China’s elderly vaccine refuseniks pose obstacle for Xi Jinping

If Xi Jinping is to navigate an exit from the zero-Covid strategy of relentless lockdowns, mass testing and contact tracing, the Chinese president must overcome a steely bloc of resistance: tens of millions of elderly vaccine refuseniks.

Xi has been forced into a rare retreat after a drumbeat of youthful dissent against his draconian pandemic controls sparked unprecedented protests in more than 20 Chinese cities.

Standing in his way of an orderly exit are about 85mn people — one-third of the 267mn Chinese citizens in their 60s — who have not received a third vaccine dose needed for a high level of protection against the Omicron coronavirus variant. Among those aged 80 and over, the under-protected rate surges to about 60 per cent, or 21mn people.

Vaccine hesitancy is pervasive not just among households in the world’s most populous country but also within its health system, according to more than a dozen interviews with the elderly, their children and health officials.

The reasons are varied. Some vaccine holdouts are risk averse and distrust Chinese-made medical products. Many do not understand why vaccines do not stop transmission of the virus altogether. Others have been lured into a false sense of security by China’s relatively low case numbers.

“My body is very sensitive and I’m allergic to many things. When I went to the vaccine clinic, they told me: ‘We can’t say what will happen, it would be better if you don’t get it,’” said a Beijing resident in her 60s surnamed Dong. “How do you explain the fact that all the young people have been vaccinated but more and more are still catching Covid?”

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Also to blame is Beijing’s refusal to import foreign jabs with superior messenger RNA technology and silence from the very top of the Communist party about the importance of vaccines.

A Lancet study from Singapore published this month found individuals who received three doses of China’s vaccines, which are made by pharmaceutical groups Sinovac and state-owned Sinopharm and based on older technology that uses the inactivated virus to elicit an immune response, were nearly twice as likely to develop severe Covid as people who received three mRNA jabs. Those with the Chinese shots were also 50 per cent more likely to be hospitalised.

A 65-year-old man in Shanghai who asked not to be named said his reasoning for avoiding the vaccine had changed over the past three years. At first, he was sceptical about its effectiveness, after the Chinese jabs were pushed through before research was available to the public. Later, he became afraid his immune system would be attacked by the vaccine. Now, he believes the virus is weaker than the effects of the vaccine itself.

Since the start of the pandemic, China has recorded 1.7mn cases, compared with 99mn in the US and 24mn in the UK. But China’s official death toll is just 5,235, far less than 1.1mn in the US and more than 210,000 in the UK.

China has administered more than 3.4bn vaccine doses, but as authorities directed resources to prevention and containment, the number of daily jabs plummeted from 24.7mn to 123,000. International experts have warned for months that China risks millions of deaths if vaccine coverage is not improved.

There are also questions about the immunity imparted by Chinese vaccines waning faster than mRNA jabs, which could pose a danger as cases soar with the reopening. More than half of Chinese in their 60s received a booster before March and authorities have yet to authorise a second.

Xinran Andy Chen, an analyst at China consultancy Trivium, said the success of zero-Covid in suppressing outbreaks had “paradoxically undercut people’s willingness” to be vaccinated.

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“But once China starts significantly relaxing Covid restrictions, more people will have the incentive to get vaccinated because they will see case numbers surge,” he said.

Yanzhong Huang, a senior fellow for global health at the Council for Foreign Relations think-tank, noted that officials had quietly confirmed the country’s top leadership was vaccinated only in recent months.

“You don’t have the top leaders themselves setting the example. Many of the former and current politburo standing committee members are elderly. Why couldn’t they roll up their sleeves and show [themselves being jabbed]?” he said.

Huang added: “They don’t have a clear, explicit, consistent message saying: ‘This vaccine is safe and effective for the elderly, you should take it, and the risk of not taking the vaccine would be much larger.’”

In the capital, there is evidence that message has not been delivered, and vaccine clinics visited by the Financial Times remain empty.

One Beijing resident, surnamed Liu, said his 56-year-old mother who works in a hospital is unvaccinated. “She said the domestic inactivated [virus] vaccines are useless, it is better to just pay attention to protection rather than getting vaccinated,” he said. “Because of my mum’s influence, none of my grandparents are vaccinated.”

Karen Grépin, a health systems expert at the University of Hong Kong, pointed out that China’s initial vaccination campaign prioritised health workers and working-aged people over the elderly, a strategy that “only made sense in the context of zero-Covid”.

“Few seniors [were] included in trials of the Chinese-made vaccines,” Grépin said. “Excluding them was actually seen as a way of protecting the elderly until more evidence became available.”

A vaccine mandate announced in July was scrapped within days following a public backlash. Now, officials are trying a lighter touch. Chinese business publication Caixin reported last week that quotas for a vaccination drive targeting the elderly had been distributed to local governments.

Chen of Trivium said the targets would spur officials to offer incentives and rewards to win over seniors. “In China, targets are rarely missed, especially when local government officials’ career prospects are tied to fulfilling [them].”

But a provincial health official in the northern city of Shijiazhuang said “a lot of doubts” persisted because the vaccines did not prevent infection. “Lots of people who’ve gotten vaccinated are still catching Covid. How do you explain that to people?”

Additional reporting by Nian Liu in Beijing and Eleanor Olcott in Hong Kong