169. COVID-19 Vaccination Hesitancy in SA is a matter of trust

Author: Ratidzo Makombe
Date: 22 February 2022
Publication: IOL News (The Star)
Image courtesy of: Hakan Nural via unsplash.com

Since the invention of COVID-19 vaccines and their administration in 2021, there has been compelling evidence of vaccine hesitancy across the world, and particularly in South Africa. At the current vaccination uptake rate, South Africa will reach its targeted 70 % mark only in July 2024, according to Covidax Live. Global COVID-19 vaccine uptake has been less among black and brown communities, compared to those of other races.  In the United States, many have demonstrated a fear of vaccination because of the history of medical atrocities by scientists against black and brown Americans. Furthermore, restricted access to the vaccine, especially in Africa, has become a major challenge for vaccine compliance.

Misinformation about the COVID-19 pandemic and vaccines has made it a challenge to educate people about the disease. The use of social media to spread misinformation and panic has made it difficult for governments to educate their citizens. The first hurdle was getting people to understand how COVID-19 is spread and the precautions they should take to avoid catching the disease, which includes masking up, washing one’s hands frequently, sanitising, and social distancing. This hurdle was eventually overcome after strict lockdown measures, and numerous educational campaigns helped to minimise the spread of the virus.

Prayer over vaccine

Currently, governments are faced with the challenge of getting their citizens to vaccinate voluntarily, which is more difficult than enforcing the rule to wear a mask. This hurdle requires citizens to trust both their governments and the medical industry. Of all the countries in Africa, South Africa was hit the hardest by the COVID-19 pandemic. By January 2022, South Africa had had over 3.6 million cases and 95,000 deaths. Under these circumstances, one would have thought that getting vaccinated would have been a top priority, but this was not the case, and vaccination uptake has been low in South Africa. The Ramaphosa government had anticipated that they would have vaccinated 70% of the adult South African population by December 2021, however by January 2022, they had fully vaccinated only 27.7% of the population.

This comes as no surprise if one looks at general vaccination skims worldwide in relation to Africans and the African diaspora. Minority communities and developing-country populations have learned to approach health services cautiously – and with good reason, given the medical industry’s history of inhumanity. A survey on the uptake of the COVID-19 vaccine, carried out by the AfroBarometer in July 2021, indicated that seven in ten South Africans had little or no trust in the government’s ability to ensure that COVID-19 vaccines were safe: 54% of citizens said they were ‘somewhat unlikely’ to get vaccinated, while 12%  indicated that they were ‘very unlikely’ to get vaccinated;  47% of South Africans believed that prayer was more effective than a vaccine in preventing the COVID-19 infection, while only 25% believe vaccines were more effective.

Building trust between the government and its citizens

Under these circumstances, the South African government should focus on building relationships of trust between healthcare providers and citizens. This should be the primary building block of healthcare delivery to ensure adequate vaccine uptake. Currently, a systemic approach to vaccination is being used, whereby citizens are encouraged to get vaccinated or face the consequences of social exclusion and the recurrent costs of continuous COVID-19 testing in order to go to work, school or church. As a result, vaccination reflectance has been high. I encourage the government to change their vaccination strategy to one that is relationship-based and patient-centred. Well-researched and thus appropriate educational interventions have been known to improve attitudes to vaccinations, especially if these are complemented by relationships of trust between citizens and healthcare providers.

A relationship-based approach involves understanding the different demographics in South Africa and their media and health literacy. Once the government invests in understanding the differing needs of various communities and, hence, how to package the messaging around vaccination, they should see a positive uptake in vaccination rates. Building trust in the vaccination programme could be done through local government, community leaders and local medical practitioners engaging with grassroots communities. Drawing on the expertise of local scientists and medical professionals to create short video clips in a language that can be understood by non-experts could combat misinformation, make the vaccine development process more transparent for the hesitant, and create a relationship between citizens and the medical industry.

Vaccination coercion

Corporate South Africa has taken a different coercive approach to get the masses vaccinated. This involves giving their employees the ultimatum to get vaccinated to keep their jobs or bear the burden and cost of weekly COVID tests, or take pay cuts if they decide to work from home. This is an infringement of their freedom of choice as they are faced with an impossible decision. Although there is no definitive answer to what will aid vaccination uptake, educating citizens gives the government a better chance of reaching its vaccination goals. As M.S. Razainotes says in his article, ‘COVID-19 vaccine hesitancy among ethnic minority groups’, there are 5Cs that impact vaccination uptake: confidence in vaccine safety and efficacy, complacency regarding COVID-19 infection risks, the convenience of access, communication, and context.

Listening to communities to determine the root causes of their resistance to vaccination is an important strategy moving forward. Conducting community-based research, such as focus groups embedded within communities, could tease out more specific reasons for their vaccine hesitancy.

Ratidzo Makombe is a doctoral candidate in Development Studies and a researcher at the University of Johannesburg’s Institute for Pan-African Thought and Conversation, South Africa.

IOL News: 22 February 2022