The Washington PostDemocracy Dies in Darkness

China’s unvaccinated elderly prevent an end to covid lockdowns

A neighborhood in Shenzhen, where vaccination rates for those over 60 are significantly lower than for other age groups. (Eva Dou/The Washington Post)

SHENZHEN, China — On a sweltering afternoon in this southern Chinese city, a young woman sat at a stand of giveaways aimed at convincing some of the city’s remaining unvaccinated residents to get their shots.

“You can get a bag of rice, cooking oil, or two bottles of shampoo,” she said, offering the tempting choice to passersby.

There are few takers because almost all of the city’s working-age residents have been vaccinated, but across the country and in Shenzhen, it is the elderly who are the main holdouts. Unlike most of China’s coronavirus prevention measures, vaccination is not mandatory, and low uptake among the country’s most vulnerable groups is a major reason Communist Party leaders feel compelled to persist with a grueling “zero covid” approach.

China tries to cover lockdown strains on Shanghai’s front-line workers

As the costs of lockdown in China have mounted, the need to vaccinate the entire population has become paramount. Shanghai has suffered staggeringly over the past month, with residents trapped by a strict lockdown unable to reach hospitals and suffering psychological breakdowns after weeks-long home confinement with an unknown end date. Supply chains worldwide have been upended.

Despite the mounting criticism, China’s top leaders declared on Thursday that there would be no letup on the zero-covid policy, and that they would fight any attempts to question the approach. The committee, led by President Xi Jinping, said relaxation of controls now would lead to “massive numbers of infections” and deaths.

They only need to look next door to Hong Kong, where the omicron outbreak this year tore through the high numbers of unvaccinated elderly people and resulted in one of the highest fatality rates in the world.

The head epidemiologist of the national covid response team, Liang Wannian, said last week that vaccination rates among the elderly and children were not high enough, and “if we choose the so-called policy of coexisting with the virus, medical resources would be very likely be overwhelmed.”

But outside the flare-up zones, it’s easy to see why older residents might be reluctant to get vaccinated. In places like Shenzhen, city life bustles as normal, except that pedestrians have to show proof of a negative coronavirus test within the past 72 hours to enter any public spaces.

China’s ‘zero covid’ policy wavers as infections spread and complaints over lockdowns surge

The vaccination drive has been mild compared to some of the other pandemic-control measures and did not prioritize the elderly. Some younger people have been required to get vaccinated for their jobs, but vaccination of retirees remains optional. Incentives like eggs, grains and other foodstuffs — a staple of China’s vaccination drive since last year — are now being bolstered by home checkups, mobile clinics and the widespread mobilization of public servants to ensure the elderly get shots.

“My neighborhood authorities arranged it,” Yuan Zhen, a woman in her 70s, said of her three shots of the Sinopharm vaccine. People over 60 are the least vaccinated group in her neighborhood, Shenzhen’s Shenshan district, and officials recently ordered nurses to make the rounds on a green bus to try to vaccinate more retirees.a

Only 56 percent of residents over 60 have at least one shot in Shenshan, far below the numbers for all other age groups. Vaccines weren’t even available for the elderly in Shenzhen until June 2021, after 88 percent of residents between the ages of 18 and 59 had received at least one shot.

On a recent afternoon, a recording played outside the Shenzhen public library, asking unvaccinated readers to get a shot around the corner before entering. Few were interested, however, even with the offers of free rice and shampoo.

Civil servants — including in some instances professionals like teachers with no public health role — are under pressure to track down and persuade elderly people to get vaccinated, sometimes being allotted a quota of households. Failure to do so could mean losing out on annual bonuses or hurting chances of promotion.

From the start, China took a different approach to immunization. Unlike many Western countries, which prioritized the elderly and immunocompromised groups to minimize deaths, China targeted people considered most likely to spread the virus.

At the time, China’s mass testing, contact tracing and quarantine measures had brought cases down to near zero. The goal for officials was “preventing imported cases and domestic resurgence.” First up for vaccines, therefore, were workers at customs and airports, taxi drivers, overseas business travelers and anyone else considered a potential vector to bring the virus into China and spread it.

Shifting messaging has also exacerbated the vaccine hesitancy. Vaccines were initially approved only for younger groups, with officials reassuring older people that they were protected by the vaccination of others and warning of the shots’ possible risks.

Before the pandemic, quality and corruption scandals had repeatedly shaken faith in China’s vaccine industry, raising fears of side effects from faulty jabs.

China’s lockdowns bring the pandemic full circle

Early in the vaccination drive, officials cited a lack of data as the main reason for delays, explaining that clinical trials tend to focus on 18-to-59-year-olds to start before moving on to other age groups.

But some government medical experts now worry this initial caution undermined the rollout. Lu Hongzhou, who heads Shenzhen’s epidemic control advisory team, told local media outlets this month that manuals should no longer warn immunocompromised people against getting a shot, instead encouraging them to do so because “they are at high risk of severe illness or death.”

The decision not to include them in required national immunization programs reflects uncertainty about whether the virus will be a long-term problem or merely a seasonal disease like the flu, according to Wang Guisong, a professor of law at Renmin University in Beijing.

In major cities like Shenzhen, the unvaccinated elderly remain a hidden minority, as the streets are filled with working-age commuters and retirees in better health who could get themselves to vaccination points. Out of more than 30 pedestrians over the age of 60 interviewed by a Post reporter over the past week, only two said they had not received any shots of coronavirus vaccine.

One of them, a 72-year-old woman who spoke on the condition of anonymity to discuss medical details, said she had tried to sign up for a shot from a hospital but was advised against it due to her numerous health problems. “If I could get it, I would have a long time ago,” she said.

Shepherd reported from Taipei, Li from Seoul. Pei Lin Wu and Vic Chiang in Taipei contributed to this report.

Coronavirus: What you need to know

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot. New federal data shows adults who received the updated shots cut their risk of being hospitalized with covid-19 by 50 percent. Here’s guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

New covid variant: The XBB.1.5 variant is a highly transmissible descendant of omicron that is now estimated to cause about half of new infections in the country. We answered some frequently asked questions about the bivalent booster shots.

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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