Securing the vaccines for Asia is only half the challenge – Up next, the mammoth task of convincing millions that the benefits outweigh the risks
From months of social isolation to a pending rapid roll out of community vaccination facilities across Asia. The challenge at the peak of COVID-19 was to keep seniors at home. Today the challenge has shifted for the 614 million persons over the age of 60 years old living in Asia. How do we convince millions of seniors – representing 58 percent of the global population – to participate in this massive global vaccination rollout that aims to protect the most vulnerable members of our communities?
In the second half of 2020, many governments were in a race to evaluate and secure supplies of COVID-19 vaccines for seniors and frontline workers. Now that supplies are in hand and on the way, how will they convince seniors to take the vaccine? The most common questions elders may have, “is the vaccine safe, proven and effective?”, “If I am not going out often, and the community threat is low, perhaps I won’t need it?”, and “the vaccine does not have a long track record.”
To date, the three common vaccines that are being distributed and adopted globally are from Pfizer-BioNTech and Moderna, with approximately 95% efficacy, followed by Astrazeneca-Oxford with approximately 70% efficacy, at preventing both mild and severe symptoms of COVID-19.
Singapore’s vaccination strategy for seniors
Ms Janice Chia, Founder & Managing Director of Ageing Asia, Singapore, shared that sentiments of seniors towards vaccination is currently a “wait and see” approach, but she believes that the confidence towards the vaccine will rise quickly once the first batch of seniors in the community are vaccinated and public education and awareness increases.
From the start of 2021, staff of nursing homes in Singapore have already started to get their vaccinations. Singapore was one of the first countries to obtain the Pfizer-BioNTech vaccine, one of the three shortlisted vaccines after an 18-man expert panel studied the safety and efficacy of 35 promising vaccine candidates. To date, 100,000 people, mostly front line workers, including staff and residents in nursing homes, have already been vaccinated, including the Prime Minister of Singapore, Mr Lee Hsien Loong.
Ahead of schedule by a month, Singapore will prioritise vaccinations for seniors aged 70 and above from 27 January via an invitation letter process, where seniors will then make bookings online or at neighbouring centres for their vaccination appointments. The first pilot batch of seniors will be from two targeted neighbourhoods. Upon a success in terms of operational efficiency, efforts will then be scaled up progressively for all seniors from mid of February with 36 vaccination centres set up, including one community vaccination centre in each of the 24 towns in Singapore. Each community vaccination centre will have the capacity to administer 2,000 vaccinations per day (from 8am to 10pm). In addition, volunteers will also be conducting house visits and activities to help seniors answer questions, and to assist them to book their vaccination appointments.
In Singapore, the government has announced that for those who opt out of taking the vaccine, the opportunity will go to the next person in line, and will have to bear with the potential consequence that if they choose to take the vaccine in the future, it may not be readily available. The country aims to complete the complimentary vaccination for all 5.7 million citizens and long-term residents by the third quarter of 2021.
Hong Kong SAR’s vaccination strategy for seniors
Dr The Honourable Lam Ching-choi, SBS, JP, Member of the Executive Council, Hong Kong Special Administrative Region, The People’s Republic of China, Chairman, Elderly Commission of Hong Kong SAR, Chief Executive Officer, Haven of Hope Christian Service, shared that in terms of population density and the ageing population, Hong Kong SAR (HKSAR) has performed well in protecting the health of the seniors in this epidemic. In addition to preventing the seniors from being infected, emotional support could be further strengthened in the future.
HKSAR had adopted a “two-pronged” strategy to procure vaccines for protecting the citizens against COVID-19. The Government has joined the COVAX Facility led by the WHO, and directly entered into advance purchase agreements with individual vaccine developers for obtaining greater supplies of vaccines at an earlier time. Priority will be given to vulnerable groups in the COVID-19 vaccination programme. The first priority group is the residents and staff of residential care homes for the seniors/persons with disabilities and other institutional facilities; the second group is the workers in health-care settings, workers in other essential services who are at increased risk of exposure to COVID-19, and persons aged 60 years or above.
Japan’s vaccination strategy for seniors
Dr Jun Sasaki, Founder & Chairman, Yushoukai Medical Corporation, Japan, shared that in Japan, vaccination of healthcare workers will start in February (ICU staff first, then all healthcare professionals). Vaccination of residents and staff of elderly care facilities will follow suite. After April, the coverage will be extended to the general public aged 65 years and above and patients with underlying diseases with high risk of serious illness.
Japan does not have a public health command center like the CDC. This time round, the government is trying to overcome the crisis by convening experts to advise the government. According to Dr Jun, it is important to make this a permanent advisory body for a smooth and scientific policy making.
Thailand’s vaccination strategy for seniors
During the first wave of COVID-19 in March-May 2020 and the current second wave from December 2020 until now, none of the elders in Thailand’s retirement homes and nursing homes was infected with the virus. The Thais took lessons from the cluster deaths in senior living in the US and Europe, and strict quarantine measures were deployed then. Unfortunately, some elders living in the communities contacted the virus through family members.
According to Dr Nart Fongsmut, M.D., Director, LivWell Co.,Ltd., Medical Director, Chiva-Som International Health Resort, Board member, Thailand Elderly Fund,Thailand will start its first phase of the Covid-19 vaccination to priority groups with AstraZeneca and Sinovac Biotech vaccines in the 2nd half of February 2021. The 19 million people in these groups are frontline medical personnel, patients with chronic diseases and people aged over 60.
Thailand has a total population of 68 million. The vaccine will be made available for free and not compulsory.
The new normal for seniors
Ageing Asia interviewed some of the industry leaders on their views on the new normal for seniors in their home country.
Hong Kong SAR
When the epidemic subsides, the elderly services could gradually resume normal under the strict implementation of effective infection control measures; In the long run, elderly persons in the community should stay vigilant and maintain good personal hygiene. They are advised to wear masks and always clean their hands, until most of the Hong Kong population has been vaccinated.
By April, there will be a certain level of vaccination for the seniors who need nursing care, so we can expect community activities to resume in earnest around the same time. Japan has stepped up contact tracing by public health centers in an effort to contain the outbreak to a small stage. This was one of the factors that prevented an explosion of infection, despite the lack of a large-scale testing mechanism. The system was originally designed to control tuberculosis, but it was also powerful against emerging infectious diseases. It is important to maintain and strengthen this function.
Thai seniors will resume activities gradually after vaccination, perhaps in the 4th quarter of this year. They will be able to participate in group activities and travel domestically. Due to climate change, we will face with emerging diseases in the future, even after COVID-19. And the elders are most vulnerable. Immunisation is going to be essential for Flu, pneumonitis and other diseases. Keeping themselves healthy in hygienic living environment, with good exercise and nutrition will be the key. Universal precaution measures will be exercised on regular basis.
After six months of starting vaccination, life activities and recreational activities will turn to normal with safety confidence eg. group activities, domestic traveling with new normal protocols (physical distancing, facial mask wearing, personal/ hand hygiene sanitation). Healthy is Wealth. So proper nutrition for seniors, nationwide essential vaccinations (flu, pneumonia) and health promotion & prevention for NCDs eg. hypertension, DM, obesity are taking the most important roles in the future. Public education and systematic approach for crisis management are the key factors for controlling and managing the contagious infection outbreaks.
Seniors will be accustomed to activities in small groups, including exercises and social activities, and use of communication technologies. They will also be used to creating COVID-19 social bubbles where they socialise in close proximity with a small group of people. A new generation of digitally empowered seniors, vaccinated, wearing masks when they leave the house and practicing good self-hygiene will become a social norm and good preparation for future infectious disease outbreaks.
Five reasons for the fast vaccine development
Although vaccines typically take years to develop, there are several reasons that global medical experts and governments feel assured by the approved vaccines.
Firstly, information on the genetic make-up of the SARS-CoV-2 coronovirus was openly shared by China to vaccine developers from the start. Secondly, vaccine development for COVID-19 by Pfizer-BioNTech was not a fresh vaccine. Years in the making before the crisis, the manufacturing process had already started.
Thirdly, massive global financial and manpower resources poured into the vaccine development enabled faster testing strategies and the adoption of new technologies (messenger RNA – mRNA) through research and development. Fourthly, there was no lack of volunteers to trial the vaccines – many who were exposed to the virus stepped forward to volunteer. Lastly, the manufacturing process of the vaccines started even before final approvals were obtained – well ahead of time, enabling many countries to receive the first batches of the vaccine at the start of the year.
Ageing Asia: Covid-19 Seniors Vaccination in Asia – Part 1