and meat.

The measures have left some residents feeling as if it were still January 2020, before the advent of vaccines, rather than 2022.

Ben Cowling, an epidemiologist at the University of Hong Kong, said elderly residents’ hesitation to get vaccinated is probably a result of the government’s “zero-covid” messaging; since the virus would be kept out through strict quarantine measures, there would not be a need to protect oneself against it.

It wasn’t until this month, as omicron spread, that the Hong Kong government announced it would require proof of vaccination to enter restaurants and other venues. The change only takes effect in late February, after the Lunar New Year holiday when families will gather for banquets and celebrations. Many have questioned why vaccine mandates were not implemented months ago.

Still, the prospect of being banished from food establishments has prodded some of the holdouts into action.

“I need to visit the restaurant and yum cha with my children and grandchildren,” said a 90-year-old woman who identified herself only as Liu, referring to having tea and dim sum. “So I’m open to taking it now,” she added, noting she would consult her doctor first.

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Cowling and others say that if having zero infections remains the government’s goal, stringent social distancing measures, flight bans and work-from-home measures will continue, too. This could further chip away at Hong Kong’s viability as an international city.

“We don’t have a clear strategy for the long term,” he said.

After the surge in recent days, about 70 percent of Hong Kong’s total population is doubly dosed. But just 19 percent of people age 80 or above have had two shots, and 47 percent of those age 70 to 79 — far behind counterparts in Japan, Singapore, South Korea and other wealthy nations. People age 60 or above accounted for 93 percent of the city’s 213 total deaths and nearly three-quarters of critical cases, official data shows.

Older residents who spoke to The Washington Post expressed fears of severe side effects, or believed they could avoid the virus simply by wearing masks and sanitizing their hands, underscoring the prevalence of misinformation and lax messaging about the urgency of vaccinating this vulnerable group.

Shek, the 68-year-old, said he heard that people’s mouths were “distorted” after receiving the shots. Another man, a 78-year-old who identified himself as Fung, said he believed the virus would simply go away. Peter Sit, 76, who got the Sinovac shot last week, said he chose the Chinese-made vaccine as he believed it was more suitable for his Asian physique.

Fear of side effects, allergic reactions and death are the main reasons for the reluctance among the elderly, said Stephanie Jean Tsang, assistant professor at the Department of Communication Studies at Hong Kong Baptist University and author of a 2021 study on understanding vaccine hesitancy in the city. News headlines with keywords such as “death,” “myocarditis” or “face paralysis,” that focus on the most serious reactions, also caused fear, as most people just read the headlines, she said.

“To many people, if side effects are so drastic, while Hong Kong was with zero covid cases, maybe this factored into why they chose not to get vaccinated earlier,” Tsang said.

Experts also point to the city’s elderly care homes, whose residents must seek permission from relatives before getting vaccinated. Kin-on Kwok, an assistant professor and researcher in infectious diseases at the Chinese University of Hong Kong’s School of Public Health and Primary Care, said that children are not pushing their aging parents to get the shots.

With the elderly largely unprotected, a surge in cases could bring the health-care system to collapse, which “will lead to a lot of deaths,” he said.

Hong Kong bans all flights from U.S. and seven other countries as omicron spreads

Omicron arrived in Hong Kong just before the new year, spread by an airline crew member who had lunch with a relative, ending months without community transmission. Anyone who tests positive is taken to an infection control center, and close contacts are quarantined in a government camp.

As health officials panic, the government has moved to incentivize inoculation by allowing walk-in vaccinations for seniors and reopening vaccination centers. But it will be months until the late takers can get booster shots to sufficiently guard against omicron. Previously, authorities had resisted mandating vaccinations except for civil servants and workers in some sectors, and had urged private businesses to require employees to be vaccinated.

Meanwhile, officials have not endeared themselves to the public through their example. Dozens of civil servants and lawmakers attended a large birthday party for a local official last week, with many ending up in quarantine after a positive case at the gathering of some 200 people. Residents pointed out the officials’ hypocrisy in demanding public adherence to social distancing measures while flouting their own guidance.

“As a political appointee I should have been more alert and considered the pandemic prevention measures first before taking any action,'' wrote Secretary for Home Affairs Caspar Tsui in an apology on social media. “I will deeply reflect upon myself during quarantine.”

Cowling said there is a pressing need to inoculate seniors as soon as possible, and he praised the vaccination mandate for restaurants as a good change.

“But it’s a shame it hasn’t been done soon enough,” he said.

Shibani Mahtani contributed to this report.

Read more:

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Coronavirus: What you need to know

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot designed to target both the original virus and the omicron variant. Here’s some guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

Variants: Instead of a single new Greek letter variant, a group of immune-evading omicron spinoffs are popping up all over the world. Any dominant variant will likely knock out monoclonal antibodies, targeted drugs that can be used as a treatment or to protect immunocompromised people.

Tripledemic: Hospitals are overwhelmed by a combination of respiratory illnesses, staffing shortages and nursing home closures. And experts believe the problem will deteriorate further in coming months. Here’s how to tell the difference between RSV, the flu and covid-19.

Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious. We’ve also created a guide to help you decide when to keep wearing face coverings.

Where do things stand? See the latest coronavirus numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people. Nearly nine out of 10 covid deaths are people over the age 65.

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