Is Immunization Still Necessary in the COVID-19 Post-pandemic Era: An Asian City’s Perspective for Asia

Abstract Hong Kong continues to face endemic waves of coronavirus disease 2019 (COVID-19) with substantial consequences for unvaccinated or under-vaccinated older adults and those with chronic medical and immunocompromised conditions. Low booster uptake among high-risk individuals remains a critical vulnerability. Periodic surges of COVID-19 activity occur approximately every 6–9 months in Hong Kong, primarily driven by newly emerging severe acute respiratory syndrome Coronavirus-2 variants and changes in herd immunity. Hospitalization rates, incidence rates of severe cases, and mortality rates remain significantly higher among residents of residential care homes for the elderly (RCHE) and the elderly aged ≥65 years. Local surveillance data show that the NB.1.8.1 variant (a descendant lineage of JN.1) is currently the dominant strain in Hong Kong, but NB.1.8.1 does not cause more severe disease. Members of the public are recommended to receive age-appropriate initial doses of COVID-19 vaccine from the respective vaccine manufacturers. The Joint Scientific Committee recommends COVID-19 booster vaccination in 2026 for RCHE residents; community dwelling elderly aged ≥65 years; persons aged 50–64 years with underlying comorbidities including individuals having chronic cardiovascular, lung, metabolic or kidney disease, obesity (body mass index [BMI] ≥30 kg/m 2 ), and those with chronic neurological conditions that can compromise respiratory function; persons with immunocompromising conditions aged ≥6 months and pregnant women. Healthcare workers may receive the COVID-19 vaccine for personal protection. Either the monovalent JN.1 vaccine or LP.8.1 vaccine is recommended as the vaccine choice in 2026. Hong Kong perspective on COVID-19 immunizations may serve as advocacy advice, especially for Southeast Asian countries.