HK's economic recovery depends on fully re-opening its borders, but it can't when so few have been vaccinated. With near-zero COVID, we must use other vaccination incentives. We propose a 4-pronged solution, including a VacciLottery and an inbound travel exemption.

How to end HK's border lockdown
27 April 2021

How are we going to get out of this mess?

After more than a year of closed borders and what should properly be called "anti-social distancing measures", and having once again driven COVID-19 to near-zero local cases through trace-test-isolate, the HK Government has yet to disclose any exit strategy from measures which are crippling its "World City" economy. Gone are the days of people flying in for the Rugby Sevens or for other international sporting events, trade fairs, exhibitions, arts festivals, pop concerts or just for plain business or tourism. Gone are the days of people flying out for a weekend in Phuket or Bali. Heck, you can't even visit the fellow SAR of Macau or the island of Taiwan, both of which have reached zero-COVID, and forget welcoming your friends and relatives to visit you in HK.

The HK Government expresses exasperation at the slow rate of vaccinations, but has yet to offer any meaningful incentive to vaccinate. With near-zero local infection rates, vaccines offer protection against a near-zero threat - what one might call a "nondemic", with a non-zero risk of side effects, including common, temporary but unpleasant aches or fever, and very rare but dangerous thrombosis. That is such a delicate balance between risk and reward that many citizens are taking a wait-and-see approach. The Government is stuck in a loop - keep the place clean, and a lot of people won't want the vaccine, but if we don't increase vaccination rates, then opening the border risks a surge of infections. So we have to change the incentives.

Hotel cross-infections - as we were saying

Meanwhile, returning residents, even if fully vaccinated, are subject to a draconian 21-day hotel quarantine (unless returning from the mainland, Macau or Taiwan) and umpteen tests: 1 before arrival, and several afterwards. This is the "price of zero" - a gross invasion of the Basic Law freedom of movement under Article 31, all to keep COVID out.

Other clean places have managed with 14 days' quarantine, and given the now clear evidence of cross-infections during hotel quarantine, a 21-day period actually increases the risk of hotel cross-infection by 50% as well as increasing the risk of releasing virus into the community when a cross-infected person leaves quarantine before testing positive. We warned about this in our article of 16-Mar-2021, and a clear case emerged in HK at the Ramada Hong Kong Grand Hotel, Tsim Sha Tsui, on 20-Apr-2021 when a person who had returned from Dubai and stayed on the same floor as 2 other cases tested negative on day 19 after arrival. He was released and then tested positive for COVID-19 when preparing to leave HK again, with a "highly similar" genomic sequence to the other cases.

3 days later, there was another case who had stayed at a different hotel, the Ramada Hong Kong Harbour View in Sai Ying Pun, in a room next-door to 2 imported cases which overlapped with her stay by 4 days. Hotel cross-infection was probably the cause of several post-release cases in 2020 when we had a 14-day hotel quarantine - hotels just weren't designed to be quarantine facilities, and those that fail should no longer be used - yet both of these hotels can still be booked for quarantine. Australia has suffered similar hotel leakages (one in Perth last week). The knee-jerk response to post-release cases should not be to add even more days to the quarantine period, as HK did at Christmas.

A pseudo-travel bubble, or a real one?

Yesterday's announcement of a so-called "travel bubble" with another near-zero place, Singapore, is tied up in so much red tape that it offers little incentive to go. You have to be fully vaccinated before leaving HK and even then, get a negative test within 72 hours before departure, another one on arrival in Singapore, another one before returning and yet another after arriving back, waiting at HK airport until tested negative. It's a pseudo-bubble.

Contrast that with the Australia-New Zealand travel bubble, between 2 other near-zero places. There's no requirement for vaccinations or testing - they have simply chosen to merge their two pools of low-risk populations, using aircraft and crews that travel only in the green-zone between them. That is a true travel bubble, like the one existing between Hong Kong Island and the rest of the HKSAR - we don't require people to get tested when they cross the harbour, despite the risk of cross-infection between the two internal populations. When you merge two pools of low risk, you get a pool of low risk - there's no reason to think that someone getting on a flight to Australia from NZ, or vice versa, has a higher risk of carrying the virus than someone crossing between the North and South Islands of New Zealand. They've got it right.

Even if HK wants to remain stuck at zero while the rest of the World opens up, we should at least have true travel bubbles with Australia, NZ, Singapore, Macau, Taiwan, Mainland China and any other place that has near-zero COVID, with no testing, no quarantine and no vaccination requirements.

Returning to open borders

Travel bubbles are not a long-term solution if the highly-externalised HK economy is to revive by returning to the pre-COVID travel era. What can we do to incentivise vaccination within HK and fully open our borders? Here is a solution:

  1. Allow test-free, quarantine-free travel into HK for people (including non-residents) from any destination on condition that the person has either (i) been fully vaccinated with a recognised certificate or (ii) tests negative on arrival and is either a child or has a medical exemption from vaccination. That would incentivise a lot of residents to get vaccinated so that they can smoothly travel in and out of HK as they did pre-COVID (the "Vaccinated Inbound Travel Exemption" or VITE, if you don't mind a quick bit of French).
  2. Accept that VITE will lead to a small number of inbound "vaccine breakthrough" infections, incentivising residents to get vaccinated sooner rather than later, leading to herd immunity among HK people when we hit around 70% vaccinations. Our hospitals can handle small outbreaks in the meantime. Maintain the trace-test-isolate system.
  3. Boost the vaccination drive by giving a free HKID-based lottery ticket to anyone who completes their vaccinations before we reach 70% of the adult population. Add HK$100 to the jackpot for each completed vaccination - so 100,000 people per week would generate a $10m jackpot, or 200,000 a $20m jackpot, and so on. Make the draw weekly, with a guaranteed winner from the HKID numbers who completed their vaccines in the prior week (no rollover - the jackpot resets to zero each week). 70% of the entire adult population of 6.5m would only cost about HK$455m - compared to over $87bn spent on the Employment Support Scheme. To be fair, start with a draw for those who have already completed their vaccinations. This "VacciLottery" would surely tilt the incentives in a unique Hong Kong way. We could further tilt it by reducing the amount of jackpot per vaccinated person each time we pass a vaccination milestone, to incentivise early takers (subject to capacity).
  4. Once we reach herd immunity, drop the requirement for inbound people to be vaccinated. Take highly-infectious measles as an example - we have herd immunity through vaccination, but we don't require people to prove that they have been measles-vaccinated when arriving here, and we can handle it when occasional clusters emerge from imported cases and fizzle out into a measly few cases (data from 2019 here, sorry about the pun).

Returning to open borders inevitably means handling occasional small outbreaks of COVID, but unless and until there is a strain robust enough to defeat all the available vaccines and harmful enough to justify border closure, we should never have to return to the border lockdown we have endured in the last year. Mainland China should of course adopt a similar track. Cutting itself off from the World by almost eliminating inbound and outbound tourism is not helpful for greater mutual understanding and geo-political stability. 

©, 2021

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