Forget 'zero-Covid' - vaccinate the most vulnerable and learn to live with virus, Hong Kong doctor says
Mainstream local media has been touting the holy grail of herd immunity for some months – if we reach the coveted 70 per cent vaccination rate then all will be saved, and we can hope for life to return to some degree of normality. It’s a message that makes Dr David Owens recoil.
“By focusing on the herd immunity argument, the 70 per cent, we are potentially harming our long-term interests . In an attempt to get high vaccine uptake – which is a good thing – we’ve lost sight of the fact that who we vaccinate really makes the biggest difference,” says Owens, a specialist in family medicine and a founding partner at OT&P Healthcare in Hong Kong’s Central district on Hong Kong Island.
The people we should be vaccinating, he says, are the elderly and the most vulnerable in our communities. He cites government statistics: at present, only five per cent of residents in elderly care homes are vaccinated – and they are the ones most likely to die if they get Covid-19.
A 75-year-old is nine times more likely to end up in intensive care and 230 times more likely to die than a 20-year-old. At 85 years of age, intensive care admission is 15 times more likely and death 600 times more likely.
“It’s incredibly important to get the right message across, but there are cultural issues, belief issues, politics. Across that whole thing, there is a relatively simple message that needs to get out there to encourage and educate people on the need for vaccines,” says Owens.
To be clear, he’s not knocking herd immunity – reaching the point where enough of a population is immune to an infectious disease that it provides indirect protection to the rest. It is a good thing, but we are not going to achieve it with vaccination alone.
Noting the considerable fear around vaccine hesitancy and talk of a need for health checks before taking the vaccine, he sees the public health messaging as focusing on the negative and is alarmed at stories of young people talking their parents and the elderly out of taking the vaccine.
“The messaging has focused on the next wave, protective quarantines, about keeping the disease out, which makes sense, but there’s not really been a positive messaging around the benefits of vaccination. Explain to people we are not trying to get herd immunity, we are trying to stop Granny dying. The disease will come in, we can’t stop it,” Owens says.
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In Hong Kong, as elsewhere in the world, politics has impacted public health strategies. After success in terms of elimination at the start of the pandemic, it’s time to evolve and move on from a “zero-Covid” strategy.
“Most public health doctors see living with Covid-19 as an inevitability, but Hong Kong has clearly made a decision to continue elimination,” he says.
The “zero-Covid” approach was the best strategy in the short-term, he says. A recent study in the medical journal The Lancet compared the health and economic outcomes of OECD (Organisation for Economic Co-operation and Development) countries that had pursued an elimination strategy with those which focused on early mitigation.
Elimination was associated with a 25-fold reduction in population mortality in addition to better measures of economic performance. And that meant Hong Kong citizens were 70 times less likely to die of the virus than those in the US and Britain.
“I would vaccinate from the most vulnerable down with the mRNA vaccines. Give it to care homes residents and staff, to everyone in a prison and residential centre. I’m not a fan of mandatory vaccines – I would be pushing the vaccine much harder in the most vulnerable groups,” says Owens.
While other countries might look to Hong Kong to pick up tips in terms of how to eliminate the virus, we can look to other countries in terms of vaccine roll-outs. Singapore has adopted a “living with Covid” approach that is based on high vaccination rates with effective vaccines – BioNTech and Moderna – and a focus on the most vulnerable down.
“Singapore has the benefit of having a strategy and a plan, it’s rational, its logical and they’ve communicated it well. They’ve responded and reacted on the basis of evolving evidence. I think we will learn a lot as we watch Singapore go through this process,” he says.
The recent move to allow Hongkongers aged 70 or older to walk into a community centre and get vaccinated without a booking is intended to encourage uptake among the elderly, but it’s really got to go hand in hand with strong public messaging about the benefits and help to reverse much of the early misinformation.
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At this stage in the pandemic, Hong Kong has three options:
1 Remain in the elimination phase. But, says Owens: “Lockdown forever isn’t feasible.”
2 Push to get very high vaccination coverage, something Owens sees China looking to do by offering booster jabs with the next generation of vaccines. “The risk here is if we get new variants we will have high levels of infected vulnerable individuals,” he says.
3 Adopt a Singapore model, based on living with Covid-19. “Personally, I think that’s the only strategy,” he says.
Owens stresses that whatever vaccine coverage percentage Hong Kong selects before opening up the city again, “it will only be effective if that covers the most vulnerable”.
This article was first published in South China Morning Post.
