On February 26, South Korea began its cautious vaccine rollout. The first to be vaccinated were frontline medical workers and those patients and residents in nursing homes and medical facilities who were under the age of 65. By March 11, over 500,000 people—that’s 67% of those targeted in this first round—had been given the first of their two doses of either the AstraZeneca or the Pfizer vaccine. Progress has therefore been quite fast, partly thanks to the publicly-run infrastructure of community health centers throughout the country.
Given the efficient progress of the rollout and very few cases of adverse side effects being reported, vaccine skepticism, though still simmering, is no longer making headlines. For months though, fears of unknown side effects, sensationalized media reporting, and politicization of the issues threatened to slow down and even sabotage the whole vaccination program. But skepticism may again rear its head once the general population begins to receive their vaccinations. Now is therefore a good time to explore how Covid-19 vaccination has been framed and discussed so far, in the media and by the general public.
Public discourse on Covid-19 vaccines in South Korea really took off after the Pfizer vaccine became the first in the world to be approved and the United Kingdom vaccinated its first citizen on December 8. As the United States, Germany, and others started their inoculation programs, Korean media outlets began questioning why South Korea was late into the “vaccine war” and calling it an “underdeveloped” country as far as vaccinations go. On December 8, the government announced that it had secured vaccines for 44 million Korean citizens through the global COVAX facility, AstraZeneca, and others, and that it would begin the rollout some time in February and March of 2021. But there were still questions being asked about why Korea did not nail down acquisition of the more effective vaccines (produced by Pfizer or Moderna) earlier. This criticism also coincided with the third wave of Covid-19, which hit the country in the winter and raised the average number of daily new cases from the hundreds to over a thousand in a matter of weeks. Was the Korean government so intoxicated with the success of the “K-bangyeok” (Korea’s response to Covid-19) that it was unwilling to heed the advice of the disease specialists on the need for vaccines?
It certainly seems that in the summer of 2020, when Korea’s Covid-19 vaccine taskforce was first launched, vaccine acquisition was less of a priority than investment into testing and tracing, and research into treatments. Prime Minister Chung Sye-kyun admitted as much on December 20, as criticism mounted. While other countries invested heavily and at an early stage into vaccine development, partly due to their high numbers of cases and deaths, South Korea was seeing daily averages of new cases only in the hundreds, a rate which existing hospitals and quarantine centers were able to handle. The government was also cautious to weigh up the cost of the vaccines against their effectiveness and safety. In his start-of-year press conference on January 18, when President Moon Jae-in was asked if he regretted not proceeding faster, he responded that Korea’s vaccine acquisition had been fast enough. The decision not to put all eggs in one basket was taken in order to hedge against the risks of low efficacy and side effects, and it also made sense to stagger the supply over several months, given the limited expiration dates of the vaccines.
Questions about the AstraZeneca vaccine
By the end of January, the government had acquired enough doses to vaccinate 56 million citizens—sufficient for the entire population. It was announced that the Oxford-AstraZeneca vaccine would be the first to be rolled out, in late February, and that ten million doses of this were being produced in South Korean facilities. While the vaccine has been found to be only 62% effective, it uses the more familiar viral vector technology, and is less costly to acquire, deliver, and store than the new mRNA-based vaccines produced by Pfizer and Moderna. Concerns about its efficacy continued, however. The US FDA has yet to approve the vaccine due to inconsistencies in the trial stage and a lack of data on the elderly. Korean media outlets continued to report that the AstraZeneca vaccine was only 8% effective on the elderly, despite corrections that the 8% referred not to efficacy but to the percentage of participants in the trial who were aged between 56 and 69. But it was the more recent news that some European countries had decided not to give AstraZeneca vaccines to the elderly which was one of the major reasons why the Korea Disease Control and Prevention Agency (KDCA) also decided to hold off on administering the vaccine to those over age 65, despite cautious approval for that age group by the Ministry of Food and Drug Safety, until more results were out in other countries.
The decision to put off vaccinating the elderly has received much criticism from disease specialists, who emphasize that we are racing against time before the fourth wave arrives and the virus variants begin to spread. Unlike other European countries, at this early stage of inoculation in Korea we have very few choices of vaccine available, other than the AstraZeneca. The decision makers seem to have reasoned that public perception and trust in vaccine safety and efficacy were the more important factors in ensuring the success of the vaccination project. Then again, this decision not to vaccinate the elderly has also been used as evidence that perhaps there really is a serious issue with the vaccine.
Media reports fueling vaccine skepticism
Inaccurate or incomplete reporting and sensationalist headlines on the supposed inefficacy of AstraZeneca’s vaccine are just some examples of how the media has swayed public opinion. Government and health experts are also concerned that last fall’s flu vaccine scare may be repeated.
To be clear, there were a few legitimate problems with the storage of some doses of last year’s influenza vaccine, which eroded trust in the government-administered vaccines to some extent. But news reports over several consecutive days tallying the number of people who had died after getting the vaccine spread fears that the deaths were somehow the direct results of vaccination. Despite explanations that most of the deceased had clear preexisting conditions that had more directly led to their deaths, and that they showed little evidence of abnormal reactions to the vaccine, the headlines were enough to sow plenty of distrust, and perhaps partly caused the flu vaccination rate of 2020 to fall to one fifth of that of 2019.
This is perhaps why the government, not wanting to risk yet another spate of reporting on deaths after vaccination, decided to delay vaccinating the elderly, who are more likely to have preexisting conditions. Nevertheless, it has now been announced that vaccinations will soon begin for this age group as well. It is quite likely that a similar scenario to last year’s will play out again and the elderly, who are more likely to lean politically conservative, may be more distrustful of the progressive government’s initiative. Already in January, the Korean media have published headline after headline counting the growing number of people who have died after getting the Pfizer vaccine in Norway. No evidence has been found to link the vaccine to the deaths of these elderly residents of nursing homes. More recently, the KDCA also announced that they had found no direct causal link between the deaths of eight people in Korea and their AstraZeneca vaccination. But once the headlines are seared into the public consciousness, much more effort is required to change hardened perceptions.
Where we go from here
Korea’s vaccination plan has Janssen and Moderna vaccines next in line to start being administered in the second quarter and Pfizer vaccines in the third, though some Pfizer vaccines have already arrived through the COVAX facility and are being given to healthcare workers. The Novavax vaccines will also be distributed in the second quarter. According to the latest schedule, the plan is to vaccinate 12 million citizens in the first and second quarters of this year. People over the age of 65 in nursing care facilities, whose vaccinations had initially been delayed, will start to be vaccinated in late March. Regular citizens over 65 will be next in line, in the second quarter, starting with the oldest age group, those over age 75. Flight attendants on international flights, school nurses, and teachers in special education schools will also be included in the second quarter. Other adults with preexisting conditions and the rest of the adult population will follow in the third and fourth quarters. The government is expecting an 80% vaccination rate among the target demographic, which means those next in line may in fact be shifted up the schedule and receive their vaccinations earlier. The general strategy is to start administering the first dose to everyone now rather than waiting for sufficient supplies to arrive to ensure two doses each. The best case scenario is to have enough of the population vaccinated by the Chuseok holiday in September that families can finally visit each other freely.
It remains to be seen whether the rollout will go as planned. Was Korea wise to wait on the vaccine rollout, given the threat of a fourth wave and the more contagious variants circulating in neighboring countries such as Japan? Inoculating a sufficient proportion of the population before that happens will be critical to preventing saturation of the medical system.
Korea might also be hit with similar problems in supply and delivery as those seen in other countries. In certain countries, the delays in supply have prompted some experts to suggest delaying the second dose, giving half-doses, or mixing vaccines. Issues with supply have also increased political tensions between the UK and the EU. Considering the pretty efficient system of testing, tracing, isolation, and treatment in Korea thus far, the government may not have much trouble with distribution once the vaccines arrive. But the international supply chain is another matter.
Media reporting and social media will be critical variables affecting public anxiety and demand for the vaccines. According to a survey by Kstat Research in January, commissioned by the Seoul National University Graduate School of Public Health, 80.3% of the participants responded that they would “certainly” or “probably” get the Covid-19 vaccine, and only 1.8% would “certainly not” take the vaccine. So, despite anxieties and caution, the Korean public seems ready to be vaccinated. However, despite the overwhelmingly positive response, only 37.8% of the survey participants said that they would volunteer for a vaccine as soon as possible, with 59.9% preferring to wait and see that they were safe. Public opinion and the degree of willingness to be vaccinated may sway further depending on how the process is reported in the right and left wing media.
The respondents in the survey also showed high levels of trust in the medical experts (80.7%), healthcare institutions (77.1%), and the KDCA (73.5%), though “people I know” ranked second in trust with 79.8%. Acquaintances and social media influencers have been spreading disinformation on Youtube, in chat rooms, and other social media. A factor that exacerbated the mass transmission clusters of Covid-19 in some extremist Christian groups, like Sarang Jeil Church in August last year and the BTJ Yeolbang Center in January, was their circulating of conspiracy theories claiming that the virus had been planted to terrorize the church, or that the vaccine has been developed by a shadowy global force and Bill Gates to enslave the vaccinated. The government is trying to address these issues by monitoring, blocking, and deleting misleading videos and posts and conducting police investigations where necessary.
Finally, while there were some spats between conservative and progressive politicians over whether or not the president should be the first to be jabbed to prove the vaccine’s safety, the issue is no longer so inflamed in the political arena. But there is still a chance that the Covid-19 response and vaccination program may be politicized in time for the Seoul and Busan mayoral races in April and for the presidential race next year.