As West races back to travel, ‘zero-Covid’ economies like Hong Kong, Singapore and Australia face hermit risk
- In a world where Covid-19 becomes endemic, economies reliant on sealed borders to keep the virus at bay will have painted themselves into a corner, experts say
- Places pursuing herd immunity, such as the United States and Europe, are already opening up. If Asian economies want to do the same, they too may need to learn to live with the virus
“The problem is that I think there is a fear and risk aversion that has got worse in countries that have done it well, rather than better,” said Peter Collignon, a professor of microbiology at the Australian National University.
“One of the issues is how you get the majority of society to accept a certain level of risk when you have markedly decreased the risks of death and a lot of disease and your health system being overwhelmed.”
On Monday, the European Union unveiled a road map under which people who were fully vaccinated would be able to visit the 27-member bloc for leisure and other non-essential reasons by June. Britain, where more than half the population has received at least one vaccine dose, is preparing to resume international travel on May 17 with the introduction of a traffic light system that will allow people travelling to “green countries” to avoid quarantine by taking a Covid-test upon their return. The US last month eased restrictions on the entry of international students from China, after lifting curbs on European students earlier this year.
By contrast, many Asia-Pacific economies have been slow to commit to lifting border restrictions, even for people who are vaccinated, a stance given fresh impetus by the humanitarian disaster unfolding in India, where a devastating second wave has resulted in daily cases passing the 400,000 mark.
Since the arrival of vaccines, public health experts have stressed the importance of reaching herd immunity – believed to kick in at 70-80 per cent vaccine coverage – to halt the uncontrolled spread of the virus and allow societies to return to normal life. But limited supplies of vaccines, poor vaccine uptake, and the emergence of mutant virus strains have called into question the likelihood of reaching that threshold.
In Hong Kong, which mandates three weeks of hotel quarantine for most arrivals, vaccinations are proceeding at such a slow rate as a result of poor public uptake that the city is unlikely to reach 70 per cent coverage in 2021 – if at all.
Vietnam, which has reported just 35 deaths since sealing its borders in March last year, has received delivery of fewer than one million doses of the AstraZeneca vaccine, and only plans to have vaccinated 20 per cent of its 98 million people by the year’s end.
Australia’s vaccination programme is on track to be completed in 2024, according to The Guardian newspaper, although the pace is expected to pick up significantly when the country receives another 20 million doses of the Pfizer jab in the final quarter of this year.
Singapore, which has had one of Asia’s fastest vaccine roll-outs, with nearly 40 per cent of the population having received at least one jab, on Tuesday extended quarantine for most travellers to 21 days amid a spike in community cases. Officials said they had no plans to postpone a travel bubble between the city state and Hong Kong that is set to begin on May 26, although they would monitor the situation to assess whether changes might be needed.
Even where there are abundant supplies and relatively high vaccine uptake, herd immunity is not necessarily assured.
In the US, which has had one of the fastest vaccine roll-outs of any major economy, with more than 60 per cent of the population given at least one dose, experts quoted in The New York Times this week said herd immunity may be an unattainable goal due to variants and stubborn pockets of vaccine hesitancy. Experts also widely agree the coronavirus will continue to circulate around the world as an endemic disease for decades or even centuries to come, irrespective of the disease control efforts of individual countries.
Dale Fisher, a professor at the NUS Yong Loo Lin School of Medicine, warned that countries such as Australia that had effectively eliminated the virus through border controls were now “painted into a corner”.
“This is not part of the media rhetoric and it’s a huge problem,” Fisher said. “I’ve raised it a couple of times, but people haven’t taken the nibble, that countries that have relied on border closures and have had zero tolerance for cases are going to really struggle to transition to the next phase.
“The rest of the world will be opening up and flying around and they will be saying, ‘How do we now transition to a situation where Covid is endemic?”
Governments adopting a zero-Covid approach have offered vague indications of the conditions under which restrictions could be eased. At most they have flagged incremental adjustments to border controls.
The emergence of new virus variants has been invoked to justify a cautious response, although studies have shown the Pfizer, Johnson & Johnson and Moderna jabs to offer strong protection against mutations, including the strains first discovered in Britain, Brazil, and South Africa. The risk of even fully vaccinated people still transmitting the virus has also fuelled caution, even though a growing body of research suggests vaccines significantly, although not fully, cut transmissions as well as preventing serious disease.
In Australia, Minister of Health Greg Hunt last month suggested border controls could remain in place even after the entire country had been inoculated, as authorities would have to consider “different factors” including transmission risks and the situation overseas.
Prime Minister Scott Morrison, who has come under pressure in recent days for instituting a temporary ban on citizens returning from India, said the same month the government was in “no hurry” to reopen the borders, but as a first step could consider allowing fully vaccinated citizens to skip hotel quarantine. On Friday, Trade Minister Dan Tehan said his “best guess” of when borders might fully reopen was the second half of 2022.
In an oped in the Australian Financial Review last week, the newspaper’s European correspondent lamented that Australia risked becoming a hermit country to the detriment of its “economy, culture and international standing in ways that seem greatly under-appreciated”.
In Hong Kong, where there is growing pressure to better incentivise vaccinations, Health Secretary Sophia Chan Siu-chee announced on Friday that people who were fully vaccinated would from May 12 be able to reduce their hotel quarantine from 14 to 7 days when returning from low-risk countries such as Australia and Singapore, and 21 days to 14 days for high-risk destinations.
People arriving from very high-risk areas including Britain and Ireland will be required to undergo 21 days of hotel quarantine, whether or not they have been vaccinated. Flights from extremely high-risk areas, including India, Pakistan and Philippines, will remain suspended.
Roberto Bruzzone, co-director of the HKU-Pasteur Research Pole in Hong Kong, said it was incumbent on authorities to take action to “move society outside of a paralysis that has been brought upon by the idea that we can keep this virus out of the door forever”.
“From a public health point of view, you get a vaccine precisely so that you can go on with your life, being a much reduced risk to all the rest of the community,” Bruzzone said, who expressed a preference for the looser approach to borders being taken in the US and Europe.
Bruzzone said questions such as when to reopen borders were political and societal decisions, not matters of science, and criticised authorities for delegating policy to “scientists who by definition will be risk-averse because they don’t want the decisions to be taken under their responsibility”.
“If you as part of a committee say, ‘We need to reopen the restaurants and the bars’, and then people open them and then one month later there are 300 cases and 10 people die here in Hong Kong, then you can see what is going to happen,” Bruzzone said, stressing that he was speaking in a personal capacity and authorities had to make policy decisions for themselves.
Bruzzone also criticised media coverage for stoking fear with outsized attention paid to variants and other risks, including the approximately one-in-a-million chance of fatal blood clots associated with the AstraZeneca vaccine – a risk far lower than many everyday activities.
“You can have a car accident, you can have a stroke while you are running or doing sports. There are many things that can happen in life,” he said.
In a study published in The Lancet last month, European researchers concluded that elimination strategies produced the best outcomes for health, the economy and civil liberties, and warned that “a clear global plan” would be needed to bring the pandemic to an end.
“Countries that opt to live with the virus will likely pose a threat to other countries, notably those that have less access to Covid-19 vaccines,” the authors said. “The uncertainty of lockdown timing, duration, and severity will stifle economic growth as businesses withhold investments and consumer confidence deteriorates.”
Todd Pollack, country director of Harvard’s Partnership for Health Advancement in Vietnam, said it would be dangerous for countries to reopen their borders until vulnerable populations had been vaccinated.
“I think if you look at the indicators out there now, the zero-Covid approach, which you could say is the Vietnam, Australia, New Zealand approach, has been shown to be the best approach,” Pollack said.
Pollack said the biggest obstacle to the return of free movement was the unequal distribution of vaccines, especially in low- and middle-income countries such as Vietnam.
“It’s true that it seems like a long road before the borders can be opened and there may be some middle ground that can happen once more people in the world are vaccinated,” he said. “But at the current time it doesn’t seem safe to change the border policy.”
Hsu Li Yang, associate professor at the National University of Singapore’s Saw Swee Hock School of Public Health, also urged caution.
“What is the threshold for vaccination and infection such that there will be no major outbreaks of Covid-19 in a country or territory? We do not know yet, but perhaps Israel and other front runners in mass vaccination will be able provide such information in the months ahead,” Hsu said.
“Until countries are sure that they will be able to reach such a threshold, or at least have the majority of their people vaccinated, it might not be best to initiate such discussions.”
But Collignon, the ANU professor, said countries would have to learn to accept some level of coronavirus spread or risk becoming hermit nations.
“I think this state of uncertainty and a lot of fear is going to persist for another year until we basically see what happens in real life,” he said. “But having said that, I don’t think zero-Covid is actually a viable long-term option.”
He recommended countries adopt a “graduation of restrictions” that took into account risk factors such as vaccination uptake, a traveller’s vaccination status, and the prevalence of disease elsewhere.
“Border restrictions may mean it’s not the same for every region in the world,” he said. “There needs to be a more nuanced, risk-based approach.”