Come flu season, Hong Kong hospitals are mobbed again. Why won’t everyone just get jabbed?

Recent events are revealing some interesting facts about healthcare in Hong Kong, in particular the continuing widespread reluctance to get vaccinated. Our accident and emergency departments have been under siege, as families rushed their children and seniors – the two most vulnerable groups – there for treatment at the first sign of flu. Waiting times have skyrocketed to eight hours and beyond in some hospitals.

The immediate cause of the panic has been the arrival of the annual flu season together with a rise in Covid-19 cases. Although the new Covid-19 variant does not seem more virulent than others circulating, there is public anxiety that contracting flu and Covid-19 together could have some nasty outcomes.

The subject was discussed on a radio show I co-hosted last week with a panel of experts comprising an emergency ward doctor from Caritas Medical Centre, a paediatrician from the Hong Kong Medical Association, the chairman of the microbiology department at the School of Clinical Medicine at the University of Hong Kong, and the president of the Practising Pharmacists Association. I also subsequently filed some questions with the Department of Health.

The consensus seems clear: there is no need for members of the public to panic when flu symptoms first appear. Most cases can be treated by staying home from work or school for a day or two and drinking lots of water. Common medicines obtainable without prescription will, in most cases, fix things. If recovery is still delayed, then a visit to the local doctor is warranted.

Only if the patient’s condition deteriorates sharply at any point is it necessary to visit the nearest public hospital. Triage nurses are there to distinguish genuinely serious cases from milder ones, not to marshal crowds with nothing more serious than a cough or cold.

On one point all the experts were clear: everyone would benefit from getting the annual flu shot. As with the Covid-19 vaccination, there is no such thing as complete immunity, but symptoms and severe effects will be reduced. What does the vaccination situation look like? In a simple word, poor.

A Hospital Authority press conference at the Hong Kong Children’s Hospital in the Kai Tak Development Area urging parents to bring their children in for the flu vaccination, on October 17. Photo: Yik Yeung-man

According to the experts, the two most vulnerable groups are children up to five (vaccination rate: 46 per cent) and the elderly aged 65 and above (vaccination rate: 47 per cent). Among the other target groups, those in the 50-64 age category have a vaccination rate of just 17.5 per cent. Overall, our community is nowhere close to achieving herd immunity.

I find it hard to have sympathy for those now falling ill or their families if they have not taken the elementary step of protecting themselves. I have had the annual jab for many years, and no fewer than six Covid shots (plus the disease itself). I get ill from time to time like everyone else, but not often and seldom seriously.

What is the government’s position? The Scientific Committee on Vaccine Preventable Diseases recommends that healthcare workers receive the seasonal influenza vaccination to reduce morbidity and absenteeism in the workforce. In other words, those vaccinated are less likely to have a serious illness and possibly die, or need time off work. Vaccinated healthcare workers can also reduce the risk of transmitting influenza to patients who are at high risk of complications and mortality from influenza.

This is surely a very important point: healthcare staff work closely with those they take care of. Even if they don’t feel a responsibility for themselves or their families, they surely have a duty to those in their professional charge.

Patients wait for treatment at the accident and emergency department of Queen Elizabeth Hospital on January 8. Photo: Eugene Lee

Under the Government Vaccination Programme, healthcare workers at residential care homes for the elderly or those with disabilities, residential child care centres, the Department of Health, Hospital Authority and other government departments are eligible for free seasonal flu vaccines.

Yet as at January 7, only 55 per cent of healthcare workers at the Department of Health and Hospital Authority had received the seasonal flu jab, and just 37 per cent of those at residential care homes. These numbers, though an improvement from the previous year’s, are nowhere near good enough.

How can we expect the public to take the matter seriously when even the professionals do not?

Suggestions have been floated to address the overloading of hospitals’ emergency facilities. One is to have a differential charge so that minor cases are charged more, while only bona fide serious ones are subject to the lower subsidised rate.

How would this work in practice? Would the decision of the triage nurse be final? Or would everyone have to pay a high initial fee with a partial refund for those cases the doctor endorses? That sounds like a recipe for chaos.

Secretary for Health, Professor Lo Chung-mau, at the government’s headquarters in Admiralty on January 9. He said the government is considering higher charges for patients who abuse A&E services at government hospitals. Photo: Jonathan Wong

Another idea is just to push charges up so private clinic fees become more competitive by comparison. Issues of affordability then arise. There are no easy options.

Meanwhile, reports are emerging of former Hong Kong residents who emigrated many years before but who still hold valid permanent identity cards returning for medical treatment at subsidised prices. This is another tricky area which merits a closer look.

We have always operated under the principle of “once a Hongkonger, always a Hongkonger”, which has an emotional ring to it. If someone is returning here to live, that works. But what about those who emigrated a long time ago, have established a permanent home elsewhere, and only pay tax there? Would it be fair if they continue to be a drag on local resources?

Mike Rowse is an independent commentator