Encouraging the elderly in China to receive the COVID-19 vaccine is the next necessary step

Since December 2021, the Omicron variant of severe acute respiratory syndrome coronavirus 2 has quickly spread throughout the world and has also mutated rapidly. According to the World Health Organization, the Omicron subtype BA.5 has become the dominant strain worldwide.¹ BA.5 has a strong level of immune escape and a high level of infectivity, which is likely to set off a new epidemic wave in the world. Data from 31 December 2021 to 6 July 2022 in Hong Kong showed that 95% of COVID-19 deaths occurred in people aged ≥60 years. Moreover, the fatality rate of the unvaccinated elderly was extremely high, and the fatality rate of people aged ≥80 years reached 16.32%.²

Safe and effective vaccination is important for controlling the pandemic and reducing the severity and fatality rate of COVID-19 infection. Although the proportion of elderly people vaccinated in China is increasing, it is still not ideal in absolute numbers.³ In many Western countries, the full vaccination rate of people aged ≥60 years is as high as 85–90%.³ In contrast, the vaccination rate of the elderly in China is relatively low, although these individuals are at high risk and are in urgent need of vaccination to boost their immunity.⁴ There are two main reasons why the vaccination rate of the elderly in China has not yet reach optimal levels. First, the elderly with underlying diseases often have safety concerns, such as the potential for serious side effects.³ It is reassuring that recent studies have proved the safety of the inactivated vaccine for patients with liver cancer.⁵ Other studies have also found that side effects of the COVID-19 vaccines were usually only mild to moderate in severity, with relatively short durations.² Second, the elderly have concerns regarding the effectiveness of the COVID-19 vaccine.³ However, the latest evidence has been very encouraging, showing that three doses of vaccine resulted in higher neutralising antibody levels than two doses of vaccine in people aged ≥60 years. The third/booster dose significantly improved the level of neutralising antibody against both the Delta and Omicron variants.²

Overall, as severe acute respiratory syndrome coronavirus 2 continues to mutate, unvaccinated people, especially the elderly, will be at greater risk. Recent studies have demonstrated reassuring findings to address the concerns of the elderly population regarding the COVID-19 vaccine. However, more combined efforts by healthcare workers, policy makers and the media to encourage the uptake of COVID-19 vaccination in the elderly and other at-risk populations, such as those with autoimmune diseases and cancer, are urgently needed to restore ‘prepandemic life’.