While epidemiologists closely monitor fast-rising Covid-19 infections to enable a rapid, efficient response to a fifth wave, vaccine hesitancy is becoming ever more entrenched, a recent survey shows.

The survey, by the University of Cape Town-based SA Labour and Development Research Unit, shows that the majority of the unvaccinated among 3608 South Africans interviewed between November last year and March this year want to remain that way. Few believe the vaccine is needed, or that it is effective. Anti-vax sentiment among the respondents has hardened between an initial survey conducted in November/December last year and a second in February/March this year.

According to research co-leader, Dr Brendan Maughan-Brown, when asked about their intentions to vaccinate, 36% said “definitely not” and 24% said “only if required. Only 18% in the second survey intend to get vaccinated “as soon as possible”.

“We observed a significant shift in intentions among the unvaccinated since our first survey, when the majority said either “as soon as possible” or “wait and see”. In Survey 2, when asked directly, only 29% thought they would be vaccinated by May 2022, which is significantly lower than future intentions stated in Survey 1,” says Maughan-Brown.

He adds that even high-risk groups such as respondents with chronic conditions are not more likely to want to be vaccinated than those without chronic conditions.

“Only 19% of respondents with a chronic illness intend to get vaccinated as soon as possible, and nearly 1 in 3 definitely do not intend to be vaccinated, a proportion only slightly lower than respondents with no chronic illnesses (37%),” he reveals. Several studies have shown that Covid-related mortality is predominantly among the unvaccinated.

The UCT survey shows that proximity to other vaccinated individuals, and positive beliefs in the efficacy and safety of the vaccine were strongly associated with higher rates of vaccination. Individuals who lived with a vaccinated person, and those who believed that the vaccine helps prevent death were more likely to vaccinate. Individuals who believed that the vaccine could kill were less likely to vaccinate.

 Access and incentives work

Co-leader of the study, Dr Katherine Eyal, said the findings also showed that “access and incentives are still important for vaccination. Nearly 60% stated a closer vaccination site, and nearly 50% stated after work or on weekends availability as one of the reasons for getting vaccinated. Almost 1 in 3 of the age-eligible (50-plus) for a Vooma Voucher reported that the shopping voucher incentive influenced their decision”.

Other, but less common, predictors of vaccination included seeing or becoming aware of others getting vaccinated; becoming aware of, or seeing first-hand, the negative health impacts of COVID-19; and a change in physical status, including improved health or no longer being pregnant or breastfeeding, she said.

Mandates boost vaccination

The research team also probed the likelihood of mandates increasing vaccination rates. Eyal said individuals got vaccinated to keep their jobs, and when looking for employment. The survey found that mandates had the greatest influence on decisions, with 1 in 5 vaccinated because of employment-related mandates, and 1 in 10 because of other mandates. Despite almost 1 in 2 respondents believing that mandates would work fairly or very well to increase vaccine coverage, Eyal said there is strong opposition to mandates among the vaccine hesitant.

She observed, “opposition is driven mainly by the belief that it is an individual’s right to decide to get vaccinated or not, with about 5% of those in opposition citing that the president said that vaccination would not be mandated. A further 15% were opposed because they believed that the vaccine is not needed, the vaccine may harm people, or the vaccine is not effective.”

Prof Barry Schoub, Chairperson of the MAC on Covid Vaccination, has told MedBrief Africa, that access, apathy, anxiety and conspiracy are the main drivers of hesitancy, but stopped short of ascribing apathy to government corruption and service delivery dysfunction. He dismissed anti-vaccination groups like Panda, labelling them a ‘very loud minority,’ adding; “any sensible person can see they’re mavericks.”

Fake news aggravates matters

Co-chair of the Ministerial Advisory Committee, (MAC), on Covid, Prof Koleka Mlisana, has complained that people contributing to fake news in the confusing Covid media milieu had stopped asking what value they were bringing, while many social and mainstream publishers were ‘just looking for hits.”

“The other interesting recent Medical Research Council, (MRC), finding on vaccine hesitancy which talks to how we can intervene is a lot of folks saying, ‘I’ll vaccinate if you do.’ This talks to people who have influence over others. So, the two top moves to decrease hesitancy I’d say would be to make sure the correct information is disseminated widely. This means identifying experts in communication who can turn around the message for the different levels of the population and communities. That’s critical. Then the second is to ask who brings that message, who are the influencers within communities, who do people listen to? (tailored to differing age groups for example). One thing government has done with some success is to create vaccination champions – ordinary volunteers who educate themselves and those around them. If you look at the HIV epidemic, the most successful education was done by those living with HIV, thus reducing stigma.

We need those who’ve been infected with Covid and were previously resistant to vaccination but have realised the benefits as these champions – from all walks of life,” she says.

Mlisana describes debating whether SA is reaching the right funding levels to mitigate Covid as a quixotic endeavour.

‘Use funds honestly and well,’ – Mlisana

“I don’t think we’ll ever get to the right funding level. There are too many issues. I mean, if we’re not able to appoint healthcare workers during a crisis, we can’t expect the vaccine programme to have enough funding. The question then becomes; even if funding is available, who is managing it? It’s critical that it is available and well managed. There was probably enough funding for PPE, but it did it get to the people?” she queried.

Prof Mlisana also told MedBrief that two of the most powerful non-Covid factors affecting the current lowest-ever vaccination uptake in South Africa are corruption and the lack of service delivery.

She said people were asking why they should trust a government that had failed to deliver services in 28 years of democracy. Besides this, corruption, especially around Personal Protection Equipment, (PPE), tenders, had resulted in a growing distrust in government – across race groups, she added.

Covid numbers on the rise

Dr Nicholas Crisp, Deputy Director General of Health and the man responsible for Covid containment told MedBrief on Friday, “the numbers are up. We have been watching carefully for two weeks and the devil remains in the detail. The next couple of days will tell us what to expect in the months’ ahead.”