(Bloomberg Opinion) — As the world begins to come to terms with Covid-19 becoming endemic, Hong Kong has chosen to stick to a zero-Covid strategy. With no local cases over the past few months, it imposes one of the longest quarantines anywhere on overseas travelers: up to 21 days in a self-funded, government-approved facility, with multiple tests along the way. At the same time, Hong Kong is struggling to boost inoculation rates that are hovering at around 50%.
Effectively closed off, the territory is brimming with frustration as residents try to understand why stringent measures, like tight border controls, remain in place and why there are few signs of a plan to open up. A couple weeks ago, I wrote about how Hong Kong had chosen to live with the fear of the virus instead of the virus itself — and why some policies meant to keep Covid-19 at bay are having harmful consequences of their own.
In response to my columns, the Hong Kong government agreed to discuss its public-health strategy with Professor Sophia Chan, Hong Kong’s secretary for food and health. The transcript of our interview has been edited for clarity and length.
Anjani Trivedi: In early 2020, as governments across the globe had to make decisions on very little information, Hong Kong responded effectively. What were the main factors informing decisions at the time?
Sophia Chan, Hong Kong’s Secretary for Food and Health: Hong Kong learned about the situation in Wuhan on New Year’s Eve. We quickly had a meeting with our experts. That evening, we had a press stand-up to let the public know what we’d learned. At the time, of course, Hong Kong still didn’t have any confirmed cases. We alerted everybody because we have experience from SARS. We were worried to a certain extent and we immediately heightened our alert.
Then, we got our first case. We raised the response level to emergency. As far as the decisions were concerned, we had very little information. They were based on the science as far as we knew, our public health experience through SARS and our leading medical experts, as appointed by the chief executive.
We’ve always used the containment strategy. If we have a confirmed case then it is hospitalized in the isolation rooms within the public hospitals. We also have a solid legal foundation, because all the testing, quarantine, isolation and mask-wearing are under a legal framework. Finally, we disseminate information with the public through press conferences.
AT: How does the government think about the social and economic costs of these measures, particularly border-control measures, given that Hong Kong is an international hub?
SC: As far as the public health authority is concerned, our [greatest] concern is actually the public health risk, how we protect people and ensure that they are safe in the community. But the government as a whole looks into the social and economic costs.
Just remember, Hong Kong has never had any lockdowns. So we never had any stringent measures, like in other countries. For example, in the latest Economist normalcy index, Hong Kong ranked number one. We have been trying to adjust our measures to a certain extent that it is acceptable by the local people.
AT: A big issue in Hong Kong has been about quarantine periods. What is the scientific basis for the 21-day
s period for travelers upon arrival? Nowhere in the world do we see this level of stringency.
SC: This is a not an easy balance, given Hong Kong is an international city. But the strategy Hong Kong has adopted as a whole is to have zero tolerance of the virus. Therefore, all our strategies are very stringent or very robust in terms of maintaining that.
You mentioned the number of days of quarantine. The Center for Health Protection, which is the public health authority in this regard, looks at the number of cases. Because we have different safeguards like testing — before and after arrival, at the airport, during quarantine — we have local data. The numbers are not very high, but because we have a zero tolerance strategy — even one [case] is not tolerable to a certain extent. Of course, you may say that, okay, you pay a price for that. Yes, we do pay a price for that.
AT: Does that then mean that because there’s a zero tolerance policy, and because our situation is such, that as long as people keep coming to Hong Kong, we will maintain a 21-day quarantine?
SC: We have to be true to our strategy. If we have adopted this strategy, our implementation and our measures are geared towards this particular strategy. That’s exactly the situation. That said, vaccines are available and globally, the vaccination rate has increased. Therefore, we think if we can achieve a high vaccination rate then we may be in a better position to work on adjustments of our strategy. Then we ensure that in our community, people are safe in terms of protecting themselves, should some virus or another wave come about.
AT: Is there any discussion on the government’s part about easing the burden of quarantine?
SC: As far as traveling is concerned, it has been difficult. But because vaccines have come into play, we have been working with other places. When people come, we try our best to facilitate without forgetting about the risk. That’s why I think many people think Hong Kong is a safe place to live in, to do business. But as you’ve said, at the same time, I think people may find some inconvenience as well.
For children and families, we’ve made available some of the family rooms or two rooms. I think we have to get this right. Many people have an impression about [the quarantine center], but improvements have been made.
AT: What is Hong Kong’s vaccination strategy? The target was at 70% by the end of September. Now its 80% to 90% and it’s been extended. Do vaccine mandates have a place in the government strategy?
SC: We do not mandate people to take the vaccine, but we provide safe application and timely vaccines. We provide information about the vaccine transparently. We have different public education campaigns, we have doctors explaining and radio programs, and so on. People in Hong Kong also want it to be very convenient. We have multiple, different spots in the community so that when people want to go there, even opportunistically, they can.
As far as the vaccination rate, because of the delta variant and the changes in the mutant strains, we should actually aim as high as possible. Obviously, we know, it would be almost impossible to get to 100%. But at least we can get to 80% to 90%.
SC: We initially thought with the rate that we have been doing, which was quite well, that we may be able to get 70% at the end of September. But now it’s 65%, first dose, and the vaccination rate has dropped.
For those who are under 70 years old, if we average out the vaccination rate, it’s about 70%. Some age groups are actually at 80%. But most worrying is the elders: for 70 years or above, its just over 30%. It is falling behind a lot.
AT: Why not just mandate vaccinations?
SC: As far as the elderly are concerned, in Hong Kong, there are some things, that if we mandate, it may not get [the result] we want. Therefore, we want to do it in a manner that is acceptable to people. We provide incentives, we facilitate and provide transparent information.
The zero strategy is a [multi-pronged one.] We do not only rely on vaccination. But, if one has been vaccinated, then at least they can ease the burden, not only to protect themselves, but also ease the burden of our health care system when we have a next wave.
AT: Has there been any discussion around treating COVID-19 and its variants as endemic in Hong Kong—which might require rethinking this zero-tolerance policy and thinking of a long term strategy to transition to whatever the new normal is?
SC: We are now in a position where our vaccination rate is only 65%. When our vaccination rate hits 80% to 90%, then we are in a better position to see how we can sort of adjust our overall strategy.
AT: Hong Kong is an entrepot with many international businesses, where a lot of travel is required and large numbers of travelers. A big part of Hong Kong thrives on that — culturally, socially and economically. People feel the policies are very China-centric and at odds with what Hong Kong represents — the centrality of Hong Kong in trade and business flows. When you’re thinking about border controls, are you considering that Hong Kong is being shut out from the world?
SC: We maintain the zero strategy. For the government as a whole, we always balance because of all these different areas of concerns. As I’ve said, when we achieve a higher vaccination rate, I think we will be in a better position of having relaxations.
AT: But isn’t this penalizing people who have been vaccinated and who are, in theory, being socially more responsible?
SC: Well, I don’t see it that way, because whoever lives in Hong Kong would want it to be a safe place to live in. And so in keeping Hong Kong safe, I think you have a responsibility. So far, everybody has been doing very well in terms of hygiene strategies, mask wearing. We, in totality, together, keep Hong Kong safe. It’s also a corporate responsibility.
AT: People talk about Singapore as a competitor, but ultimately, Hong Kong is the one that’s got the intellectual and financial depth — everything that can absorb talent. That depends on open borders and it’s what Hong Kong is built on for so many people. Is easing border control measures a priority for the government?
SC: When we talk about opening borders, there are different sides. There’s opening borders to the rest of the world and opening borders with mainland China. In Hong Kong, many people have families in mainland China, many people have businesses in mainland China and they’d like China to open borders with us. So, we have to look at the whole thing in totality.
I understand the 21 days of quarantine [is frustrating.] By the way, it isn’t always 21 days; we are only talking about travel to and from high-risk countries. It can be as little as seven days for the low risk countries. Its only 21 days for high risk countries.
AT: But that’s where the most flow of people is from, like the U.S. and the UK.
SC: We understand. Unfortunately, this is the situation. Our Department of Health has assessed the risk of all these countries. If you look at the social and economic side, that’s something that’s very challenging. But if you look at the safety, and the prevention and control measures of infectious disease, the volume of people actually hurts. They pose a very high risk to the community.
AT: That’s the flip side of being an international hub – it’s one of the biggest challenges that Hong Kong faces.
SC: Yes, that’s right. That’s exactly true.
AT: Globally there’s talk about boosters. We’re in a lucky position where we have a lot of vaccines. Are you considering offering boosters in Hong Kong?
SC: Yes. Our Joint Scientific Committee under the Center for Health Protection has been discussing the need for booster shots. That includes different questions: whether we are going to have booster shots; whether it’s a mixed vaccine platform or whether it should be the same; and the timing — how far away from the first or from the second dose.
AT: But they haven’t ruled it out?
SC: No, they haven’t ruled it out. We have already started reviewing the situation. We have funded a number of studies on booster shots and our experts are reviewing that data and are waiting for more data to come. They have not recommended any booster shots yet, but if they are going to recommend, they have said perhaps it’s the elderly and the immunocompromised people who should come first.
AT: That’s similar to the vaccination drive. But the elderly are the ones that are lagging on the [first round of vaccinations], does that logic work then?
SC: That’s why we are frantically trying to get the vaccination of elderly people to go up, because they are the most vulnerable group. They should be the first to take the booster, but if they have not taken the first dose, they can’t.
AT: Based on all your experience in public health, what are the chances of Hong Kong starting to transition towards normal?
SC: When you talk about normalcy, it really depends on how you define it. If it’s a local normalcy, I think we are already there. But if we are talking more about borders — people who are coming in and coming in going out — I think it’s when we have a higher vaccination rate. With a high vaccination rate, we will be in a better position to actually look at the overall strategy and to revisit in totality.
In terms of the strategy, as you know, around the world there are two schools of thoughts: one is living with the virus and the other one is the zero strategy. These two strategies are tied to different measures. We’ve always been trying that balancing act, which I think is the most difficult.
Please be rest assured, we understand Hong Kong’s position as an international city. That’s very important for Hong Kong. But let’s keep Hong Kong safe for now.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Anjani Trivedi is a Bloomberg Opinion columnist covering industrial companies in Asia. She previously worked for the Wall Street Journal.