OT&P COVID-19 Update and Podcast
When dealing with the inevitable frustrations of social distancing measures, it is easy to lose sight of how well the epidemic has been managed in our densely populated city. COVID-19 is a mild disease in the majority of circumstances, but it has the potential to overwhelm health systems because of a potentially rapid increase in the numbers of infected patients. Avoiding excessive strain on the hospital system is one of the main goals of the public health controls. In this episode, OT&P talks to a Hong Kong doctor who has spent the last year working as a front line emergency doctor in London. He discusses his personal experience of the first wave, an intensive care unit working at triple its normal capacity and the impact of being called upon to ventilate fellow healthcare workers including colleagues and friends. More recently ambulances take up to 6 hours to offload patients as the hospital strains under the stress of the epidemic surge. Ultimately though, he remains positive, both about the arrival of vaccines and that, although under strain, the system is, and will continue, to cope. You can listen to the interview here or you can subscribe to our podcasts via the following links on our website, Spotify and iTunes.
Vaccination represents the best chance to escape the current public health restrictions. Apart from the logistical challenges of vaccine development, delivery and injection, it will also be necessary to manage vaccine hesitancy within the community. Before the COVID-19 pandemic, vaccine hesitancy was ranked by the WHO as one of the ten greatest threats to global health. Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2 - 3 million deaths a year, and a further 1.5 million (Excluding COVID-19) could be avoided if global coverage of vaccination improved. Improving global vaccination will save almost the same number of lives as died from COVID-19 in 2020 every single year.
Recent studies have suggested high levels of vaccine scepticism in Hong Kong. A recent Hong Kong University survey suggested that only 46% of the population would take a COVID-19 vaccine if offered. In a Chinese University of Hong Kong study relating to sampling in the summer of 2020, the figure was 37.2%. In our recent survey of 1,020 patients and staff, 90.4% of OT&P patients indicated that they intend to be vaccinated. Numerous studies show that older patients are more likely to be vaccinated than younger patients but younger patients in our survey still had high acceptance rates, 85% under 35 years of age.
There is a clear, relative preference for either the Pfizer-BioNtech or Oxford-AstraZeneca vaccines. Although 16% of the total cohort expressed no preference/first available vaccine, of those who did express a preference only 4% indicated Sinovac-Biotech as the first choice. It seems logical that this relates to the lower reported effectiveness and the mixed messaging associated with the release of clinical trials data. We have described in a previous article the different measures of vaccine effectiveness. Managing this messaging within Hong Kong will be a key challenge in increasing vaccine uptake.
One of the interesting findings in the University of Hong Kong survey is that higher educational and income levels are associated with lower levels of vaccine acceptance. This association has been previously noted in a number of international studies. The reasons for discrepancy between our results (high vaccine acceptance in population with high education and income levels) and the HKU cohort, is something we intend to research further.
We asked patients who indicated that they did not want COVID-19 vaccination if they would be more likely to take the vaccine if a) they received a cash payment b) international travel or quarantine free travel required a certificate. At least within our population, individuals who indicate vaccine hesitancy are significantly more likely to be encouraged by the possibility of easier and/or quarantine free travel (65%) than they are by a financial incentive (4%). In other population groups this may well be different. The full results of our survey and further analysis are available on our website.
In our survey the vast majority of respondents indicating that they would not currently be vaccinated cited concerns over safety as the reason. These are natural, understandable and appropriate concerns. We have previously explained the principles of vaccine development and research. The current vaccines have been developed and rolled out at an accelerated pace. For that reason, we are also accumulating safety data at an unprecedented rate (at least relating to short term complications). Genuine questions remain about both rare or longer-term complications and especially the effectiveness of the vaccines in preventing transmission or mild disease. At the same time, we know that the risks of COVID-19 are skewed towards elderly and vulnerable populations in whom the risk-benefit will always be different in comparison to a younger population. In this context, the best strategy, both in terms of population effectiveness and safety, is to vaccinate the community in order of vulnerability. Open and honest communication of evolving risk-benefit will be key to increasing uptake. We will continue to update information on COVID-19 vaccines as the data evolves.
Ensuring adequate immunisation is a key component of preventative medicine. On our website, we have summarised the recommended vaccinations for children and adults living in Hong Kong. We are not yet sure what our role will be in the delivery of COVID-19 vaccinations, but in anticipation of managing what will invariably be a logistical challenge, we have undertaken significant IT development. If you would like to be included in our COVID-19 vaccination database, please complete this brief form. We provide the option to review your current vaccination status and will provide further updates by email as we receive information about the vaccine rollout. Register for interest here.
Thank you for the positive feedback for the series of interviews with Professor Ben Cowling. We will continue this initiative including interviewing other COVID-19 experts and researchers in Hong Kong. The next interview with Professor Cowling will be after Chinese New Year and will focus on COVID-19 vaccinations. If you have any specific questions which you would like to be addressed please contact us. You can also subscribe to our podcasts via the following links on Spotify and iTunes or by registering here.
OT&P Healthcare
