Only half of Chinese people aged 80 and older are fully vaccinated against COVID-19, highlighting a key vulnerability as the country grapples with its worst outbreak since Wuhan and the prospect of reopening to the world.

About 51% of over-80-year-olds have received two shots and some 20% have gotten boosters, health officials told reporters at a briefing in Beijing Friday. While 87.9% of China’s 1.4 billion people have been vaccinated with two shots — a high percentage globally — the numbers decline with age, with the figure dropping to 82% for those between 70 and 79.

Of the 264 million Chinese aged above 60, 52 million are yet to be fully vaccinated, officials said.

It’s the first time China has fully broken down its elderly vaccination numbers, and they’re concerning. They show the country is at risk of a situation like Hong Kong’s, where an even larger proportion of elderly people is unvaccinated — some 63% of those over 80.

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Elderly people have accounted for more than half the city’s deaths in the current COVID-19 wave, its worst of the pandemic with new cases now in the tens of thousands each day. Nearly 5,000 people have died in Hong Kong since early February, up from less than 300 at the start of the year.

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The data comes as President Xi Jinping pledges to adjust China’s COVID-fighting approach so that it’s less disruptive to the economy. Beijing is trying to walk a line between maintaining the curbs that keep the virus out — and have delivered China one of the lowest COVID death rates — while keeping the engines of growth firing as the rest of the world opens up.

The numbers also show why China is reluctant to ease its strict COVID Zero strategy just yet, with lockdowns, border curbs and mass testing being increasingly deployed in the world’s second-largest economy as a series of omicron clusters from Shenzhen in the south to Jilin province in the northeast flares.

Besides its low vaccination rate among the elderly, China faces an under-resourced hospital system, raising questions over whether it could handle the surge in cases and deaths that could ensue from letting the virus circulate. There are also concerns about the locally developed vaccines universally deployed throughout the nation, which have been found to be less effective than the mRNA shots used prevalently in the United States.

While most Western countries and others in Asia prioritized vaccinating elderly people first, there has been some hesitation in Hong Kong and China. In South Korea, for example, more than 90% of those 80 and older have had two shots and almost 85% have gotten boosters. About 86% of people 75 and older are fully vaccinated in the United States.

Zeng Yixin, deputy head of China’s National Health Commission, said the country is trying to bolster the elderly vaccination rate. Officials are reaching out to key groups and nursing homes to talk about concerns around the safety of the vaccines and their impact on any underlying diseases.

In Hong Kong, some seniors were initially advised to avoid COVID-19 shots if they had any other health conditions, advice that seems to have been prevalent in parts of the mainland too.

Many elderly people on both sides of the border also didn’t feel the need to get vaccinated last year, confident that travel curbs, contact tracing and other COVID Zero policies would continue keeping cases at a minimum. That complacency left Hong Kong’s seniors exposed when omicron pierced the city’s defenses.

Unlike other countries that started their vaccination efforts with elderly people and those with weak immune systems, China initially focused on essential workers such as health professionals, leaving the old among the last holdouts when close to 90% of the 1.4 billion population is fully vaccinated.

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