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When Hong Kong Chief Executive Carrie Lam rolled up her shirt sleeve to get the Asian financial hub’s first COVID-19 vaccination last month, she gave a ringing endorsement of the shots produced by mainland Chinese firm Sinovac Biotech Ltd.

“We are taking the Sinovac vaccine today, which was developed and manufactured in the mainland, because this is the first vaccine that has arrived in Hong Kong,” Lam said on Feb. 22 as she got inoculated in a public ceremony with her top aides.

Since then, confidence in both Sinovac and her government’s vaccine drive has plummeted. Seven deaths and dozens of adverse reactions were reported following the first 160,000 doses of the shot, and residents began signing up in droves for the vaccine made by BioNTech SE and Pfizer Inc. — the only other one available.

While official investigations revealed no connection between the deaths and Sinovac, and one fatality was also reported after a resident took the BioNTech vaccine, the hysteria came on top of mounting public mistrust of Hong Kong authorities over the past two years as Beijing moved to restrict free speech and lock up democracy advocates. Even before the latest crisis, only 37% of adults in the city said they would take a COVID-19 vaccine, according to a survey from the Chinese University of Hong Kong.

Now Lam and other officials are pleading with the public to take vaccines before they expire, while also expanding eligibility to healthy adults aged 30 to 59. The low vaccination rate, which trails Singapore’s, threatens to delay Hong Kong’s reopening compared with other major cities, hurting an economy already pounded by the dual blow of the pandemic and pro-democracy protests in 2019.

‘Negative impression’

“The recent death cases related to Sinovac have created a negative impression of vaccines, even if the government says they’re not related,” said Kenneth Ip, a 43-year-old property manager in Hong Kong who said he doesn’t want to get vaccinated. “If they made it compulsory, I will choose BioNTech, not Sinovac.”

The skepticism in Hong Kong underscores the public hesitation over vaccines facing governments around the world, including the future of the shot made by AstraZeneca PLC following reports of serious blood clotting in a small number of people in Europe.

Hong Kong has so far administered doses equivalent to cover 2% of its population, compared with 6.9% for Singapore and 54% in Israel, which leads the world in inoculations, according to Bloomberg’s vaccine tracker. Authorities have twice moved to expand the group eligible for vaccines after just a small percentage of people in priority groups opted to get jabbed.

In a weekly briefing on Tuesday, Lam said the city would consider expanding vaccine eligibility to anyone over the age of 16 once more doses arrived. She also said she would examine more incentives to boost vaccination, including whether it would be possible to reduce the 21-day mandatory quarantine for residents returning to the territory.

“I will personally look into this matter,” she told reporters.

Liu Peicheng, a Sinovac spokesperson, said the number of deaths initially reported in Hong Kong following the first round of inoculations was “unexpectedly high.” While he understands the worries among residents, Liu stressed the deaths weren’t linked to the vaccine while adding that a media frenzy exacerbated the situation.

“Once the confidence is hurt, it’s indeed really hard to overturn,” Liu said, adding that Sinovac has had more pushback in Hong Kong than anywhere else in the world. He said 70 million Sinovac doses have been given across the globe, with nearly a third of them going to people 60 and older, and the rate of adverse events is similarly low across all age groups.

Sinovac said late Monday that it would be able to produce 2 billion COVID-19 vaccine doses this year.

Hong Kong’s own analysis shows Sinovac’s efficacy at just around 62% after a second dose, compared with 97% for BioNTech. And although BioNTech was available in Hong Kong later than Sinovac, it’s now getting used at a faster rate.

The percentage of people failing to show up for Sinovac appointments has hovered around 20% over the past seven days, according to government data, compared with an average of less than 7% for BioNTech. Since Friday, an average of 15,000 people per day have received a BioNTech dose, the data show, while the number of residents who received Sinovac during that time averaged about 10,700.

Lam Ching-choi, a medical doctor and adviser to Carrie Lam, said that “with hindsight” it was possible the government’s early deployment of Sinovac and the highly publicized but unlinked deaths dissuaded people from getting inoculated. However, he added, the administration’s experts said that Sinovac was safe and could be used on the elderly.

“Every measure, whether it’s epidemic control or rolling out the vaccination program, all are calibrated and guided by the science and the experts,” he said. “But unfortunately, sometimes these may not be perceived as positive by the general public.”

Besides the deaths early on in the rollout, a lack of data from Sinovac on how the shots affect the elderly has fed public reluctance to get vaccinated. In its emergency approval for Sinovac, Hong Kong’s expert committee noted there was “insufficient data of efficacy in people aged 60 and above.”

In a statement last week, the government said the expert committee recommended Sinovac because the benefit “generally exceeds the risk of not using any vaccines” in people 60 and above. It accused critics of trying to “smear” Sinovac’s vaccine.

“I’m not sure why there’s so much enthusiasm for Sinovac” in Hong Kong’s government, said Benjamin Cowling, a professor and head of epidemiology and biostatistics at the University of Hong Kong. “It’s not as effective a vaccine, and there’s not much evidence of its effectiveness in older adults above 60.”

Carrie Lam herself has criticized the slow uptake, and said last week that the government will explore whether there’s room for social distancing measures to be relaxed for vaccinated people. Beijing earlier this month eased the visa process for people who received Chinese-made vaccines.

But Hong Kong’s pro-democracy opposition blames the government for using public health issues for political ends, including citing the pandemic for delaying Legislative Council elections by a year. Beijing earlier this month revamped the election system to ensure the Communist Party has a veto over any candidates.

Ramon Yuen, a district councilor for the opposition Democratic Party, said Carrie Lam only got the Sinovac shot to show her “loyalty” to China and should’ve been more cautious in rolling out vaccines for the elderly.

“It’s damaged people’s trust in the system,” Yuen said. “Many people are saying the government has its own agenda, and this will impact the effectiveness of public health policy.”

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