Why is it necessary to improve COVID-19 vaccination coverage in older people? How to improve the vaccination coverage?

ABSTRACT

In accordance with the COVID-19 surveillance data from Hong Kong, over 95% fatal cases were elderly patients aged ≥60 years, and the median age of the dead cases was 86 years in the fifth COVID-19 wave. COVID-19 case fatality rates increased with age, vaccinations offered notable protection against COVID-19 death, and the protection was enhanced as the doses of vaccinations increased. The data fully demonstrated that elderly people were the main group of victims in the COVID-19 pandemic, and the vaccination was a vital weapon against COVID-19 in elderly people. In light of the experience of China’s COVID-19 response, the measures to improve COVID-19 vaccination coverage in older people were shown as follows: dispatching volunteers into residential communities to urge older people to complete COVID-19 vaccinations; ascertaining the vaccination status of elderly people suffering from underlying diseases; mobilizing various public institutions to participate in COVID-19 response; releasing a great deal of news via mass media every day to educate the elderly about COVID-19 prevention and control measures; assisting elderly people in rural and remote areas through drug distribution and emergency reserves.

To the editor

The Joint Prevention and Control Mechanism of the State Council, as a Chinese central government organization for COVID-19 response, announced new 10 measures to adjust prevention and control measures against COVID-19.¹ Since then, the dynamic zero-COVID-19 policy has been practically abrogated. In accordance with previous experience, the Chinese government realized that elderly people were the main group of victims in the COVID-19 pandemic, and elderly people were the key to ending the dynamic zero-COVID-19 policy. The vaccination is the most important weapon against COVID-19 in elderly people, because the vaccination effectively prevents progression to severe COVID-19, protects individuals from severe illnesses and complications from COVID-19, and markedly reduces COVID-19-related mortality.²

For instance, over 95% fatal cases were elderly aged ≥60 years, and the median age of the dead cases was 86 years in the fifth COVID-19 wave from December 31, 2021 to January 29, 2023 00:00 according to the COVID-19 surveillance data from the Center for Health Protection of the Department of Health, Hong Kong (https://www.chp.gov.hk/sc/index.html). A total of 13,115 COVID-19-associated deaths occurred in the fifth wave, and more than 90% of the deaths were with known chronic diseases. Here, the COVID-19 death case was defined as that a case died within 28 days of the first positive specimen collection day. As shown in Figure 1, COVID-19 case fatality rates increased with age, vaccinations offered notable protection against COVID-19 death, and the protection was enhanced as the doses of vaccinations increased. In addition, in accordance with the COVID-19 surveillance data during September 1, 2022 to October 15, 2022 from the Ministry of Health, Singapore (https://www.moh.gov.sg/covid-19/statistics). In people aged 60–60 years, 70–79 years, and over 80 years without minimum protection, the case fatality rates were 0.19%, 0.29% and 2.5%, respectively. The case fatality rates were decreased to 0.014%, 0.064% and 0.54% in those people with minimum protection. The minimum protection referred to vaccinating three doses of Pfizer-BioNTech/Comirnaty, Moderna/Spikevax, or Novavax/Nuvaxovid as well as four doses of Sinovac-CoronaVac. These data fully demonstrated the importance of COVID-19 vaccinations in elderly people.

Figure 1.

COVID-19 case fatality rates divided by age groups and vaccination status during the fifth wave in Hong Kong. The COVID-19 case data were reported from December 31, 2021 to January 29, 2023 00:00. It is counted based on the date of case reporting of each reported case with respect to the date of vaccination to arrive at the time interval. This additional counting method for ‘no. of vaccine doses received’ is implemented starting from 7 April 2022, including all retrospective data. People who were unvaccinated included the people who have received 1 dose but not yet reached 14 days. People who received 1 dose, 2 doses, 3 doses, and 4 doses of COVID-19 vaccines have reached 14 days.

The Chinese government has long been committed to promoting COVID-19 vaccinations in elderly people. Before the abolishment of the dynamic zero-COVID-19 policy, the government frequently dispatched Communist Party volunteers into residential communities to urge older people to complete COVID-19 vaccinations. As a member of the Communist Party of China, I have participated in the voluntary service activities many times during 2020–2022 (Figure 2a). In the activities, the vaccination must adhere to principles of voluntariness.

Figure 2.

China’s efforts to promote vaccination in elderly people. (a) The author as a volunteer entered into residential areas to persuade elderly people to complete vaccinations. The COVID-19 vaccination coverage of people aged ≥60 years in the Chinese mainland as of November 28, 2022 (b) and December 12, 2022 (c).

On November 29, 2022, the Joint Prevention and Control Mechanism issued a government document entitled “A work program to enhance COVID-19 vaccination coverage in older people.” The objective of the work program was to accelerate to improve COVID-19 vaccination coverage in people over 80 years and continue to increase COVID-19 vaccination coverage in people aged 60 ~ 79 years.² As of November 28, 2022, there were 264 million people aged ≥60 years in the Chinese mainland, covering 18.7% of the total population, and the COVID-19 vaccination coverage was shown in Figure 2b. On the whole, the vaccination coverage in elderly people aged ≥60 years was high. In addition, the work program shortened the time interval between the second dose of vaccine and the third dose of vaccine (updated booster) to 3 months.²

After the end of the dynamic zero-COVID-19 policy, the focus of COVID-19 response was transferred from zero COVID-19 cases to the prevention and treatment of severe COVID-19.³ The government released a great deal of news via mass media every day to educate the elderly about COVID-19 prevention and control measures, and the main measures were shown as follows: avoiding outings as much as possible, especially going to closed places where people gather; wearing a mask correctly when an outing was necessary; staying away from people with fever and cough, and trying to live apart from family members or caregivers with fever and cough; keeping air circulating in the home by opening windows for half an hour two to three times a day; avoiding direct contact with external objects, washing hands frequently, and paying attention to hand hygiene; elderly people suffering from chronic diseases should prepare regular medications, take medications on time, minimize the times of visits to the doctor, and their family members could get medications on behalf of them.⁴

Elderly people as well as patients with underlying diseases have been the focus of attention since the end of the dynamic zero-COVID-19 policy. The access to nursing homes and welfare homes required a COVID-19-negative test, despite the fact that most of places had abrogated the limitation. The government ascertained the vaccination status of elderly people suffering from underlying diseases, including cardiovascular disease, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), diabetes, chronic kidney disease, cancer, immune deficiency, and other diseases, and promoted the implementation of graded and classified management based on the ascertained results. In addition, the government mobilized various public institutions to participate in COVID-19 response, and the public institutions included urban and rural grass-roots medical and health institutions, residents’ committees, and public health committees.⁵

People in rural and remote areas, especially elderly people in rural and remote areas, should be paid special attention, due to poor health outcomes and medical conditions. To address the concern, China make great efforts to assist these people through drug distribution and emergency reserves. The government and community workers delivered care packages containing ibuprofen and other medical supplies to older people living alone. Rural doctors also contributed a lot in the assistance to elderly patients who have walking difficulties. In addition, e-commerce platforms enabled more than 200 million COVID-19 patients to access medical supplies without outings, and most of the benefited patients were in remote rural areas.⁶

On December 12, 2022, the COVID-19 vaccination coverage in people aged ≥60 years were slightly improved compared to that on November 29, 2022 (Figure 2c).⁷ Despite the high vaccination coverage, a total of 59,938 COVID-19-related deaths occurred in medical Institutions between December 8, 2022 and January 12, 2023. Of whom, about 90.1% were aged ≥65 years, about 56.5% were aged ≥80 years, and the average age at the time of death was 80.3 years.^8,9 Moreover, 5,503 patients died of COVID-19-induced respiratory failure, and 54,435 patients died of underlying diseases accompanied by COVID-19 infection.⁹ It also demonstrated that elderly people were the vulnerable population during the COVID-19 pandemic. With regard to the accumulative COVID-19 infection rate in the Chinese mainland as of January 12, 2023, no authoritative data have been published up to now. Here, the Henan Province was taken as an example, the Henan Province government announced that the accumulative COVID-19 infection rate as of January 6, 2023 was 89%.¹⁰ Considered from this point, the death number (59,938) was much less than the number predicted by American experts,¹¹ on the basis of the fact that most of critical COVID-19 patients would be sent to hospitals for emergency treatment.

Funding Statement

The author(s) reported there is no funding associated with the work featured in this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Ke-Wei Zhu is the sole author of the article.

Data sharing statement

The datasets supporting the conclusions of this article are included within the article.