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What’s more than a jab? Trust.


Editor's note: Dr. Alexander Wong (not his real name) weighs in on the low vaccine uptake rate and who was it to blame.

By Dr. Alexander Wong

Vaccine uptake rates in Hong Kong, including among health care workers, have been suboptimal. As of today, fewer than 20% of the population has received at least one dose. We are still very far away from achieving herd immunity.

In its usual style, the government has laid the blame on Hong Kong citizens and also lambasted the health care profession for allegedly smearing China-made vaccines. I am surprised to see many in the health care profession, including those who claim to be anti-government, echo the government’s stance and criticize members of the public or health care professionals for not being more proactive in getting vaccinated.

Chief Executive Carrie Lam gets second jab of Sinovac COVID-19 vaccine. 

This is clearly victim-blaming. The problem in Hong Kong is first and foremost one of lack of trust and information. Three months into the vaccination programs, patients are still asking me at every consultation whether they can be vaccinated against COVID-19. A few are dead-set on not receiving what they see as an experimental vaccine, but most of them are just confused and at a loss as to where they can get reliable health advice.

The public’s uncertainty should not be surprising if you have been following the news on vaccination since the beginning of the year. From the start, the government politicized the issue of vaccination, as I have highlighted in previous posts, making it difficult to sell the vaccination programme to a deeply divided and polarized society such as Hong Kong. The general public clearly does not trust anything the government says, given the events of the past two years. Coupled with the controversy and scepticism surrounding any new medical breakthrough, I don’t blame the public from being suspicious and apprehensive from the beginning.

The government made it more difficult for itself by shifting its stance repeatedly and fudging every attempt to properly inform the public of their choices. What started off as confident assurance by the government that “everyone can and should receive Coronavac” quickly degenerated into panic and confusion, as the government realized the consequences of even a few untoward adverse effects and deaths after vaccinations. Suddenly, a hastily put together guideline suggested that those with chronic medical problems might not be eligible for vaccines, or should seek advice from their health care providers. This is in spite of the fact that health care providers, myself included, never received any formal guidance from the government as to who can or cannot receive a Sinovac vaccine. Nor are there any actual, published journal articles that can inform health care professionals especially when it comes to the Sinovac vaccine. To this day, the guidance for health care professionals is vague, non-specific and non-committal. This is in start contrast to the far clearer advice that is disseminated in other jurisdictions, such as Singapore.

As the situation spiralled rapidly out of control, the media had a field day. Every single death or hospitalization after vaccination was covered extensively. It didn’t matter whether it was Sinovac or Biontech; to the vast majority of the public, vaccines are just vaccines - and the media said people got vaccinated and people died. Many don’t seem to know - and why should they, when no one bothers to tell them? - of the real world statistics of each available vaccine or the relative risk of uncommon side effects. The government and the expert panel have all but failed to counter this mass hysteria. There is good safety data from around the world for mRNA vaccines, and comparatively less for inactivated vaccines like Coronavac, but the Hong Kong government would never tell the public any of that because it highlights the relative deficiencies of a Chinese-made vaccine. In the end, the widely-held perception seems to be that any death after vaccination is quickly deemed by the expert panel to be unrelated to the vaccine itself and swept under the carpet, with no detailed explanation or reassurance given to the public. Foolishly, health care authorities also continue to neglect to explain to the public just how many unvaccinated people die of various causes on any given day (the short answer is “a lot”), causing the public to mistakenly attribute every death after vaccination to the injection itself. With how muddled the government information campaign has been, it is very hard for a regular member of the public to be able to sift through the deluge of misinformation and make a genuinely informed choice to get vaccinated.

Make no mistake, I personally support mass vaccination against COVID-19 to achieve herd immunity, especially with a potent, highly immunogenic and well-proven vaccine. Hong Kong is a developed city with all the available infrastructure and setup to quickly deliver thousands or even millions of doses within a short period of time, and should be doing much better with vaccination statistics. But the problem in Hong Kong is one of systematic state failure, and that is much harder to counter than problems with hardware.

Blaming the people of Hong Kong is not going to solve the problem, but would only exacerbate tensions in society and reinforce vaccine-related conspiracy theories. We need someone trustworthy and respected - ideally someone not directly related to the government - to take the lead in vaccine promotion. This can be a renowned scientist, or a celebrity or other public figure. The science needs to be explained clearly and concisely, and the follow-up and investigation of vaccine-related side effects needs to be and seen to be a lot more thorough and transparent. Clearer and more tailored guidance should be available to health care professionals so that we may counsel patients more effectively. Only then can people have the information and confidence to get vaccinated.

But who are we kidding? This is Hong Kong in the year 2021, and no one seems to believe in logical solutions anymore.


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