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Quickly Vaccinating Hong Kong May Be a Long Shot

A top epidemiologist says that many are hesitant as rollout begins.
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After a year of showing the world how it could keep the COVID-19 pandemic at bay, Hong Kong on Friday began rolling out vaccines for the disease, making the Asian financial hub one of the latest places in the region to get the shot.

But could its success at handling the outbreak now become its challenge in getting out the vaccine?

One paper, the Chinese territory should play out as a vaccination success story. It has so far secured enough shots, including those from Chinese company Sinovac  (SVA)  and BioNTech  (BNTX)  to vaccinate its entire adult population later this year. (The BioNTech vaccine is not being marketed by Pfizer  (PFE)  in China.) The territory's government boasted on Friday that the vaccination program landed to an “enthusiastic public response.”

The reality, however, is that many people there are unsure about getting the jab, according to surveys. That’s not much different from what’s happening in places like Japan, where the risk of getting the disease is relatively low.

“There is quite a bit of hesitancy in Hong Kong,” said epidemiologist Benjamin Cowling, a professor and head of the Hong Kong University’s division of epidemiology and biostatistics. “In Hong Kong we’ve done pretty good at dealing with COVID so far.”

The area has under 11,000 confirmed cases in a population of about 7.5 million. Assuming more people were infected but didn’t get tested, the total probably comes to about 0.5% of the population who’ve had the disease, said Cowling during a call with TheStreet this weekend.

“That also means the risk of COVID is perceived a little bit differently compared to in the U.S. or other parts of the world,” he said. “Probably you know many people who have had COVID. For me, I don’t. For a lot of people in Hong Kong, they don’t.”

Cowling’s team at HKUMed has been surveying vaccine confidence in Hong Kong and the results so far show a population uneasy with the shot. They found that about 20% of people say they will get it as soon as they can, and about 10% to 15% say they will not get it no matter what. About 60% to 70% said they are going to wait and see, he said.

“So that is hesitancy,” said Cowling. The problem with that, he said, is vaccination is “our pathway back to normal.”

To a lesser extent, a similar hesitancy could be seen in Japan earlier this month when it began distributing Pfizer shots. The spread of COVID there is also much less than in the U.S. and surveys show the willingness to get the jab is around 50% or more.

A top virologist there told TheStreet that if half the nation got the jab, he would consider that a high rate. Disease experts there say advocacy would be needed to change minds.

"People do not have the correct scientific data, just an image of the vaccine,” said Dr. Nobuhiko Okabe, a member of the Japanese government's COVID-19 control advisory committee, last week in an interview with TheStreet.

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“The situation in Japan is quite similar to here,” said Cowling.

Other areas in Asia with low infection rates could see similar problems. A recent note by Capital Economics pointed to a YouGov survey that showed that less than half of people in Hong Kong, Taiwan and the Philippines would “definitely” take a COVID-19 vaccine if they could get one.

“Our working assumption is that for most places it will take around 12 months for the most vulnerable to be vaccinated. Singapore and Hong Kong are likely to be sooner, parts of South Asia much later,” according to Capital Economics. Thailand also rolled out its shots this weekend.

Cowling noted, however, that surveys about vaccine hesitancy are hypothetical, and people may change their minds when they really have the option to inoculate themselves against COVID-19.

As in Japan and most other places, Hong Kong’s department of health is boasting its adverse reaction reporting system and it’s begun campaigns to promote the shots, appealing to both the desire for personal safety and community responsibility with slogans like “protect yourself and protect others, get vaccinated.”

Despite the relatively high efficacy of the BioNTech shots, Cowling said, enthusiasm is a bit more for Sinovac’s one in Hong Kong, which rolled out first. But he feels reaching so-called herd immunity would be easier with BioNTech's.

“I would take the BioNTech,” he said, “we probably need about two-thirds the population to be vaccinated to get to herd immunity.”

That’s important, he says, because another potential obstacle is that if resistance to vaccination is high and spread is low, it means many people could be susceptible to the virus until it's quashed globally.

Cowling said that early in the pandemic, people were willing to social distance and stay home.

But since, he said, “we’ve seen people's enthusiasm wane. “

If vaccination coverage lacks, said Cowling, the alternative would be for Hong Kong to get to “zero and stay at zero. Rather than saying, ‘Let’s get back to normal,’ they could say, ‘Let’s get to zero and stay at zero.’”

On the one hand, he said, Hong Kong could then expand “travel bubbles” with other low-risk nations, but the disadvantage would be continued quarantines and restrictions and new lockdowns every time there is a local outbreak.

“If the vaccination coverage is low, that may be our only choice.”