How Hong Kong’s lagging vaccination drive staged a surprise comeback

For months, people in Hong Kong have lived with little to fear from COVID-19. The city of 7 million has one of the world’s most effective responses to COVID-19, in terms of keeping infections at bay. The most treacherous wave of cases numbers peaked in July last year, at 149 infections per day. Since April this year, most of Hong Kong’s new cases have been found in inbound travelers, caught by the city’s zealous quarantine rules. The Chinese Special Administrative Region has gone 52 days without a community outbreak.

But Hong Kong’s triumph in containing COVID-19 proved a handicap when the government began rolling out vaccines in February this year. With the threat of infection so low and mistrust of the pro-Beijing government high, many residents were reluctant to roll up for a jab. By May, Hong Kong was so awash with unused vaccines that the government warned it would have to throw away millions of expiring doses. But by July, something had changed.

Local vaccine uptake has doubled in the last seven weeks, after crawling along at a dismal pace since the vaccine drive began on Feb. 26. As of Monday, 30% of the population had received two doses of either a Sinovac or a BioNTech vaccine—the two types available in Hong Kong—and 40% have received at least one jab.

The number of vaccine doses administered reached highs in late March and mid-April at 25,254 and then 43,279, respectively. But from late April to late June, the daily number of administered shots fluctuated, dropping to a low of 25,061 on May 25 and never crossing the 46,000-mark.

But in early July, the numbers began to tick up steadily. Last Friday, the city hit the highest number of shots administered on one day: 70,783.

Hong Kong has one of the few mature vaccine drives in which uptake of the jab has accelerated as the inoculation campaign drags on. Vaccinations in the U.S., by comparison, plateaued with just under 50% of the population innoculated with at least one dose. Now, with COVID cases resurgent, rising 145% in two weeks, U.S. officials are grasping for ways to boost vaccine uptake. The U.K., which has inoculated 70% of people with at least one dose of a vaccine, is likewise struggling to encourage 18- to 25-year-olds to get the jab.

Hong Kong’s uptick in vaccination coincided with the rollout of numerous lottery schemes, run by private businesses, that offered prizes for residents who are fully vaccinated. Giveaways include new iPhones, a Tesla, and even a $1.4 million apartment. According to Sino Group, the developer offering the free apartment, over 1 million residents signed up for its lottery in the first week.

Hong Kong University epidemiologist Ben Cowling says there are numerous factors that have encouraged vaccine uptake in Hong Kong, including the lottery initiatives, improved confidence in vaccine safety, as well as imminent government policy that could make vaccines essential for certain workers.

When Fortune visited several of the city’s vaccine centers on Tuesday and conducted interviews along the steady stream of visitors emerging inoculated against COVID-19, almost all of these factors were on show. Notably, though, none of the vaccine recipients interviewed by Fortune said lotteries were their main motivation for getting vaccinated now—five months after the rollout began.

“I don’t think I’m that lucky,” said a 39-year old man, who gave his surname as Ho and had just received his first dose of BioNTech at the Queen Elizabeth Stadium vaccine center. The center had been scheduled to close on July 1 due to low demand. The month before, the facility, designed to distribute up to 2,000 doses per day, was only servicing around 300 people per day. But Medical Conscience, the private contractor that operates the Queen Elizabeth Stadium vaccine center, decided to keep the site open after the government approved BioNTech vaccines for children as young as 12 in June, and the number of bookings at the center increased.

Ho, like many other Hong Kongers, delayed registering for a vaccine due to his concern over the possible side-effects. During the rollout’s initial stages, local media coverage of people becoming sick, entering the hospital, or dying after receiving a vaccine was relentless and arguably irresponsible, associating accidental deaths with COVID-19 vaccines. The hysteria over vaccine side-effects was amplified by the government which, in a show of transparency, reported all post-vaccine deaths in its daily news briefings—even those with no connection to vaccine side effects.

“These reports do not constitute a cause-effect relationship, but the general public are not expected to understand the technicalities of epidemiology,” says Tze Wai Wong, a professor at Chinese University Hong Kong’s school of public health and primary care.

On June 1, a government committee recommended the government only notify the public of “meaningful cases” and “only reveal [deaths] that have a potential link with the vaccine.” Two months later, Hong Kong residents are feeling more confident about the safety of COVID vaccines—although, some late adopters admit they have been pressured into joining the program, too.

“At first, I didn’t feel secure to get the vaccine because of my health issues,” says Shing Zhong, a 34-year-old security guard, receiving his first dose of BioNTech. “The post-shot reactions scared me but, eventually, my office encouraged all employees to get the shot, which was more like an unofficial requirement.”

Two other first-timers—one a civil servant and the other who said he worked in education—told Fortune that job requirements had encouraged them to finally get vaccinated too. Last week, Hong Kong Chief Executive Carrie Lam said the government would add more professions to a list of people that are required to take regular COVID-19 tests if they are not vaccinated.

“We now need to push hard to push up the vaccination rates to build up herd immunity,” Lam said during a weekly briefing, highlighting teachers and civil servants as professions that could be added to the list. Hong Kong is targeting a 50% vaccination rate by September, but that’s still 20 percentage points below the level generally recognized as ensuring herd immunity. As local officials look to reopen the city’s border with mainland China, which has been mostly closed since February 2020, the government will have to find new ways to incentivize vaccination if it wants to reopen safely.

“Hong Kong is still far from having a big enough population of immune individuals,” Wong says. “We need to promote vaccination much more vigorously and it is important to know which groups have a low coverage and why, so that remedial actions can be taken.”

But for now, at least more residents are seeing the benefits to taking a vaccine.

“The lucky draws are not important,” said a 73-year-old woman at a vaccine center offering BioNTech vaccines. “It’s important to get the vaccine first to help keep Hong Kong safe and secure.”

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