Vaccine hesitancy among Taiwan’s elderly mars its pandemic performance and prevents reopening

Rosa Yin is 69 and more sceptical of the Covid-19 vaccine than she is afraid of the virus. Last week, she joined about 30 protesters in Taiwan’s capital Taipei to denounce the government’s pandemic response and its plans to introduce a limited vaccine passport. 

Ms Yin believes her vitamin regime, and other unapproved drugs, will protect her if the virus spreads in Taiwan when border restrictions ease. She lives with her 100-year-old father, who has only had one dose of the vaccine. 

“I told him no more,” she said. “He is old and asked ‘why do I have to take medicine again and again?’”

Taiwan has done well during the pandemic, keeping Covid-19 deaths below 1,000 through strict immigration controls, 14-day quarantines, and sophisticated contact-tracing. It's borders have all but remained closed for two years now but life within the country has, for the most part, carried on as normal.

The country's overall vaccine rate is close to 74%, higher than the UK’s 71.8% and 63.9% in the US. This looks promising for the country's reopening but the headline figure disguises a serious problem - many of its most vulnerable are not vaccinated.

Much lower vaccine rates among the over-75s threaten to scupper Taiwan’s tentative moves towards successfully unwinding its zero Covid policy and opening up to the rest of the world again.

Vaccination rates for one of the most vulnerable demographics, in a society that is hurtling towards the designation of “super-aged,” is hovering at an alarming 68%. The lower take-up contrasts starkly with 83% of fully vaccinated Americans over the age of 75. In the UK, 91.7% are already boosted. 

Among the hesitant Taiwanese seniors is Mr Jheng, 90, who lives in the central city of Tainan, and who told The Telegraph that he worried vaccine side effects could worsen his chronic asthma and hypertension.  

“I don't trust the vaccine because of my illness. And there are 20% of the population who are not vaccinated, and they are all fine,” he said. 

He said he took the precaution of reducing visitors to his home and wore a mask and washed his hands when he went outside. Mr Jheng did not want to consider the consequences of opening the borders. “Thinking too much will only make people suffer,” he said. 

In some ways, Taiwan’s exit strategy is a victim of its pandemic success, which has created a prolonged sense of security and an element of complacency about the virus. 

Taiwan experienced a short semi-lockdown during a three-month long outbreak last summer, but with the exception of foregoing easy travel abroad, it’s population of 23.5 million have largely enjoyed a normal life. Its economy expanded 6.3% in 2021, the fastest annual growth since 2010.

Despite a national vaccination rollout that prioritised the elderly, Mr Jheng’s views are typical of many of Taiwan’s senior citizens, who fear the potential side-effects of the vaccine pose a greater risk than riding out the pandemic by hunkering down at home.

Dr Jason Wang, director at the Centre for Policy, Outcomes and Prevention at Stanford University, said one of the underlying reasons was the lifestyle differences between the US and Taiwan. 

While mobile American seniors had a “real sense of wanting to enjoy life,” the elderly in Taiwan tended to live more in multigenerational households, he said. 

“When I talk to the elderly in Taiwan, there is a sense of ‘let’s not go out too much, let’s be safe, and their kids want to shield them from the virus. The overall outlook on life for this age group is different between the West and the East,” he said. 

But observers say the darker side to the story is rife misinformation about unverified vaccine-related deaths and exaggerated reports about side effects that spread through social media and were hyped up by sensationalist 24-hour news channels, all of which has strongly influenced the older generation. 

“Taiwan’s media sometimes magnifies the adverse effects of the vaccines,” said Dr Wang. 

Professor Chan Chang-chuan from National Taiwan University College of Public Health agreed that misinformation and the politicisation of the vaccine rollout – when the government struggled with shortages last year - had led to confusion, and misguided views that certain brands were unsafe. 

Reopening the borders with the current lower rates of vaccination among the elderly would be “very dangerous,” he said. “Converting those percentages into real numbers, can reach about one million. That’s a huge amount of people without any antibodies.”

It could take months to shift out of a “zero Covid” mindset, he said, adding that the government needed to set an “age specific target” to vaccinate the elderly. 

The Omicron variant could be a gamechanger for Taiwan. 

“We don’t have a clear policy goal of living with the virus. We are still focusing on a zero-tolerance policy We thought we always can keep the virus away from Taiwan but the current Omicron variant has taught us it’s not easy so it is better to prepare earlier,” said Prof. Chan.

Globally, data has shown that widespread vaccination of the elderly has reduced severe disease, hospitalisations and deaths. 

Despite record daily infections topping 16,000 in nearby South Korea, a booster rate of 85% in the over-65s had prompted a drop in ICU occupancy, said Dr Jerome Kim, the director general of the International Vaccine Institute in Seoul.

A lower sense of urgency in Taiwan had perhaps lowered the demand for vaccines, he suggested. 

Dr Alex Cook from Singapore’s Saw Swee Hock School of Public Health, said many places in Asia with low vaccination uptake rates “had more successes in keeping the epidemic in check—for instance Hong Kong and Taiwan—which may have encouraged a fraction of the population to procrastinate.”

He added: “A final explanation is cultural attitudes, such as the notion that whether you will be infected is in the hands of fate or the gods, which can inculcate a fatalism about getting vaccinated.”

In Singapore, vaccination rates among the over-80s had finally reached more than 90% after a large Delta wave in August “helped convince some of the vaccine hesitant not to tarry any longer,” he said. 

As Taiwan rallies to keep out the Omicron variant, which has seeped in with tens of thousands of new arrivals for the upcoming Lunar New Year, senior officials have tried to gradually prepare the public for a mental shift. 

“We shouldn’t be afraid of living with the virus, and we must speed up increasing full vaccination coverage,” Chen Chien-jen, a popular former vice president and epidemiologist, wrote on Facebook this week. 

Dr Huang Li-min from Taiwan’s National University Hospital, believes a vaccination rate of more than 80% in this age group could help Taiwan “safely open the borders.”

Taiwan’s Centres for Disease Control (CDC) acknowledged that second dose vaccinations needed to be improved and said it was trying to increase accessibility and public health messaging.

It said gradual reopening of the border would be adjusted to the international situation, domestic vaccine campaign, and medical resources.

International businesses, pilots, foreign diplomats and the tourism industry have urged the government to find ways to co-exist with the pandemic. 

But the political case to disrupt the comfort levels of much of the population by reopening the border is difficult to make even among younger generations. 

Yang Zon Gru, 43, said he used to travel a lot for his petrochemical company, but the last two years had been a bonus for his family life as he could spend time more time at home with his new baby. 

“The reason why Taiwan still keeps the border closed is that the government saw last year's economic performance and they don't think it is necessary to reopen,” he said.

“We saw that Europe and the US opened their border and the spread of the pandemic has been increasing.”

He added: “For my personal life, I hope the border doesn't open this year..Give the world one more year, then the vaccination rate will be even higher.”

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