Mikhail Moosa argues two recent surveys showed there is support for vaccination, but there needs to be an improved supply of Covid-19 vaccines to rural and township areas and a targeted approach to reaching older South Africans.

Scepticism of vaccines is as old as vaccination itself.

When the British government introduced mandatory smallpox vaccination in the 19th century, sceptics formed anti-vaccination organisations and claimed the cure was worse than the disease.

Nearly three centuries later, during the Covid-19 pandemic, marches and demonstrations against vaccination have occurred around the world, using the same slogans.

But not all those who are concerned about the Covid-19 vaccine are against vaccination. On a spectrum of pro- and anti-vaccine, many people lie in the middle of the scale, somewhere between uncertain and hesitant.

In South Africa, the first signs of vaccine hesitancy among the population are beginning to show.

The number of daily inoculations has never reached the target of 300 000 set out by the president and attendance at vaccination sites has waned each time before new age categories are eligible.

At the beginning of September, only 15% of South Africans had been fully vaccinated against Covid-19, and many over the age of 60 have yet to receive their jab.

The government’s decision to expand eligibility for the Covid-19 vaccine to include young adults may have been a boon for daily doses and social media engagement, but it should also be a concern for the success of the vaccination programme.

South Africa’s public vaccination efforts have been commendable over the last few months, but will the government be able to reach enough people to remove social restrictions?

Public opinion on vaccines

Three main surveys provide credible insights into the scale of vaccine hesitancy and uptake in South Africa.

Each has a different methodology, sampling method and questionnaire design, so they are not directly comparable. But each survey helps to paint a picture of national opinion at one point in time.

The latest available public opinion survey on vaccination was conducted by researchers from the Human Sciences Research Council (HSRC) and University of Johannesburg.

Their survey, conducted via the Moya Messenger app in multiple languages between June and July 2021, found 10% of adults had been vaccinated already, 49% said they would definitely get the vaccine, and a further 12% said they would probably get the vaccine. The report sums these responses to claim vaccine acceptance is more than 70%.

READ | Vaccine hesitancy: Researchers find side effects a key concern, highlight need for right messaging

These findings are in line with an earlier telephonic panel survey conducted by researchers with the NIDS-CRAM survey in April and May 2021.

When asked to agree or disagree with the statement, “if a vaccine for Covid-19 were available, I would get it”, 64% of respondents strongly agree, 10% somewhat agree, and a further 2% said they had already been vaccinated. This survey suggests nearly three-in-four South Africans would want to be vaccinated.

Finally, the Afrobarometer survey, conducted via face-to-face interviews across the country in multiple languages in May and June 2021, revealed a much more negative response to vaccines.

Researchers found only a minority of South Africans were in favour of vaccination, with one-in-four respondents saying they were very likely to get vaccinated, while a further 18% said they were somewhat likely.

The question asked by Afrobarometer differed substantively from the other surveys, as it asked respondents to suggest their likelihood of being vaccinated with the explicit proviso the government says the vaccine is safe. The more negative response to vaccination can also be understood as a negative sentiment of trust in the government.

Public opinion is highly susceptible to change, especially on new and much-publicised topics such as the Covid-19 vaccine.

These surveys are not crystal balls. They cannot precisely predict how many South Africans will be vaccinated, but they are useful in providing a snapshot of public opinion during a particular time.

Reasons for hesitancy

Most people who are not in favour of being vaccinated are those who are hesitant about the process, not fundamentally opposed to it.

In both the UJ-HSRC and NIDS-CRAM surveys, respondents who did not want to be vaccinated said they had concerns over the vaccine’s potential side effects and they believed the testing was rushed. These are reasonable concerns grounded in rationality and not indicative of conspiracy theories or anti-vaccination sentiments.

But public concerns over side effects and the speed of vaccine development can and should be allayed by effective scientific messaging and responses from the government, private sector and civil society. Why then are so many South Africans still not vaccinated?

READ | Opinion: Vaccine misinformation: What to do when its coming from leaders?

Perhaps the most obvious barrier to increased vaccination is the degree of public access to the vaccination sites.

The legacies of apartheid spatial planning, combined with deficient urban reform over the last two decades, has meant a large share of the population, typically with little access to income or education, live on the peripheries of urban centres. South Africa’s inequalities are impeding the success of its vaccine rollout.

The high degree of support for vaccination in the first two surveys suggests there is a substantial demand, but there needs to be an improved supply of Covid-19 vaccines to rural and township areas and a targeted approach to reaching older South Africans.

A broader issue behind hesitancy is the degree to which South Africans believe the information provided by their government about the pandemic and vaccines. The Afrobarometer survey found most South Africans did not trust the official Covid-19 statistics or their government to ensure the safety of vaccines.

A more recent publication from the same survey found public trust in a variety of institutions is at its lowest levels since Afrobarometer began asking these questions in 2006. Over the last decade, which saw corruption scandals, poor economic growth and rising unemployment, South Africans’ trust in their government has declined precipitously.

Restoring trust

Public trust – similar to the will to be vaccinated – is not static and can be influenced by several factors.

The Limpopo health department has shown the value of restoring public trust to increase uptake of the vaccine.

Authorities have engaged with local religious and traditional leaders to ensure their constituencies are aware of the benefits of taking the jab. This proactive approach, combined with unconventional messaging aimed at a younger audience, has seen the province become an unexpected leader in vaccinations.

READ | Overcoming vaccine hesitancy: ‘My neighbours laughed, said I was digging my own grave’

Civil society, including labour unions, community networks and activist groups, will also have an important role to play in reaching the increasingly large pool of people who are uninterested in the opinions of political leaders. But if political parties treated the vaccine rollout with the same importance they attach to electioneering, their supporters would be more likely to queue for their jabs.

Resolving South Africans’ main concerns, such as unemployment or housing, will take several years, but it is crucial the public believes their leaders are willing and able to do so.

In the short-term, the state will have to draw on the resources and legitimacy of the media, religious and traditional leaders and businesses to ensure South Africans are well-informed of the benefits of vaccination.

The vaccine rollout serves as a test of trust in the government. And this is one Covid-19 test we all need to have a positive result.

– Mikhail Moosa is the project leader for the South African Reconciliation Barometer at the IJR.

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This article was first published on News24