Low elderly vaccination rates in Asia: an overlooked explanation

Science and policy can’t always explain everything

Over the past few months, I’ve come across many articles commenting on how hesitancy towards and low rates of vaccination amongst elderly in parts of Asia are holding back the likes of China from opening up.

Some of the reasons given:

• Older people have underlying diseases – vaccination may not be safe

• Policy reasons: working age population was prioritised

• Communication of effectiveness and safety of vaccines

• Effectiveness of local vaccines vs. Western vaccines

Here are some snippets:

There’s one explanation however I think a lot of the Western media has either missed or understated. One to do with the cultural factors at play across Asia.

Culture crash course: Confucianism and filial piety

Filial piety (more generally, respect for elders) has been part of the woodwork of East Asian culture for millennia - something the philosopher Confucius was a key proponent of.

It’s been around a long old time… Illustrations of the Classic of Filial Piety Song dynasty (960-1279)

Confucianism, which began to spread in earnest around the 6th and 5th centuries BC, espouses communal activities, and self-cultivation of virtues and ethics.

I’m no student of Confucianism, but one thing Asian culture prizes highly is respect for elders and respect for their experience. Allowing them to “lose face” is a non-starter.

It was something all of us learnt about from a young age (perhaps something comparable in the West would be the Magna Carta, a staple of UK primary school curricula).

This can also explain why most East Asian families have very tight-knit networks, and mutual support is a tradition.

My own experience

As it turns out, my grandmother is one of these un-vacc’d statistics. Only recently placed into a care home after becoming less mobile (she’s 93, bless her), she is sprightly and in remarkably good health (plus she has a ravenous appetite! 😆)

There have been some fun and colourful exchanges between her and my family trying to convince her to get jabbed:

First it was,

I don’t trust the vaccines

Then it was,

Nah, I’m old as it is already

And then it was,

Just listen to what I say!

It was both amusing and amazing to see how, after all the remonstrating from her children, she always had the last word (seeing them in stunned silence was also quite funny).

Over time, she seemed to soften to the idea of getting jabbed…

But, ultimately, she didn’t get jabbed at all on the basis of local medical advice. I’d dare say in Europe she would have had at least one jab by now, if not the whole set!

Part of the woodwork

To give you an idea of how embedded filial piety is in Asian society, let’s see what Hong Kong has, as an example:

• 🍈🍉🍵Tea/fruit money for over 70s (HKD1,475/USD185 per month)

• 💰Income tax breaks of up to HKD100,000 (USD12.8K) for people spending money to care for elderly relatives

• 🚋Super cheap travel: HK2 for >60 year olds (that’s like 25 US cents per ride, for most modes of transport)

• 🏠Care homes generally don’t allow any visitors for fear of infecting elderly residents

So, the moral duty to elders is deep-rooted and formalised in Asian society.

Filial piety is pretty well institutionalised

So, what’s next then?

Vaccination drives in Asia and the West have taken different roadmaps. As tempting as it is to compare and contrast the superiority of one against the other, I think this misses a crucial point – that most of us just want Asia to open up as quickly and safely as possible.

OK, respect for elders is not just an Asian thing. But it’s pretty well institutionalised in Asia.

Since Asian culture places huge emphasis on avoiding direct criticism of elders (and those in positions of power) or their decisions – Western institutions might do well to heed this cultural point. Though there have been great leaps in innovation in Asia, things generally don’t change in knee-jerks, but in small enough increments that face is not lost in the process.

The government in China is already ramping up efforts to vaccinate the 60-79 age group, particularly the over 80s age bracket.

So I think they are well aware of the importance to convince them, thinking harder for ways to best message this to the, revered, geriatric community.

Earlier this year, in Hong Kong, when nothing seemed to persuade the elderly population to get vaccinated (not even incentives such as shopping vouchers, cash hand-outs, cars, or even… a US1.4m apartment), the government pulled out their trump card and said…

No vaccine, no dim sum.

Soon enough, vaccine centres were flooded with over 70 year-olds queuing to be jabbed so as not to miss their daily staple and chit chat time.

Dim sum in Hong Kong costs US$2.5 to US$5 on average

Priorities eh?

I’m not professing definitive solutions to anything, but simply being aware of this could be insightful to those curious about why things are the way they are in this part of the world.

And if awareness of this helps the East and West to see more eye-to-eye, perhaps unlocking cooperation on a whole range of other matters, then so be it.

I’m hopeful we’ll see a proper reopening in 2023. Famous last words.

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All views contained in this article are my own and do not necessarily represent the views of any other organisation.

None of the above constitutes investment advice in any way.