As COVID-19 resurges across China and millions are under lockdown, Yao Yuan worries for her elderly parents, who are still unvaccinated.
Ms Yao — who lives in China's "Silicon Valley", Shenzhen — said her parents were deterred by "fake news" on social media, which falsely claimed the vaccines were not effective nor safe, and could spread other serious diseases.
"They sent me the WeChat article. Obviously, it is fake news. [It has] no writer, no evidence, no reference," she said.
Because her parents live in Weifang, a city in northern China, without the vaccine's protection, Ms Yao is concerned about their safety in this new outbreak.
"The COVID-19 outbreak is continuing to grow in [their] city. My parents are asked to be self-quarantined at home," she said. "[They still] don't want to get vaccinated."
Her parents are not alone: According to the National Health Commission, last month more than 44 million people over the age of 60 years remained unvaccinated in China.
That is about 17 per cent of the older population, and the vaccination rates were lower for those aged over 80 years, with around half of that cohort still yet to receive two doses of the vaccine.
It has been reported that posts on the Chinese social media platform WeChat have been spreading the false claim that mRNA vaccines can integrate with a person's DNA and transform recipients into "genetically modified humans".
Misinformation, or disinformation, is not the only reason elderly people have been left in limbo, and some are unable to be vaccinated due to underlying conditions.
That's the situation Yan Zhiming's mother finds herself in, after she was diagnosed with lung cancer last year.
In her specific case, her local doctor advised her against being vaccinated while she was undergoing cancer treatment.
In Australia, immunocompromised people are strongly encouraged to get vaccinated, and to consult their doctor regarding timing if they are on immunosuppressants or undergoing chemotherapy.
Just like Ms Yao, Mr Yan and his mother live apart in different provinces.
He told the ABC that he was not too worried about his mother because she was living in a small city in western China where there were currently no confirmed cases.
"She is not too worried. She doesn't even leave the residential compound," Mr Yan said.
"When she needs to see the doctor, my father will take her straight to the hospital and avoid contact with others."
Why do China's elders have a low vaccination rate?
In November, the director of the development centre for medical science and technology at China's National Health Commission (NHC), Zheng Zhongwei, expressed concern about the millions of unvaccinated older people.
"It is like the population of a medium-sized country," he said.
Compared with Australia and other Western countries, China adopted a different approach, where the elderly population was not a priority group for the vaccine in the early stages of the pandemic.
Instead, China prioritised people aged between 18 to 60 years who were working in essential services, identifying them as more likely to be infected and spread the virus.
China started to roll out vaccines for people aged 60 and above only from March 2021.
George Liu — the China health program director at La Trobe University — said China didn't prioritise elderly people in the first place, due to a lack of scientific data.
"The vaccines developed in China were only tested in some developing countries outside of China because of the low prevalence of COVID-19 in China," he said.
Dr Liu also said that the low uptake of vaccines among China's elderly population was partly because of the country's zero-COVID environment and low COVID-19 death rate.
"Over the past two years, the elderly populations have been well protected," he said.
Why are China's cases rising?
But now the situation has changed. China is experiencing its worst COVID-19 outbreak in two years.
Although daily cases in China's recent resurgence are low compared with other countries, they are the highest the mainland has seen since the Wuhan outbreak.
Shanghai — the country's financial centre of more than 24 million residents — called on the public not to leave the city unless necessary, while Beijing has quarantined a village because of three new confirmed cases.
In Ms Yao's city, the Shenzhen city government summoned all officials and staff of state-run organisations to become community volunteers to help medical personnel curb the outbreak.
The city's health authority published a notice ordering all businesses — except those that supply food, fuel and other necessities — to close or work from home from this week.
"The resurgence is likely to be associated with the new variant, the surge of infections in Hong Kong, and higher population movements over the Chinese New Year holiday season," Dr Liu said.
Several Chinese cities have reported cases of people infected with the Omicron sub-variant BA.2, including Nanjing, where Mr Yan lives.
"I am not sure whether the booster shot can prevent it."
The sub-variant is believed to have caused the recent spike in cases in Sydney.
The World Health Organization (WHO) says studies have shown the BA.2 variant appears to be more transmissible than BA.1, but there is believed to be no difference in the severity between the two.
Will China's new strategy end its COVID-zero policy?
Since the local authorities have tightened control amid the latest outbreak, the national health authority is adjusting its COVID strategy to free up more medical resources.
In new guidelines released on Tuesday, the NHC said mild cases would not be sent to the hospital directly.
They will be isolated and monitored at designated facilities first and sent to hospitals if needed.
People who are critically ill or at high risk – such as the elderly and those with comorbidities – will be treated at specialist hospitals.
"People infected with the Omicron variant are mostly asymptomatic or light cases that do not require too much treatment, but admitting them all to hospitals takes up too many medical resources," the NHC said in a statement.
The NHC will also allow rapid antigen tests (RATs) for early detection, in addition to polymerase chain reaction tests (PCRs).
Previously, RATs were not legally sold for private use in China. Instead, the government supplied the test kits to the hospitals and communities where they were needed.
Dr Liu said the new policy changes were not abrupt shifts in China's COVID-19 strategy.
"I would see the approval of RATs as one step forward preparing for future challenges," he said.
"China always adopts an incremental approach in its health reforms and policy development.
"It can help avoid the panic of the public when China finally relaxes restrictions and adopts multiple strategies to mitigate the impacts of COVID-19."
