South Africa is currently facing a new wave of infections related to the much increased transmissibility of the omicron COVID variant and its sub-variants. The most recent spike has had similar characteristics to the fourth wave of January 2022: increases in infections have not been matched by similar increases in hospitalizations and deaths.
These changes present a challenge for policymakers trying to improve vaccine uptake, particularly in vulnerable groups. The people most vulnerable to severe illness with COVID include the elderly and those with underlying medical conditions.
The South African government has set a goal of vaccinating 67% of the population by the end of 2021. But the rates have fallen short. As of May 22, 2022, only 31.4% of the population had been vaccinated.
Understanding the depth of vaccine hesitancy and the factors behind the lack of uptake is critical to preventing more deaths, infections, and continued damage to the economy. Vaccine uptake is particularly crucial for the country due to the HIV prevalence rate of 13%, as well as the fact that it has the highest rates. Link of the incidence of TB and TB/HIV in the world. Both are known correlates of COVID-19 mortality.
We have been involved in research to understand levels of vaccination reluctance in the country in order to provide insights into how vaccine uptake can be boosted, particularly among high-risk groups.
Two surveys of unvaccinated South Africans have been conducted. The first took place from November 15 to December 15, 2021. The omicron variant had been announced a few weeks earlier. The second survey consisted of 3,608 unvaccinated people, of whom approximately half were interviewed again in Survey 1, as well as 386 people who were vaccinated between Surveys 1 and 2.
The data set cannot be considered a prevalence survey nor representative at the national level. However, it was a diverse sample with broad coverage on race, vaccine-eligible age categories, province, income levels, and geographic area.
We found that vaccine hesitancy in our sample was high and had taken hold since December 2021.
We also test the likely success of information and messaging campaigns, and how information should be framed and distributed. Understanding the precise drivers of vaccination reluctance is key to designing these interventions.
vaccine hesitation
Most of the people we spoke to did not want to get vaccinated. A small part was still undecided. Fewer than one in five intended to get vaccinated as soon as possible, half the number reported in December 2021.
More than a third definitely did not intend to get vaccinated.
A quarter of those surveyed said they would get vaccinated only if mandated to do so. Worryingly, those with chronic illnesses were no more likely to get vaccinated than others. Vaccine refusal was very high among older respondents. And we found that access did not figure at all as a reason for not getting vaccinated among the most reluctant (a large group).
Our results showed that it is imperative to spread awareness of the need for the vaccine, despite the current omicron context.
Few of the respondents we spoke to thought they needed the vaccine, and many cited very low personal risk of becoming seriously ill from COVID.
Many also thought that the vaccine does not work and that it could kill them.
Few thought that it would protect them against death.
Few people believed that the vaccine was safe for pregnant women, nursing mothers, or the chronically ill. And only one in four of our entire sample say they are very confident in government information about COVID-19.
A large number of respondents opposed a vaccination mandate (nearly 75% of the entire sample), although about half thought the mandates would work well. Opponents overwhelmingly cited that it was an individual’s right to decide, with some saying the president said vaccination would not be mandatory.
Next steps
Since mandates are likely to be used at work or school, with South Africa’s high unemployment rates, mandates may not substantially improve vaccination rates and will need to be approached with care.
Messaging campaigns are a tool often used to improve acceptance and are attractive due to their low-cost nature.
We tested two vaccine promotion messages—be part of the solution to end the pandemic or get vaccinated for greater freedoms—and found some small impacts on vaccination intentions.
The project also involved a proof of concept of testing policy messages and receiving results quickly.
Our results showed that targeted campaigns would be necessary among groups with higher hesitancy or risk.
The surveys allowed us to identify some key determinants of vaccination levels and established that political action should not stop after vaccination: increased communication should ensure that people return for boosters and share their positive vaccination experiences with others.
Fears about the safety of vaccines must be allayed, and improving belief in their efficacy is critical if vaccination rates are to increase. This information will have to come from innovative sources given the low confidence in government information on COVID-19.
This article is republished from The Conversation, a nonprofit news site dedicated to sharing insights from academic experts. The Conversation has a variety of exciting free newsletters.
It was written by: Katherine Eyal, University of Cape Town.
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Katherine Eyal does not work for, consult with, own shares in, or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond her academic position.
