There are few places in the world where it is easier to get a COVID-19 vaccine than Hong Kong.
Shots are free and available to everyone above the age of 16. Bookings are made via an easy-to-use Hong Kong government Web site, and people can be in and out of the 29 vaccination centers dotted throughout the territory in 20 minutes.
They even get a choice between two shots — a Chinese-made one from Sinovac Biotech, or the Pfizer-BioNTech vaccine, the world’s most effective COVID-19 shot.
Illustration: Mountain People
However, most people are choosing not to get vaccinated.
According to Bloomberg data, enough doses have since late February been administered to cover 11.6 percent of a population of 7.5 million. That is behind leading places like the UK, at 39.7 percent, and Singapore, at 19.4 percent, where available doses are so in demand that most of the adult population has not yet been granted access.
In Hong Kong, so many doses are languishing that the government has warned people that some would expire in September.
On Sunday, vaccine appointment bookings dropped to their lowest in a month, with just 2,100 taking the Sinovac shot and 6,800 receiving the BioNTech jab.
The situation is making Hong Kong a conspicuous global outlier. While other developed economies with strong vaccine supplies such as Germany, the UK or the US see vaccine reluctance as a challenge to overcome later in their inoculation drives, Hong Kong has faced skepticism from the start, fueled by a breakdown of communication between the unpopular, unelected government and the population.
The slow uptake is likely to further delay the territory’s return to normalcy and undermine its attractiveness as a business hub amid signs of an exodus of expatriates and locals alike.
Hong Kong Monetary Authority Chief Executive Eddie Yue (余偉文) said that the territory’s low vaccination rate could make international firms question whether to set up base there.
Vaccine reluctance has been generally higher in the Asia-Pacific region, where early containment success has meant that people do not fear COVID-19 as much.
Hong Kong has reported less than 12,000 cases and 210 deaths since the COVID-19 pandemic began, while peers like Taiwan, Singapore, New Zealand and Australia have been similarly less-affected by the pandemic.
What makes the dynamic harder to resolve in Hong Kong is a deeper well of mistrust stemming from unprecedented street protests in 2019, as well as a subsequent crackdown by Beijing and local authorities that has eroded key political freedoms.
With political distrust permeating through every sphere of life in Hong Kong, some see a refusal to heed government calls to take the vaccine as a form of resistance — particularly as COVID-19 restrictions and the National Security Law imposed by Beijing means that forms of dissent have mostly been snuffed out.
“I won’t take the vaccine, because my friends and I just don’t want to follow any instructions or recommendations from the government,” said a 16-year-old student who gave her surname as Chau. “I don’t trust anything from them. We’ll do our best to resist and fight against the government in the way we still can.”
Elaine Tsui, a lecturer in health psychology at Hong Kong Baptist University, said that vaccine hesitation is driven by three psychological factors: convenience, complacency and confidence.
In the territory, getting a shot is convenient, but there is high complacency due to the perception that COVID-19 does not present a significant health threat to residents.
Yet where the population stands out is in confidence — or the lack of it, she said.
With the level of distrust in government “more severe” in Hong Kong than many other places due to the events of the past few years, people are more prone not just to vaccine skepticism, but conspiratorial readings of any public health initiative linked to the government, Tsui said, adding that media reporting is one way this unfolds.
In Hong Kong, medical incidents or deaths among people after they get vaccinated are widely reported, although some have very little link to the shot.
In one example, a 41-year-old man earlier this month died five days after an accident where a barbell fell on his chest in a gym during a workout, with media reports adding that he had taken the BioNTech vaccine earlier.
Overall, 16 people have died after taking the Sinovac shot, although the government said that none have been linked to the vaccine.
That has contributed to the distrust of vaccines, despite overwhelming scientific evidence in Hong Kong and globally showing their safety.
Selene Yau, a 24-year-old marketing professional, said that news of the deaths and side effects are scaring people regardless of their politics.
“My relatives and I have different political views, but we still want to wait and see. There is a lot of news about the adverse reactions spreading on social media and WhatsApp groups,” Yau said.
The febrile atmosphere also puts pressure on government officials to act cautiously in ways that have further raised resistance.
One example was an abrupt 12-day suspension of the BioNTech vaccine in March after healthcare workers reported packaging defects like “loose lids” and “stains” to the government and company.
“In other places it may not have risen to what it rose to in Hong Kong,” said Ben Cowling, head of the University of Hong Kong’s department of epidemiology and biostatistics, adding that the BioNTech factory that manufactured those shots had also sent doses to many other places around the world, without issues reported.
The government said in a statement that a number of officials have “led by example by getting vaccinated,” and that it would “go public to clarify misinformation and misconception about the safety and benefit of taking vaccines.”
To stoke interest in vaccinations, the government has relaxed social distancing rules for vaccinated people, allowing them to visit bars and gather in bigger groups at restaurants.
A “travel bubble” with Singapore scheduled for the end of this month is also only to be opened to vaccinated Hong Kong residents.
Those measures have not boosted vaccination demand significantly. After an initial one-day bounce, bookings have stayed flat for both vaccines.
On Friday last week, the government announced that vaccinated people would also be subject to shorter periods of quarantine if they are found to be close contacts of infected people or are traveling from a handful of low to medium-risk places.
While experts say that even stronger incentives are needed, a government adviser suggested that an atmosphere of distrust in the territory limits their policy options.
“Since the trust level is not high, so we can’t push it like mainland China or elsewhere, so we must do it in a voluntary basis and every individual must decide for themselves,” said Lam Ching Choi (林正財), a medical doctor and member of the Hong Kong chief executive’s advisory Executive Council. “It’s a very delicate position for the government.”
The government is now reaching out to local celebrities to convince people to get vaccinated. Hong Kong Secretary for the Civil Service Patrick Nip (聶德權) publicly thanked Hong Kong billionaire Li Ka-Shing (李嘉誠) for publicizing on Facebook that he received a BioNTech shot and asking others to do so, too.
Still, much of the population looks set to dig their heels in — even frontline medical workers at risk of being infected.
Hanson Chan, who works as a nurse at a public hospital that treats COVID-19 patients, said that vaccine development was rushed and the prospect of rare side effects worries him.
“The government keeps saying those cases of abnormal side effects have no clinical evidence to indicate that they are caused by the vaccine — that may be a fact,” Chan said. “However, it’s not convincing enough for residents to believe this argument from the government’s mouth.”
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