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Although the Comirnaty vaccine is “strongly recommended” by local experts as a booster, the government has placed little emphasis on this detail, while urging citizens to “get all three doses”.
This advice and its publication (or lack thereof) directly affects the level of protection the city builds against Omicron infection. However, the advice to receive the Comirnaty vaccine as a booster is not mentioned in any television vaccination advertising, and appears only deep in the vaccination programme’s website.
As of February 20, 62% of people opted for Comirnaty as their booster, a percentage that remains very similar to that of people primarily inoculated with Comirnaty.
The recommendation to receive a Comirnaty booster is stated in an official guideline issued late in October of last year, by the Scientific Committee on Emerging and Zoonotic Disease and the Scientific Committee on Vaccine Preventable Disease, as well as the Chief Executive’s expert advisory panel. “A third dose of Comirnaty vaccine may elicit a better immune response and offer greater protection than the CoronaVac vaccine”, it reads, but “personal preference is respected”.
The guideline also recommends higher-risk adults who received two doses of Comirnaty to take an additional dose of the same, six months from the second dose.
The third-dose vaccination programme commenced in early November last year, first for immunocompromised cohorts and cohorts with a higher risk of infection, and thereafter expanded to include other members of the public. Citizens were free to choose the type of vaccine they received.
With the emergence of the Omicron variant, local scientific committees updated their guidelines on December 23 to “strongly recommend” that adults opt for a Comirnaty booster, regardless of whether they had been primarily inoculated with two doses of Comirnaty or CoronaVac.
Statistics, however, show that the preferences of the general public have not been in line with expert advice. The proportion of people choosing Comirnaty as their booster remains similar to those who received a second dose of Comirnaty vaccine.
In the first two months of a booster being made available, 53% of the people who were boosted chose CoronaVac over Comirnaty. The proportion of people opting for Comirnaty climbed only in early January this year. As of February 20, 62% of 1.46 million people had chosen a Comirnaty booster. The remaining 38% chose CoronaVac.
The proportion of first-dose recipients choosing CoronaVac also rose from 36.8% in early January to 41.2% by February 20.
The government’s vaccination publicity and promotional material scarcely mentions the advantage of a Comirnaty booster over CoronaVac, even though local experts do, in fact, recommend Comirnaty over CoronaVac. This recommendation is also not mentioned in the now ubiquitous “Enhance Protection, Get All Three Doses” advertisement.
Neither is it easy to find this advice on the government’s official vaccination programme website. It does not appear until one scrolls down to the 36th question in the Frequently Asked Questions section. “For individuals aged 18 years and above who have received two doses of Comirnaty or CoronaVac vaccine, a third dose of Comirnaty vaccine is strongly recommended,” it reads, without explaining why, adding that “personal choice for the vaccines is respected and these individuals may receive Sinovac(CoronaVac) as 3rd dose as well.”
Although these recommendations issued by their experts in the past year have been uploaded to the website, all of the documents are only available in English.
Major officials ‘set examples’ to receive CoronaVac vaccines
Contrary to the advice of local experts, major government officials have appeared to prefer CoronaVac ever since the beginning of Hong Kong’s vaccination programme. Last year, many officials publicly opted for two doses of CoronaVac. More recently, Chief Executive Carrie Lam, Secretary for the Civil Service Patrick Nip and Secretary for Food and Health Sophia Chan again chose CoronaVac as their boosters in November last year, despite their scientific committees recommending Comirnaty instead.
Carrie Lam explained her reasoning during an interview, saying that “more antibodies aren’t necessarily better.”
Sophia Chan, in a blog post dated January 30, did not outline the difference in the available boosters either, though she nonetheless generally encouraged members of the public to receive a third jab amid the spread of Omicron.
In March last year, as the vaccination programme was launched, the Health Authority Employees Alliance questioned CoronaVac’s low efficacy and the lack of experimental data in populations aged 60 and above. The HAEA pointed out that herd immunity could hardly be achieved even if most people in Hong Kong were to be vaccinated with CoronaVac.
In response, the government condemned the organisation for “placing individual political gains above public health” by “smearing the vaccination programme” and “misleading citizens”.
In a press conference on February 8, Director of Health Ronald Lam was asked by Hong Kong Free Press to provide information on the vaccination statuses of confirmed COVID-19 cases. He did not give a direct answer, but did defend CoronaVac, saying that it had been proven effective in preventing severe illness and death via the T-cell responses it induces, even if it produced lower levels of antibodies than Comirnaty.
Singapore requires an additional mRNA booster in those who opted for three CoronaVac doses
In some other countries, the low antibody levels produced by the CoronaVac vaccine figures large in their policy-making. For example, Singapore’s Ministry of Health advises people who have already received CoronaVac as their third dose to additionally receive a fourth booster dose of an mRNA vaccine (CoronaVac is an inactivated vaccine, not an mRNA vaccine).
In Chile and Uruguay, citizens who were previously vaccinated with two CoronaVac doses aged 55 or above are given AstraZeneca boosters, while Uruguayans and Chileans aged below 55 receive Comirnaty boosters.
The National Health Commission of China announced last Saturday that it would allow two-dose recipients of the CoronaVac or Sinopharm vaccines – both inactivated vaccines – to opt for heterologous boosters “of a different technology” in order to combat the Omicron variant.
Last Wednesday, FactWire sent an inquiry to the Department of Health to ask if the government will draw attention to their experts’ recommendations to receive Comirnaty boosters, and whether it will require three-dose-CoronaVac recipients to receive an additional Comirnaty booster. No reply has been received thus far.
