Amidst widely reported protests and unrest at the continuation of a stringent zero-COVID strategy, China has admitted that it has struggled to vaccinate its elderly population. On closer examination the BBC suggested that in April 2022 only 20% of over-80s had “received two jabs plus a booster”. Considering the elderly are more likely to suffer severe consequences from infection with the virus compared to younger populations, this is a risky situation.  

With renewed efforts the Chinese are apparently setting themselves the goal of increasing this statistic to 90% by the end of January. However, months on from the initial figure, there are still barriers to achieving this. Here we examine some of the key reasons that older people have been reluctant or unable to accept the recommended vaccination programme.  

First impressions matter 

Vaccination is a deeply emotional issue, with facts and figures often getting lost in streams of emotive imagery. Thus, when someone decides that the COVID-19 vaccines are unsafe, it is hard to dissuade them of this concern. Professor Zhengming Chen told The Economist in April that “once you have formed your opinion, it’s really difficult to change: it requires ten times more effort”. 

However, it is important for the vaccine-positive among us to remember that at the start of the global rollout of the jabs, data was only available on those under 60 years old. Just as we explored with maternal immunisation, a key target population was necessarily initially excluded from the process. Therefore, any recommendations came with a risk.  

Specifically for the Chinese vaccines, which the BBC suggests were tested outside the country and offered first to working-age groups, the national narrative was not targeted to let alone inclusive of, the elderly. Finally, the BBC infers that recent “safety issues and production” concerns surrounding jabs like the rabies and tetanus vaccines have influenced attitudes to the COVID-19 vaccines.  

Made in China 

Despite urgent recommendations from abroad, China is reluctant to accept jabs produced elsewhere. Speaking in November 2022, a spokesperson for the German government, Steffen Hebestreit, noted that “Europe and Germany have had very good experience with administering mRNA vaccinations”. The Chinese aversion to these vaccines might have exaggerated suspicion of Chinese vaccines. Huang Yanzhong of the Council on Foreign Relations told The Economist that health workers were cautious about recommending vaccination to the elderly who had certain conditions.  

WHO data in June 2022 suggested that Sinovac was 51% effective against symptomatic infection. Phamaceutical Technology commented that the vaccine demonstrated a “modest” profile, while the BBC identified research that suggests that Pfizer/BioNTech’s mRNA vaccine, when taken in a recommended schedule of two doses, is 90% effective. By contrast, Sinovac offers 70% protection.  

Zero-COVID measures  

Extended lockdowns in China have not only caused civil dissatisfaction but have reduced human interaction to the extent that exposure to the virus is, naturally, lessened. Therefore, the potential for so-called “hybrid immunity” is reduced. This “impressive synergy” is described as a “combination of natural immunity and vaccine-generated immunity” by Professor Shane Crotty in Science. The infographic below illustrates the “larger-than-expected immune response” that results. BBC Health and Disinformation reporter Rachel Schraer suggests that the “rest of the world” has worked towards a “wall of protection”.  

Infographic from Shane Crotty “Hybrid Immunity” in Science, June 2021

Furthermore, with lower infection rates, the argument for vaccination might diminish as the perceived risk grows smaller. How, then, can Chinese health authorities compel one of the most vulnerable groups to accept their jabs?  

To learn more about efforts to vaccinate the elderly and what we should be learning from COVID-19, come to the World Vaccine Congress in Washington 2023.