In chasing zero Covid-19 infections, Hong Kong, Singapore, Australia and others have become trapped by their own success

As more transmissible variants emerge, places with very low infection levels must consider ever more stringent controls to maintain the status quo
A reluctance to accept the virus will become endemic and populations that see no urgency in getting vaccinated mean the early victors may be the last to reopen

Published: 10:30am, 8 May 2021

In places that have been successful in suppressing Covid-19, such as mainland China, Taiwan, Hong Kong, Australia, New Zealand and Singapore, there seems to be a reluctance to accept that the disease will become endemic.

The coronavirus variants that are emerging are more transmissible, so to achieve zero or close to zero infections in these places, health authorities say virus control measures must be more stringent than before.

This is neither wise nor tenable for much longer.

With highly effective vaccines available, health authorities in these places should be focused on rolling out mass vaccination quickly so as to achieve a degree of herd immunity. This would allow them to return to normality even if the virus continues to circulate at low levels, without overwhelming the health-care system.

The irony is that due to their successful suppression of Covid-19, these places are now finding it hard to roll out vaccinations quickly. With the threat of Covid-19 having mostly receded, their populations see less incentive to get jabbed.

There are a variety of reasons why these governments also often find it hard to accept that the virus will , eventually, circulate in their populations.

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First, they have expended significant resources and effort in suppressing Covid-19. The ‘sunk cost bias’ means these governments do not want to feel their previous efforts have been wasted; they are therefore more likely to persist with harsh suppression to maintain or achieve zero new cases than to accept, or adapt to, Covid-19 becoming endemic.

Second, governments are loss averse: they care more about avoiding losses than pursuing gains. In places where new cases are down to very low numbers, even one new case is considered a loss (hence, mainland China’s obsession with zero infections). Opening up the economy is viewed as a gain that is weighted much less. Related to this is that decision-makers have a diminishing sensitivity to ever larger losses. As economic losses mount, decision-makers may have become insensitive to them. But in the places that have had zero (or close to zero) cases, even a handful of new cases is viewed as unacceptable.

Third, there is the ‘status quo bias’. Now that suppression is the status quo in these places, it is very risky for officials to propose anything but a maintenance of, or quick reversion to, stringent measures whenever there is a spike in cases. If they fail to do this and the subsequent surge in cases reveals they had erred, they would be punished by an unforgiving public. Meanwhile, sticking to the status quo is virtually risk-free: even if they are found later to have been too risk-averse and should have loosened the restrictions earlier, no one is punished for excessive conservatism.

Members of the public sit at socially distanced intervals on a ledge in the financial district of Singapore. Photo: EPA

In the case of Hong Kong, there is also the pressure from the mainland authorities to achieve zero infections.

So what should be done? Given the strength of the biases highlighted above, it is not realistic to hope that these governments will change their minds any time soon. In some instances, these governments are advised by experts who prioritise elimination of the virus above everything else, making it even harder for officials to pursue anything other than the same, or even harsher, suppression measures each time there is an uptick in cases.

It is more realistic to ask these governments to step up their vaccination efforts and identify ways to reduce vaccine hesitancy among their populations. This is something most people can agree on, regardless of whether we think Covid-19 can be eliminated.

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In this regard, two things are worth emphasising. First, given public concerns over more transmissible variants, governments should use this opportunity to remind people that vaccination is the only way they can significantly reduce the risks of infection and severe illness.

Rather than focus on predicting the next wave (which is as pointless as counting waves in a sea), experts and policymakers should emphasise that the vaccines – which are also highly effective against the variants – are the best way to protect people. The Covid-19 vaccines are therefore more like seat belts and motorcycle helmets – we should all wear them for our own protection, all the more so if the risk of traffic accidents has increased.

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Second, if we accept that Covid-19 may become endemic – even if this is not a foregone conclusion – experts and policymakers would do well to modify their messages to the public. Already, people have a binary bias – a tendency to place information in one of just two categories, rather than see a spectrum of possibilities. In this instance, most people view Covid-19 as something that will either be eliminated completely or become a crippling disease that will overwhelm us completely. The middle scenario – of Covid-19 remaining with us for the foreseeable future, but not causing serious harm if most people are vaccinated – is not considered because it is hard for people to imagine.

What this means for experts and policymakers is that they should communicate this possibility, even if they still have to maintain suppression measures at this point in time. Failing to do so now would only lead to public cynicism and distrust later when other societies that have attained a level of herd immunity (either through mass vaccination or prior infections) are able to loosen domestic restrictions and open up their economies to travellers.

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Already, we are seeing members of the public in places that have done well to suppress Covid-19 show an unwillingness to accept any relaxation of measures that may put their health at risk. And if vaccination rates remain low, it will further jeopardise their economic reopening. If so, their earlier “victory” over Covid-19 would be a handicap.

Donald Low is Professor of Practice in Public Policy at the Hong Kong University of Science and Technology, and director of the university’s Leadership and Public Policy Executive Education