Could the breakdown in public trust explain Hong Kong's sluggish vaccine roll-out?

Image from Flickr user: Alachua County. Public domain.

Hong Kong is one of the few places in the world where the supply of COVID-19 vaccines is abundant. Anyone over the age of 16 on the island can choose to take either China-made CoronaVac or German-American Pfizer/BioNtech jabs for free.

Yet, a majority of the people are still hesitant to take the shot. Only about 20 percent of Hong Kong's 7.5 million population have taken the first vaccine dose since the government debuted its vaccination drive on February 26.

As more than a million Pfizer vaccine doses are about to expire, the city is now considering donating them to other countries in need.

The vaccination rate of the elderly, in particular, is far below expected — only 14.8 percent of the 60-69 age group has taken the first dose, and only 5.1 percent of the 70-79 age group.

According to local medical research, to achieve herd immunity, 56.1 percent to 66.9 percent of the population would have to be fully immunized. Currently, on average only about 25,000 vaccines doses are being administered per day. By that rate, it would take between 6 and 10 months to hit that herd immunity target.

Vaccine anxiety escalated in early March after media reports on three elderly Hong Kong residents’ died after taking the first dose of CoronaVac, the first vaccine used during the launch of Hong Kong's vaccine program. According to an assessment by the city's Expert Committee on Clinical Events, there is no evidence linking the deaths to the shots.

Public concern was also fueled by the fact that, at that time, China wasn't vaccinating its elderly, and that China's Center for Disease Control and Prevention (CDC) warned people with pre-existing diseases such as diabetes, high blood pressure, and thyroid disease, to have their health conditions under control before taking a COVID-19 vaccine. China included the elderly in its vaccine program at the end of March.

Coronavac has received emergency approval in 37 countries, according to a compilation maintained on Wikipedia. The WHO is now in the final stages of studying whether to authorize CoronaVac to be included in COVAX, the agency's mechanism that buys vaccines for poor countries. If it receives the stamp of approval, it will be the second Chinese vaccine to be included in the program, after Sinopharm's shot was so in early May.


In many Western countries that were hit hard by COVID-19, fear of the disease has, in large part, driven the vaccination roll-out. However, in Hong Kong, the total number of deaths caused by COVID 19 is at 210 since the pandemic began — even less than the deaths (299) caused by the SARS outbreak in 2003.

Recent research indicates that Hongkongers’ intention of receiving the COVID-19 vaccine decreased significantly after the city successfully controlled the second wave in July 2020 through social distancing measures. Researchers suggest that the city's “complacency” — not perceiving the disease as high-risk and vaccination as necessary — has become a key factor behind vaccine hesitancy.

The year-long social distancing measures, however, have harmed Hong Kong's economy, and the government is eager to restart it by achieving herd immunity through vaccination as soon as possible.

To boost the vaccination rate, authorities introduced a “vaccine bubble” policy, making employee vaccination a pre-condition for businesses such as restaurants to relax social distancing measures.

In addition, officials agreed on a “travel bubble” arrangement with Singapore, through which fully-vaccinated Hongkongers can travel to the latter without quarantining on return. However, Singaporeans are not required to be fully vaccinated in order to visit Hong Kong.

As Hong Kong is about to hit the 14-day zero local infections criteria for the quarantine-free “travel bubble” with mainland China, Chief Executive Carrie Lam stated on her Facebook page that vaccination would be made a precondition for Hongkongers to travel to mainland China.

Public distrust

The above soft coercion policies have some effects: As indicated previously, Hong Kong's vaccination rate among breadwinners (30 to 59-year-olds) is higher than other age groups. Yet, such policies do not necessarily strengthen people's sense of social responsibility, which has been shown to be key for achieving herd immunity.

The political distrust after the enactment of the national security law and the crackdown on the democratic movement has resulted in a breakdown of trust in institutions in Hong Kong. As pointed out by Francesca Chiu in Hong Kong Free Press, Hong Kong anti-vaxxers’ arguments include statements such as “the government is trying to force people to get the jab to please Beijing,” or simply “whatever the government asks me to do, I’ll just do the opposite.”

Meanwhile, pro-establishment politicians are getting impatient and have started calling for more coercive measures in recent weeks. In early May, pro-Beijing lawmaker Julius Ho suggested that the government should set a deadline for people to take the vaccine, and after that citizens would have to pay HK$10,000 to receive them. His suggestion was recently echoed by former Hong Kong Chief Executive Leung Chunying, who also urged the Hong Kong government to impose “sanctions” on those who did not take the vaccine by making them “pay the price.”

Such rhetoric risks further dividing the society and politicizing the vaccine program. For many Hongkongers, the city has already faced many “sanctions” since 2019; the “vaccine sanction” would just join the list.

While trust and solidarity are known remedies in dealing with vaccine hesitancy, in Hong Kong the social and political divide keeps widening:

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