Older Chinese Are Demanding Money to Get Vaccinated

When China launched its COVID-19 vaccines in early 2021, it prioritized immunizing people from 18 to 59 years old. That was in stark contrast to most Western countries, which prioritized the elderly and people with chronic diseases—the groups most vulnerable to COVID-19.

Today that decision is coming back to bite the country, as the omicron variant of the coronavirus threatens China’s once-solid “zero-COVID” wall. Around 48 million people over 60 years old remained unvaccinated as of May 5, which accounts for nearly 14 percent of this age group—including nearly half of those over 80. According to data released March 18, just 51 percent of people over age 80 are fully vaccinated, and only 20 percent in this age group are boosted. In Hong Kong, which also made use of China’s vaccines, a similar lack of vaccination among the elderly was responsible for the city having the world’s highest per capita death rate from COVID-19 this March after its containment strategy failed. That’s causing Chinese officials to come up with increasingly desperate solutions.

The original decision to deprioritize the elderly population seems to have been made because of a lack of trial data among people older than 60. According to vaccine expert Lina Tao, recruiting older people for the trials was difficult due to health concerns such as the older population having more complex medical conditions and more underlying diseases.

The barriers to elderly people getting immunized are considerable. An announcement issued by China’s National Health Commission on April 1, 2021, stated that people age 60 and over were included in the population suitable for the COVID-19 vaccine. But in practice, elderly people had to pass a general health screening before they could be vaccinated. According to a document published by the People’s Government of Sichuan Province, some of the screening standards included a blood pressure lower than 160/100 and a fasting blood sugar level of less than 250. That excludes a lot of the elderly population. Sixty-seven percent of Chinese people over 60 years old have high blood pressure and nearly 20 percent have diabetes.

Another barrier is prevailing distrust of vaccines. A doctor who works in Changzhou, Jiangsu province, and who asked for anonymity said that rumors among the elderly of negative side effects are common—and that changing their minds is nearly impossible. China has a long history of vaccine scandals. Elderly unvaccinated people are also mostly clustered in hard-to-reach rural areas.

The Chinese government is well aware of the problem, especially as omicron continues to grip Shanghai and threatens to spread to other Chinese cities, prompting lockdowns throughout the country. But there’s no easy solution.

Local government has turned to a favorite answer in China: mandatory quotas, forcing other government-employed staff to aid the campaign in order to hit their own numbers. In late March and early April, a few Weibo posts claimed that the Education Bureau of Zhanjiang, Guangdong province, was forcing primary school, middle school, and kindergarten teachers to aid in the elderly vaccination campaign. Each teacher had to provide evidence that they had gotten at least one person over 80 vaccinated. Failing to hit their numbers meant consequences such as bonus cuts or rendering them ineligible to be promoted to leadership roles for six months. There was no official government announcement, and when teachers asked about the legitimacy of the policy, no documentation was provided.

A teacher who asked to be known as Mrs. F confirmed this information to me. As her chat history with other teachers showed, they had a very difficult time finding unvaccinated elderly people since the unvaccinated elderly usually live in remote villages.

“They were really stubborn and didn’t believe in the effectiveness of the treatment. The government officers have already tried very hard to persuade them to get vaccinated and still couldn’t convince them. They are either in their 80s or 90s or have very serious underlying conditions,” said Mrs. F.

The demands on teachers have produced a mini-market in elderly people. According to Mrs. F, at the beginning, teachers provided unvaccinated elderly people with transportation and free food items like cooking oil and rice in order to persuade them to get the jab. But later on, because of huge demand, elderly people started to demand monetary compensation, and the price went up rapidly, from a few hundred yuan to a few thousand yuan. That was a lot of money for the teachers, whose salaries averaged between 6,000 and 8,000 yuan a month (roughly $900 to $1200). Mrs. F said that she tried to ask her family and friends to help her find a suitable subject but didn’t have any luck. In the end, she had to pay 3,000 yuan to get a villager vaccinated, with a local official taking a cut as a middleman. According to some Weibo posts—many of them now removed by censors—some teachers paid as much as 8,000 yuan.

It’s unknown whether other areas have introduced similar policies, but this is not the first time that quota systems have caused problems with vaccine plans. As an article published by BJ News last year exposed, a large number of pregnant women in Lu’an, Anhui province, were listed as vaccinated when that wasn’t the case. As with the teachers, local officials had mandatory quotas to make or faced losing performance bonuses, so they had started registering unvaccinated people as vaccinated to keep their numbers up.

Even if the program gets the numbers down, there’s one bigger problem: Chinese vaccines simply aren’t as good as Western ones. According to data collected in Hong Kong, the Sinovac vaccine is less effective than mRNA vaccines at preventing death among the elderly. A published paper shows that two doses of the Pfizer-BioNTech vaccine has 88 percent protection against severe disease and death among adults over 60, while two doses of Sinovac offers only 74 percent protection. A Sinovac booster shot, however, appears to improve efficacy considerably.

But politics means that mRNA vaccine imports are out. China has spent the last year denigrating Western vaccines and spreading conspiracy theories—and that doesn’t seem likely to stop. According to a reporter working for a Chinese state-affiliated media outlet, who asked for anonymity, “Even objective and factual covering of other countries’ pandemic control and prevention strategies is prohibited.” Articles elaborating the usage of more effective vaccines and discussing cautiously and gradually loosening COVID-19 restrictions are not allowed to be published. As China faces more lockdowns and the possibility of an uncontrolled outbreak, “Only articles disapproving foreign countries’ pandemic control strategies are allowed.”