Why is Hong Kong's coronavirus 'vaccine bubble' plan already drawing flak?

A vial labelled with the Pfizer-BioNTech coronavirus disease (Covid-19) vaccine is seen in this illustration picture taken March 19, 2021.
PHOTO: Reuters

Hong Kong’s incentive-laden plan to boost its sluggish Covid-19 vaccination uptake has prompted an outcry from some of the sectors most affected by the looming rules changes.

Hailing it as a “new direction in fighting the pandemic”, Chief Executive Carrie Lam Cheng Yuet-ngor on Monday (April 12) unveiled a “vaccine bubble” scheme that would allow for the easing of numerous social-distancing measures, including changes tied explicitly to Covid-19 vaccinations. 

The plan, which aims to push the city towards eventual herd immunity, will give vaccinated residents greater freedom to dine out in bigger groups, travel abroad and visit care homes.

But it drew an immediate backlash from food and drink sector representatives, who questioned its workability and suggested the responsibility for getting a wary public vaccinated was being unfairly placed on their shoulders. 

As of Tuesday, just 8.2 per cent of Hong Kong’s 7.5 million residents had received their first jab since the inoculation programme began in late February, while four per cent had got two doses.

Health experts have suggested a vaccination rate of 70 per cent is necessary for herd immunity.

Below, the Post looks at why the new plan has been the subject of resistance, whether experts believe it will be an effective strategy, and how countries around the world have incentivised their citizens to take the jab.

PHOTO: South China Morning Post

1) How will the ‘vaccine bubble’ work?

Included among Lam’s new measures is a three-stage road map for easing restrictions on restaurants and bars designed to encourage vaccinations. The new rules are expected to take effect on April 29 at the earliest.

Lam insisted the plan was to provide a road map for Hong Kong to return to normality. “(Now) we have a direction, timetable and road map to return to a relatively normal life. This is for everybody,” she said.

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For restaurants, a staged relaxation will permit diners to eventually eat in groups of 12 and extend dine-in services to 2am if all restaurant employees and customers have been fully vaccinated.

They will also need to designate specific “clean” zones for customers who have had at least one Covid-19 jab.

Bars and pubs – closed entirely since late November – will finally be allowed to reopen at limited capacity, but only if all staff and customers have received their first vaccine dose.

More restrictions will be lifted if both shots have been taken. Every diner and bar patron must also record their visit using the government’s contact-tracing “Leave Home Safe” app.

Residents with two jabs will also be allowed to visit care homes after passing rapid virus tests, while authorities are looking to cut quarantine stays for fully vaccinated arrivals from lower-risk countries, possibly to fewer than seven days for some. 

The “Return2HK” scheme, which exempts Hongkongers arriving from Guangdong province and Macau from quarantine if they have tested negative for Covid-19, will be extended to cover visitors arriving from the rest of the mainland beginning in May.

Restaurant seating zones for those who have been vaccinated have been called largely unworkable by industry representatives.
PHOTO: South China Morning Post

2) Why the backlash from restaurants and bars?

The vaccine bubble plan has triggered a strong backlash from the restaurant and bar industries, with many operators reacting with anger and disappointment to the conditions placed on the easing of Covid-19 restrictions.

Many have said they cannot force their employees to receive jabs, while others have suggested the incentives were an attempt to coerce Hongkongers into vaccination, an accusation Lam has denied.

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Some have also expressed fear they will offend customers by turning them away for not having the government app on their phones.

Wing Chin Chun-wing, vice-president of the Hong Kong Bar & Club Association, said the government had unfairly shifted its responsibility for getting people vaccinated onto the catering and bar sector.

“We cannot force our staff to get jabbed, as some elderly employees may have medical conditions. If we sack them for failing to take the shots, it would be unethical and could incur legal consequences,” he said.“If they fall sick after getting jabbed, will employers be held liable?”

Aside from getting staff vaccinated, Chin pointed out that it was unfeasible to implement the complicated rules, citing the example of setting up separate “clean zones” in restaurants and bars for both customers and staff who have got the jab.

“This delineation idea is hard to put into practice. It means that for the clean zone, larger groups of people could be served and operating hours could be extended, but for the non-vaccinated zone, operations would still be subject to the same restrictions,” he said.

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He also noted that restaurant staff were not authorised to check the vaccination documents of customers and might breach privacy laws by doing so, while separating restaurants into different sections with different rules risked the appearance of discrimination.

“The segregation of a clean zone appears to be discriminatory against the unvaccinated. I am afraid this may further widen social divisions,” he said.

“Why is (local theme park) Ocean Park allowed to open without its staff and customers being required to get jabbed, but these tough rules are imposed on the catering and bar sector? This is so unfair.”

Hong Kong leader Carrie Lam receives her booster jab against the coronavirus.
PHOTO: South China Morning Post

3) What have countries around the world done to encourage vaccination?

Israel leads the world in terms of its pace of vaccination, with 57 per cent of its nine million residents having been fully inoculated with either the Moderna or Pfizer-BioNTech vaccines as of April 11, just four months after its roll-out began.

A wide range of incentives were offered to Israelis to take the jabs.

The vaccinated are granted a green pass allowing them to visit places including gyms, hotels, religious venues and swimming pools.

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Travellers returning to Israel with a green pass plus a negative Covid-19 test result are exempted from mandatory quarantine.

“The green pass allows you to have more rights compared to people who don’t have it,” said Ahuva Spieler, Israel’s consul general to Hong Kong. “These few measures not only bring back normal life to people, but the economy has also started to flourish … as it was a year and a half ago.”

Britain has had a similar experience. The daily caseload of coronavirus infections plummeted by 98 per cent after a vaccination programme began in December. Some 48.2 per cent of the country’s 66.65 million people have now received their first jab, and 11.5 per cent have had their second. 

Following a massive outbreak in December, Britain changed strategies by spearheading an all-out vaccination drive, setting up inoculation centres at general practitioner’s clinics, elderly care homes, hospitals and pharmacies to make it convenient for eligible people to take the jabs. 

The gradual restoration of the country’s social life began on Monday, with outdoor drinking resumed and venues such as retail stores, gyms and hairdressers allowed to reopen for the first time since a lockdown was instituted on January 5.

British authorities aim to fully lift social-distancing measures alongside the accelerating vaccination rate.

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Professor Chui Chun-ming, a pharmacist and president of the Society of Hospital Pharmacists of Hong Kong, said the city could directly copy Israel’s green pass scheme.

“The vaccination rate in Hong Kong is very low,” Chui said. “People are hesitant because the pandemic here is not that severe, and reports about deaths after vaccinations also hamper people’s willingness to get a jab, even though the deaths have been proved unrelated to the vaccines.”

However, he cautioned: “The government should not push it too hard. You have to take the groups who can’t be vaccinated into consideration, and make the measures more humane.”

Asked how to overcome the hurdle of Hongkongers’ mistrust of the government, infectious disease specialist Dr Wilson Lam said: “Even if you don’t trust the government, you should trust the health experts encouraging people to get vaccinated, because it is really important.”

PHOTO: South China Morning Post

4) Do health experts believe the vaccine bubble will boost inoculation rates?

Professor David Hui Shu-cheong, a respiratory medicine expert at Chinese University and government pandemic adviser, said he believed encouraging vaccination for people working in high-contact sectors such as restaurants would allow the industry to avoid closures in the long run. 

“Whenever the infection numbers start to go down, there’s always a loud cry to lift restrictions for different premises, but a few weeks later, we see a rebound,” Hui explained.

“But that was before we had the vaccines. When more people get vaccinated, the community has greater immunity and we can stop the transmission chain.”

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But Dr Leung Chi-chiu, a respiratory medicine specialist, said it was meaningless to designate “clean zones” for customers who have had at least one Covid-19 jab, as the restaurant’s ventilation system would be shared with other customers anyway.

“Easing the restrictions should be based on the low case numbers, not because of an increase in vaccination rates,” he said.

“Of course, the government is pushing people to get vaccinated using this strategy, but we’ll have to see how receptive various industries are.”

The most recent US Centres for Disease Control and Prevention guidelines suggest fully vaccinated people can gather among themselves, visit private indoor places and meet fully vaccinated adults without wearing a face mask.

But the World Health Organisation has advised people to maintain health precautions such as wearing masks in crowded places and ensuring proper indoor ventilation. 

Hong Kong residents queue up for a BioNTech jab at Sun Yat Sen Memorial Park Sports Centre in Sai Ying Pun.
PHOTO: South China Morning Post

5) What about countries that have high rates of vaccination but also high infection numbers? 

Despite the correlation of higher vaccination rates with better protection against the coronavirus, there are exceptions. 

Chile, for example, has recently seen a resurgence of confirmed cases even with 38.6 per cent of its 19 million residents having received one dose and 24.4 per cent fully vaccinated. It predominantly relies on the Chinese-made Sinovac vaccine. 

“Vaccination is not the only factor influencing the direction of the pandemic, other factors such as the enforcement of social-distancing rules also contributed to the resurgence of Covid-19 cases in Chile,” Dr Lam said.

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“But the death rate has been decreasing since the vaccinations began in Chile; this is also one of the purposes of the mass-inoculation programme.”

“But based on the research, taking the vaccine with a higher efficacy rate is certainly a better option,” he added.

Hong Kong has made two vaccines available – German-made BioNTech and Sinovac – with the former having a general efficacy rate of 95 per cent and the latter 51 per cent for symptomatic cases.

As of Tuesday, 521,100 city residents had taken at least one dose of the Sinovac vaccine and over 397,600 had taken at least one BioNTech jab.

This article was first published in South China Morning Post.