Background Effective risk communication about the outbreak of a newly emerging infectious disease in the early stage is critical for managing public anxiety and promoting behavioral compliance. China has experienced the unprecedented epidemic of the coronavirus disease (COVID-19) in an era when social media has fundamentally transformed information production and consumption patterns. Objective This study examined public engagement and government responsiveness in the communications about COVID-19 during the early epidemic stage based on an analysis of data from Sina Weibo, a major social media platform in China. Methods Weibo data relevant to COVID-19 from December 1, 2019, to January 31, 2020, were retrieved. Engagement data (likes, comments, shares, and followers) of posts from government agency accounts were extracted to evaluate public engagement with government posts online. Content analyses were conducted for a random subset of 644 posts from personal accounts of individuals, and 273 posts from 10 relatively more active government agency accounts and the National Health Commission of China to identify major thematic contents in online discussions. Latent class analysis further explored main content patterns, and chi-square for trend examined how proportions of main content patterns changed by time within the study time frame. Results The public response to COVID-19 seemed to follow the spread of the disease and government actions but was earlier for Weibo than the government. Online users generally had low engagement with posts relevant to COVID-19 from government agency accounts. The common content patterns identified in personal and government posts included sharing epidemic situations; general knowledge of the new disease; and policies, guidelines, and official actions. However, personal posts were more likely to show empathy to affected people (χ21=13.3, P<.001), attribute blame to other individuals or government (χ21=28.9, P<.001), and express worry about the epidemic (χ21=32.1, P<.001), while government posts were more likely to share instrumental support (χ21=32.5, P<.001) and praise people or organizations (χ21=8.7, P=.003). As the epidemic evolved, sharing situation updates (for trend, χ21=19.7, P<.001) and policies, guidelines, and official actions (for trend, χ21=15.3, P<.001) became less frequent in personal posts but remained stable or increased significantly in government posts. Moreover, as the epidemic evolved, showing empathy and attributing blame (for trend, χ21=25.3, P<.001) became more frequent in personal posts, corresponding to a slight increase in sharing instrumental support, praising, and empathizing in government posts (for trend, χ21=9.0, P=.003). Conclusions The government should closely monitor social media data to improve the timing of communications about an epidemic. As the epidemic evolves, merely sharing situation updates and policies may be insufficient to capture public interest in the messages. The government may adopt a more empathic communication style as more people are affected by the disease to address public concerns.

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Vaccine hesitancy can be heightened due to increasing negative reports about vaccines. Emphasizing the social benefits of vaccination may shift individual attention from individual to social benefit of vaccination and hence promote prosocial vaccination. In six rounds of a population-based survey conducted over one major community epidemic of coronavirus disease 2019 (COVID-19) in Hong Kong from June to November 2020, we manipulated the question asking about acceptance of a COVID-19 vaccine with or without emphasizing the social benefit of vaccination against COVID-19 (prosocial priming) and monitored the changes of vaccine confidence by news media sentiment on vaccines. Population-weighted percentages of accepting COVID-19 vaccines by priming condition and vaccine confidence were compared across survey rounds. Logit regression models assessed the main effect of prosocial priming and the modification effects of vaccine confidence and perceived personal risk from COVID-19 on acceptance of COVID-19 vaccines. We found that prosocial priming significantly increased acceptance of COVID-19 vaccines across all survey rounds except for Round 3 when incidence of COVID-19 reached a peak. Vaccine confidence significantly declined in Round 6 when news media sentiment on vaccines became predominantly negative. The effect of prosocial priming on promoting vaccine acceptance was significantly greater in participants with low vaccine confidence and those perceiving the severity of COVID-19 to be mild/very mild. Our study suggests that packaging vaccination against COVID-19 as a prosocial behaviour can help overcome low vaccine confidence and promote prosocial vaccination particularly when disease incidence temporarily declines and the public perceive low severity of COVID-19.

T he coronavirus disease (COVID-19) pandemic disproportionally affects socially disadvantaged populations because of economic, social, and demographic factors, as well as their health conditions and practices (1). Identifying vulnerable communities and effectively allocating ameliorating resources to them are necessary if policy makers are to manage the effects of COVID-19. Community vulnerability indexes (CVIs) have been increasingly used to assess community social vulnerability to a pandemic using community-level socioeconomic and demographic data (2-7). In the United States, greater CVI and vulnerability in domains of minority status, household composition, housing, transportation, and disability at the county level were signifi cantly associated with greater risk of COVID-19 diagnosis (3,4). We aimed to construct a CVI more socioculturally adapted to metropolises in Asia to explain the impact of COVID-19 across more microgeographic units (i.e., districts) within a highly urbanized city, Hong Kong, China. We also analyzed the extent that CVI was correlated with the evolution of the COVID-19 pandemic in Hong Kong. The StudyHong Kong has long been regarded as an epicenter for many infectious diseases and is predisposed to severe COVID-19 impact because of its dense and rapidly aging population (8,9). Geographically, Hong Kong comprises 3 main regions, New Territories, Kowloon, and Hong Kong Island, which are further subdivided into 18 administrative districts (10). As of August 31, 2020, Hong Kong had experienced 3 waves of COVID-19 (Appendix Figure 1, https:// wwwnc.cdc.gov/EID/article/27/7/20-4076-App1. pdf), reporting 4,811 COVID-19 cases, including 89 deaths; 76.5% of cases occurred in wave 3 (11).Following methods used by the Surgo Foundation (6), we fi rst defi ned 5 domains that contributed to an overall CVI: socioeconomic status, household composition, housing condition, healthcare system, and epidemiologic factors. We included 22 indicators in the 5 domains for calculating domain CVI and overall CVI (Table 1). We fi rst ranked each indicator by district, with a higher rank indicating greater vulnerability. Then, we calculated the percentile rank of each district over each indicator using the formula of percentile rank = (rank -1)/(n -1), where n refers to total geographic units (n = 18). A higher percentile rank indicates greater relative CVI of the district over the specifi c indicator. We then summed the percentile ranks over all indicators within each domain, reranked them to calculate domain CVIs, and summed the percentile ranks of all domains to calculate an overall CVI for each district. We assumed equal weights for indicators within domains and for the 5 domains within the overall CVI because of a lack of available evidence informing a more optimized weight scheme. Finally, we categorized all districts into very high (>80%), high (60%-80%), moderate (40%-60%), low (20%-40%), and very low (<20%) vulnerability on the basis of their domain and overall

OBJECTIVES Older adults have been disproportionately affected by the COVID-19 pandemic. While COVID-19 vaccines are effective for reducing mortality and severe complications, vaccine hesitancy remains a substantial concern particularly among older adults. This was a qualitative study to explore how Chinese older adults reached a decision to delay or refuse the COVID-19 vaccines in Hong Kong. METHODS Semi-structured in-depth interviews were conducted with 27 older adults aged ≥60 years who had never received COVID-19 vaccines. Grounded Theory approach guided the selection of informants, data collection, data analysis and report writing. RESULTS Older adults’ vaccine hesitancy and resistance weaved into the context of lacking sufficient decisional support and attitude roots of negative perception of ageing, fatalistic risk attitudes, present-oriented time perspectives, and negative values on western biomedicine. Attitude roots were used as decisional anchors to further shape older adults’ peripheral processing of vaccine-related information, resulting into a spectrum of vaccine-resistant and vaccine-hesitant attitudes. While participants refused or delayed COVID-19 vaccination, they engaged in alternative coping strategies to regain self-control and justify their vaccination disengagement in the pandemic. DISCUSSIONS Interventions to address vaccine hesitancy in older adults should focus on addressing attitude roots and strengthening the connectivity of older adults with family, doctors, and government to engage older adults in the vaccination decision making. Risk communication should shift to provide more personal relevant information in a caring style, meet older adults’ preference for peripheral information processing, and address their existing misperceptions about COVID-19 vaccines.