One of the Covid-19 pandemic’s few success stories, Hong Kong entered February having recorded just 213 deaths from the virus. In a few short weeks, that figure has skyrocketed to almost 4,000.

The crisis in the special administrative region peaked on 11 March, with 294 deaths recorded in a single day. At 39 deaths per million residents, that is far worse than the pandemic’s peak in any other territory of comparable size. In the UK and the US, for instance, daily deaths per million people peaked at 27 and 13, respectively.

Like the rest of China, Hong Kong’s government pursued a zero-Covid strategy. That has meant very low rates of infection throughout the pandemic, but also very little natural immunity in the population. 

Health authorities might have hoped that the roll-out of vaccines would give citizens enough immunity to fight off the virus. Approximately 72% of Hong Kongers are fully vaccinated, similar to rates in the US and UK. 

However, uptake has been notably low among elderly residents, who are most vulnerable to serious infection. Uptake among over-80s is just 30%, according to the Financial Times

The problem with vaccine complacency

Health researchers are warning that “vaccine complacency” appears to be an unintended side effect of the successful containment strategies seen in East Asia and Oceania. In Taiwan, which has seen just 853 Covid-19 deaths since the start of the pandemic, just 69% of over-75s are vaccinated, compared with 89% of young people.

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While Hong Kong’s crisis is real, the fact that its spike in deaths was so sudden and severe compared with other territories is partly a result of its small size. 

Epidemics in large countries such as the US, Russia and Brazil rise and fall more slowly because they consist of a series of flare-ups in particular cities and regions. When a territory consists entirely of a single city, its waves are likely to appear much more dramatic.

Hong Kong’s recent peak is only the 11th worst since the pandemic began. Notably, the top ten were all in extremely small territories.