By Francesca Chiu

Hong Kong’s Covid-19 vaccination rate has been criticised as low and slow, but it’s worth looking at the actual numbers to see how dire things really are.

The Covid-19 Vaccination Programme was officially launched on February 26 but in its first three months of implementation, just 1.25 million people had received at least their first dose as of May 23, less than a fifth of the total population. Some 892,000 people had received their second dose, meaning that 13.6 per cent of the city’s population was fully vaccinated.

A Pfizer-BioNTech Covid-19 vaccine. File photo: IMF Photo/Ernesto Benavides, via Flickr.

That pales in comparison to our potential travel bubble buddy, Singapore. The city-state started its vaccination programme in late January, and by May 21 more than a third of the total population had received at least one dose, and about a quarter of the total population was fully vaccinated. Even though Singapore started its vaccination programme one month ahead of Hong Kong, the yawning gap in progress remains undeniable.

Many pundits, public health experts and government officials have tried to explain why Hong Kong’s populace – especially locals – have declined the jab, but these analyses often simply provide a laundry list of different reasons. These include not seeing an urgent need for vaccination; concerns over hypothetical long-term health effects of the vaccines; doubts about vaccine effectiveness; lack of concrete incentives; and last but not least, historically low levels of trust in the Hong Kong government.

A boy wearing face mask as a precautionary measure against the COVID-19 coronavirus riding a scooter by the waterfront of Tsim Sha Tsui district in Hong Kong. Photo: May James/HKFP.

These may all play a part but this long list does little to help identify how to solve the serious and pressing problem Hong Kong faces of vaccine hesitancy in the midst of a deadly global pandemic. A more useful approach is to categorise people based on their different reasons for refusing the jab so we can use tailored arguments that are more likely to win them over.

Here, I’ve divided these rationales into two main camps: anti-Covid vax, and politically anti vax.

Covid anti-vaxxers

This group does not deny the benefits of vaccination, yet believes that it should not get the Covid jab yet, or at all. To understand the Covid anti-vaxxer position requires a look at the medical history of Hong Kong.

Officers of Hong Kong’s Fire Services Department receiving vaccinations. File photo: GovHK.

The city survived the deadly SARS outbreak of 2003 without any vaccines since there were none available. Wearing a mask, social distancing and personal hygiene helped it to fight SARS. When Covid-19 struck, Hongkongers had an autopilot mode ready to do exactly the same thing to protect themselves, even before the government acted. The lessons the locals learnt from SARS has led some to believe that vaccination for Covid is not necessary, particularly since Covid has a much lower death rate than SARS.

Many locals have also expressed concern about the safety of the Covid vaccines and worry about long-term side effects, although trial results from the BioNTech vaccine do not support this belief. A survey conducted by the Chinese University of Hong Kong last year showed that overall Covid-19 vaccine acceptance rate for Hong Kong adults was 37 per cent, and lack of trust in the vaccine and its manufacturers were the biggest hurdle to getting a jab. Combined with widespread confidence in mask-wearing, these Covid anti-vaxxers are content to adopt a wait and see approach to vaccination.

Political anti-vaxxers

This group says no to the jab due to its lack of trust in the government. It understands the benefits of vaccinations yet has abstained because of suspicion about the government’s programme.

Vials during the production of the Sputnik V vaccine production line operated by a contractor, the pharmaceutical company Biocad, in Saint Petersburg, Russia. File photo: IMF Photo/Sergey Ponomarev, via Flickr.

Common rationales include arguments like “the government is trying to force people to get the jab to please Beijing,” or simply “whatever the government asks me to do I’ll just do the opposite.” The group also expresses concern over human rights, especially in the light of increasing fears over personal freedom after 2019. I have more than one acquaintance who said that “as long as the government is asking people to take the jab, they won’t take any,” to exercise their freedom to say no.

The government’s policy during the ongoing pandemic has also prompted some locals to refuse the jab due to dissatisfaction. It has been criticised for its slow reaction at the beginning of the pandemic; its refusal to completely close the city’s borders as Covid-19 spread through cities across China; ever-changing and unscientific social distancing rules; selective issuance of penalty tickets; and poor arrangements for those in quarantine.

Photo: Hong Kong police.

I’m not suggesting that the above two groups do not overlap. Rather, their positions are interrelated and reinforce one another. When the government promotes information on the safety of vaccination, that information is inherently discounted by those who view its actions as inherently suspect.

But vaccine hesitancy is not a binary of acceptance and rejection. It is a spectrum along which people in are in constant motion. Underlying the hesitancy is a lack of trust in authorities – not just the government per se, but also public health organisations, pharmaceutical companies and research institutes.

So what’s to be done?

For the Covid anti-vaxxers, government measures to relax travel restrictions, or warnings that the unvaccinated could face more curbs, have no impact because they do not address the group’s biggest concerns.

The government has provided plenty of information on vaccine safety through its own channels and the media. But the sad irony is that it has not even been able to convince its own employees, a fact I have experienced first-hand.

An evacuation in Tsim Sha Tsui. File photo: Michael Ho/StudioIncendo.

One member of my family has been living in a government-subsidised elderly home during the pandemic – part of an extremely vulnerable population that has frequently been cut off from the outside world on government orders. But when I spoke recently to one of the social workers there, he told me that many of his colleagues and staff working at elderly homes across Hong Kong had advised residents not to get the jab in order to avoid any risk.

While there is no official data on the percentage of vaccination among residents in elderly homes, we do know that fewer than 80,000 people over 70 have been vaccinated (as of May 23). The fact that anti-vaxxer attitudes are so prevalent among the social workers and staff at elderly homes is alarming and a danger to the residents whose health they are charged with safeguarding.

That makes it all the more important to address vaccine scepticism through an approach that addresses the concerns of Covid anti-vaxxers as comprehensively as possible – separating distrust of the government from the question of vaccine safety.

But it is also important not to dismiss the concerns of political anti-vaxxers as nonsense without understanding why they have this hesitancy in the first place. Public health is never merely a medical issue – it is always political, and personal as well.

Photo: GovHK.

For this group, the necessary motivation could well come from outside of Hong Kong. Planned relaxation of travel restrictions by other countries and the possible introduction of vaccine passports, such as by the EU, have already spurred some of my political anti-vaxx acquaintances to book an appointment for their first jab.

That may be encouraging. But it is a sad state of affairs that many Hongkongers now seem more likely to respond to the incentives of other governments in lieu of a more coherent response from their own.

Francesca Chiu is a PhD candidate focused on urban marginality and spatial politics in Myanmar at the University of East Anglia and the University of Copenhagen. She is a former researcher at the Centre for Civil Society and Governance at the University of Hong Kong. Follow her on Twitter.

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