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Unlike the U.S. where anti-vaccine fringe groups have fueled resistance to COVID-19 shots, Hong Kong is facing a different challenge. Most of the city’s older residents are reluctant to get inoculated, and some point to an unlikely source for the hesitancy: their doctors.

Almost half a year into the territory’s vaccination program with freely available shots, older people are still staying away, due in part to advice from ultracautious doctors to defer vaccination if they have chronic conditions not yet under control. The physicians appear to have taken their cue from a mid-March government recommendation that came after several post-vaccination deaths and cases of adverse reactions were reported in the early days of the rollout, though studies found no links between the fatalities and the shots.

Thanks in part to such doubts and fears, Hong Kong has one of the lowest vaccination rates among developed economies, hampering efforts to reopen borders and spur a recovery from the pandemic. Among people age 65 and above, just an estimated 28% have received at least one dose, according to a Bloomberg analysis of government data, compared with 90% in the U.S. and 87% in Japan. For those above the age of 80 in Hong Kong, the number shrinks to 8%.

While walk-in appointments for older people, incentives and a June advisory emphasizing the safety of the vaccines are helping turn things around, interviews with some of the city’s older people and experts show most aren’t yet ready to line up in droves at vaccination centers. It may take two years to cover older people, University of Hong Kong microbiologist Ho Pak-leung told Radio Television Hong Kong last week.

“If they are concerned about any side effects, the elderly are referred to their family doctors, who may not want to deal with any issues with liability and are therefore more likely to tell them to be more cautious,” said Ben Cowling, head of epidemiology at the University of Hong Kong.

The Hong Kong Medical Association declined to comment.

With the highly contagious delta variant of the coronavirus spreading worldwide, including in mainland China, the hesitancy is posing a threat to the COVID-19 defenses Asia’s financial hub has built employing some of the world’s toughest travel curbs and quarantine policies.

A community vaccination center in Hong Kong | REUTERS
A community vaccination center in Hong Kong | REUTERS

Though BioNTech SE’s messenger RNA vaccine and Sinovac Biotech Ltd.’s China-made inactivated shot are free and easily available for anyone over the age of 12, only about a third of the city’s population is fully vaccinated, according to the Bloomberg Vaccine Tracker. That compares with 63% for Singapore, which has an ambitious plan to soon reach 80% and restore some international travel by as early as September.

Hing So, 74, suffers from the “three highs” — blood pressure, blood sugar and cholesterol. She has been holding off on the shot following her family physician’s advice to be “cautious and wary.”

“My doctor won’t tell me outright whether I should take the vaccine or not, but I feel like his attitude is very skeptical,” So said.

Cheng Siu-kum, 67, who gets bouts of dizziness, said she didn’t bother to get the shot after her friends with similar conditions were discouraged by their doctors. “It’s all right not to be vaccinated for now,” the retired waitress said. “The risk of getting COVID now in Hong Kong is not really that high.”

Lam Ching-choi, chief executive officer of the Haven of Hope Christian Service, which provides aid to 6,000 or so older people in nursing homes and public housing estates, worries about the seniors in his care. Few of his patients have been vaccinated, frightened by sensational tales of fatal side effects.

“At the start, there wasn’t a united front presented by medical authorities and the government that the vaccine was safe to take,” said Lam, who is also chairman of the Elderly Commission, a government advisory panel. “I’ve heard doctors still recommending to this day that elderly persons with chronic diseases not take the vaccine.”

The wariness among older residents started shortly after Hong Kong kicked off its inoculation program in late February. In the early days, the Sinovac shot was the only choice, and priority was given to people over the age of 60, a group that comprises about a quarter of Hong Kong’s 7.5 million people. Local media’s coverage of seven deaths and dozens of cases of negative side effects — sensational at times — spooked many seniors and family members. Official investigations revealed no connection between the deaths and the China-made vaccine.

The incidents prompted a government panel co-led by Ivan Hung, an infectious disease expert at the University of Hong Kong, to issue the March directive asking older people with chronic illnesses to delay vaccination “until their condition is under control.” Many front-line doctors amplified that cautious message instead of emphasizing the need for vaccination, said Jean Woo, professor of gerontology and geriatrics at the Chinese University of Hong Kong.

“Nobody talks about the risk of having the disease itself,” she said. “That has not been presented well at all.”

A vaccination center in Hong Kong in February | REUTERS
A vaccination center in Hong Kong in February | REUTERS

The problem is more extreme in nursing homes, she said, where many seniors have degrees of dementia and social workers don’t want to deal with liability in the event of adverse effects.

“The government supports this public anxiety, where everyone is cautious because no one wants to take any risks or assume any liability,” Woo said.

Blaming health care providers is unfair, Hung said, blasting the media for sending the wrong message and scaring older citizens. “The impression they got is that they should defer — everyone should defer — but that is the wrong impression,” said Hung, who is also the co-convener of the Expert Committee on Clinical Events Assessment Following COVID-19 Immunisation.

In a bid to accelerate the pace, authorities have modified their message by underscoring COVID-19 vaccines are safe for seniors who have received flu shots. On July 29, authorities started allowing seniors to walk in at community vaccination centers without prior online appointments, making it easier for those unfamiliar with technology.

The government has stepped up its campaign to get more older people inoculated, with private corporations pitching in as well. For doctors participating in its vaccination programs, the administration last month announced an additional incentive of 50 Hong Kong dollars ($6.5) per dose per patient age 60 or above. Many local companies have been dangling rewards for vaccinated people of all ages, including lucky-draw prizes of gold bars, a Tesla Model 3 and apartments costing as much as $1.5 million.

Sophia Chan, secretary for food and health, said last month that Hong Kong could achieve a 50% vaccination rate by September.

Authorities may need to consider tougher policies such as barring unvaccinated older people from entering restaurants, said Regina Ip, a member of the city’s executive council and a lawmaker with the pro-Beijing New People’s Party. “We don’t want them to be the weakest link,” she said.

Ngan, 81, who declined to reveal her first name for privacy reasons, said she held off after her doctor advised her to “wait and see” because of possible risks from a stroke she had in 2014. After ascertaining her condition is stable, she finally got the Sinovac shot in mid-July.

“A lot of the elderly actually want to get jabbed,” said Owen Tsang, medical director of the Hospital Authority Infectious Disease Center at Princess Margaret Hospital. “All they need is a bit of reassurance and confidence from their doctors.”

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