Can Hong Kong move from ‘zero Covid’ to living with the virus?

As public frustration grows, the government’s twin pushes for vaccination and stricter Covid-19 measures will only work if there is a clear plan for a return to normal life
But its desire to reopen the border with the mainland is a stumbling block, and protocols need to evolve to cope with Covid-19 acceptance internationally

John Hanzhang Ye

Published: 9:15am, 11 Jan 2022

Why you can trust SCMP

As Covid-19 cases spike, the Hong Kong government has reimposed restrictions to control the spread of the Omicron variant. Meanwhile, the city’s vaccination rate has reached nearly 70 per cent, a level some consider to be sufficient for achieving herd immunity.

What the government appears to have neglected is that its vaccination policy is not just a public policy, but also creates an expectation among the public of a return to normal life, to some degree at least. Therefore it is critical to manage public expectations and be clear about the transition from a zero-Covid policy to coexisting with the virus, to sustain public cooperation.

Last August, the government promoted vaccination as a way to build a “protective shield” for the city. Public health experts claimed that a 70 per cent vaccination rate would confer herd immunity on the city. Although many Hongkongers were hesitant, the vaccination rate for those having received two doses still managed to edge up to 70 per cent.

But cultivating a public expectation of herd immunity conflicts with the Covid-19 policy of zero tolerance. A zero-Covid policy means eliminating every possible case while herd immunity means most people in the community are protected. But it does not guarantee zero infections.

The government does not make clear whether a high vaccination rate will see a policy change from zero-Covid to living with the virus.

05:07

Return of Hong Kong’s social distancing restrictions deals heavy blow to restaurants

This discrepancy is reflected in an official vaccination promotion video mocked by some netizens which features an elderly woman saying she got vaccinated so she can still go to restaurants and see her grandchildren.

The implied message is that, even with Covid-19 in the community, those who are vaccinated can go out and lead a relatively normal life. However, the latest tough restrictions are damaging those expectations.

Take the case of the 22 employees of Moon Palace, a restaurant patronised by an infected diner. As they pointed out, they had fully complied with the government’s Covid-19 rules, including getting vaccinated. But they were still sent to the Penny’s Bay quarantine centre, where they were forced to spend a miserable new year.

If following government guidelines and getting vaccinated cannot give citizens a normal life, they may well decide it’s not worth getting vaccinated or having a booster shot.

This damages public trust not only in the government but also in public health experts. Yet the administration continues to urge Hongkongers to get vaccinated without clearly explaining how its Covid-19 response will change once the vaccination rate reaches 70 per cent or higher.

The public are hoping to return to a normal life, hope that the government has raised through its vaccination campaign. Reaching herd immunity and returning to normality should also mean avoiding imposing tough restrictions in response to community infections, as the population should have enough antibodies to cope.

The question for the government is how to transition from a zero-Covid approach to some degree of tolerance of local infections once most people are vaccinated. A transitional policy now needs to be discussed. It would serve not just as a basis for further action, but also help manage public expectations.

There are two major challenges for the government. The first is the desire to reopen the border with the mainland, which has been a government priority. Key to achieving this is Hong Kong imposing measures similar to those on the mainland, which effectively means a zero-Covid approach – unless things change across the border.

Beijing’s main concern is that Hong Kong could be a point for the virus to break through to the mainland if the two sides reconnect. So, to ensure it is safe for reopening, the Hong Kong government is expected to be tough on any local cases. In other words, a Hong Kong wanting to reconnect with the mainland is locked into the zero-Covid strategy for now.

01:06

Hong Kong leader on delay of vaccine passport and border reopening with mainland China

The second challenge relates to the international community. With many nations now employing a policy of living with the virus, especially in the West, Covid-19 will be around for a long time. Yet, for the Hong Kong government, the number of new cases in these countries is the basis for its policy on international travel.

Although close monitoring is necessary, the government should use hospitalisation rates, rather than case numbers, as a basis for policy after herd immunity is achieved. A low hospitalisation rate signals a low risk for a vaccinated population. Under these circumstances, it is hard to justify tough restrictions.

These challenges leave Hong Kong’s policymakers in a dilemma. On the one hand, to reopen the mainland border, Hong Kong should maintain its Covid-zero approach. On the other, a higher vaccination rate signals that the city may have achieved herd immunity, which the government has said would signal a return to some kind of normality.

This situation requires public health officials to devise a transitional policy to ensure borders can be reopened safely while satisfying citizens’ need to begin to return to a normal life – including international travel. Otherwise, once this fifth wave has passed, it will be hard for officials to justify the continuing vaccination push alongside tough restrictions if people see no difference to their way of life in the city.

John Hanzhang Ye is a PhD student in science and technology history at the University of Minnesota, Twin Cities and also holds an MPhil degree in sociology from the Chinese University of Hong Kong