Dr YANG Siu Ming, Sam
Dr Sam YANG
The 5th wave of COVID-19 infection caused an unprecedented impact to the Hong Kong healthcare system. The emergency medical service was on the verge of collapse. The photos of bedbound elderly patients lying on beds in the temporary tents outside hospitals in the cold rainy night hit the headlines internationally. The dead bodies of those deceased were scattered on the floor, some were even underneath the bed of other patients under active treatment. The pledged arrival time of ambulance service dropped to a record low of ~20%, compared to over 90% in previous years, due to the historically large number of emergency calls received related to covid infection. Every part of these seemed contradictory to what we experienced in the past two years, when we were well protected from the zero-COIVD policy.
Vaccine hesitancy: more deadly than the virus
Perhaps one of the root causes for Hong Kong being hard hit by the virus in the preceding month was vaccine hesitancy, which was well warned by scientist before initiation of global COVID-19 vaccine campaign. In fact, vaccine hesitancy was considered as one of the ten threats to global health by WHO in 2019.
Hong Kong started its covid 19 vaccination program in Feb 2021. Yet, with the abundant supply of vaccine, the first dose vaccination rate had climbed steadily but reached a plateau of ~60% from Sep 2021 thereafter. The complacency from the success of control of the virus in the previous waves led us into a false belief that we were distant from the virus and that imminent risk never existed. People tended to sense a threat from real life experience rather than from numbers and data. Ironically, while the zero-covid policy protected us from previous waves of infection, it seemed to be the pill of poison for the 5th wave.
The peculiar distribution of vaccination rate by age groups in Hong Kong further put our vulnerable group at stake. It would be surprising to see the elderly groups, who were the most in need of vaccination, had the lowest vaccination rate. By early Feb 2022, the first dose vaccine recipient rate for age groups 70-80 and >80 years old was only ~ 33% and 60% respectively, compared to those younger age groups which had generally above 80% uptake rate. Looking at available data across the world, most other countries had their elderly vaccine uptake rate comparable, if not being the highest, to younger age groups.[5,6,7] Such a low vaccination rate in the elderly was unique in Hong Kong. Some people were skeptical of the Comirnaty (BioNTech)vaccine which was developed with new technology and with more vigorous post-vaccine reactions. On the other hand, they also hesitated to let their elder family members receive CoronaVac(Sinovac) vaccine in which ‘uncontrolled severe chronic disease’ was one of the contraindications. There was no clear-cut definition of what it meant by ‘uncontrolled severe’. Many people were misled into believing that any patients with ‘severe chronic disease (even under well controlled)’ were deemed at risk of life-threatening events from ANY COVID-19 vaccines.
With billions of doses of vaccine given across the world, more and more evidence proved the effectiveness of COVID-19 vaccines and the safety. Our previous experience with use of other inactivated vaccines such as influenza, hepatitis A, rabies etc in patients with chronic medical illness also showed more benefit than harm as well.
Though many myths that made the general public resist against vaccines were indeed scientifically baseless, they were contagious and pervasive. Research carried out by Betsch et al. developed a 5 C framework explaining vaccine hesitancy, which were Confidence, Complacency (perceived personal health status and invulnerability), Constraints / Convenience, risk Calculation and Collective responsibility. To boost up the vaccination rate in our elderly group for future waves of COVID-19 infection, perhaps we should the mitigate the most important C in our community.
Dror, A. A., Eisenbach, N., Taiber, S., Morozov, N. G., Mizrachi, M., Zigron, A., Sro, S., & Sela, E. (2020). Vaccine hesitancy: The next challenge in the fight against COVID-19. https://doi.org/10.21203/rs.3.rs-35372/v1
World Health Organization. (n.d.). Ten health issues who will tackle this year. World Health Organization. Retrieved March 30, 2022, from https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
Ritchie, H., Mathieu, E., Rodés-Guirao, L., Appel, C., Giattino, C., Ortiz-Ospina, E., Hasell, J., Macdonald, B., Beltekian, D., & Roser, M. (2020, March 5). Coronavirus (COVID-19) vaccinations. Our World in Data. Retrieved March 30, 2022, from https://ourworldindata.org/covid-vaccinations?country=~HKG#country-by-country-data-on-vaccinations
Ritchie, H., Mathieu, E., Rodés-Guirao, L., Appel, C., Giattino, C., Ortiz-Ospina, E., Hasell, J., Macdonald, B., Beltekian, D., & Roser, M. (2020, March 5). Coronavirus (COVID-19) vaccinations. Our World in Data. Retrieved March 30, 2022, from https://ourworldindata.org/covid-vaccinations?country=~HKG#vaccinations-by-age
Ritchie, H., Mathieu, E., Rodés-Guirao, L., Appel, C., Giattino, C., Ortiz-Ospina, E., Hasell, J., Macdonald, B., Beltekian, D., & Roser, M. (2020, March 5). Coronavirus (COVID-19) vaccinations. Our World in Data. Retrieved March 30, 2022, from https://ourworldindata.org/covid-vaccinations#vaccinations-by-age
Covid-19 Vaccine Tracker: European Centre for Disease Prevention and Control. COVID-19 Vaccine Tracker | European Centre for Disease Prevention and Control. (n.d.). Retrieved March 30, 2022, from https://vaccinetracker.ecdc.europa.eu/public/extensions/covid-19/vaccine-tracker.html#age-group-tab
Vaccination statistics. Ministry of Health. (n.d.). Retrieved March 30, 2022, from https://www.moh.gov.sg/covid-19/vaccination/statistics
Betsch, C., Schmid, P., Heinemeier, D. K., Korn, L., Holtmann, C., & Böhm, R. (2018). Beyond confidence: development of a measure assessing the 5c psychological antecedents of vaccination. https://doi.org/10.31234/osf.io/ytb7w