Vaccine Hesitation: Here’s Why Unvaccinated South Africans Refused Covid-19 Shots

SALDRU conducted two surveys of unvaccinated South Africans and found that hesitation over the Covid-19 vaccine was not only high, it was deeply ingrained.


South Africa is currently facing a new wave of infections related to the much higher transmissibility of the Omicron Covid-19 variant and its sub-variants.

The most recent spike in Covid-19 had similar characteristics to the fourth wave in January 2022: the increase in infections was not accompanied by similar increases in spikes in hospitalizations and deaths.

These changes pose a challenge for policy makers seeking to improve vaccine adoption, particularly in vulnerable groups.

The people most vulnerable to serious illness with Covid-19 include the elderly and those with underlying medical conditions.

Vaccination in South Africa

The government of South Africa has established a objective to vaccinate 67% of the population by the end of 2021. But rates have fallen far below that.

Starting May 22, 2022 only 31.4% of the population had been vaccinated.

Understanding the depth of hesitation about vaccines and the factors behind lack of adoption is critical to preventing further deaths, infections and continued damage to the economy.

Vaccine adoption is particularly crucial for the country due to the HIV prevalence rate of 13% as well as the fact that it has the highest TB linkage rate and TB / HIV incidence in the world.

Both are known correlates of Covid-19 mortality.

Vaccination hesitancy in SA

We have been involved in research to understand the levels of hesitation towards the vaccine in the country in order to provide information on how to increase vaccine adoption, particularly among high-risk groups.

Two polls of unvaccinated South Africans were conducted. The first occurred from From 15 November to 15 December 2021.

The Omicron variant had been announced a few weeks earlier.

the second poll consisted of 3,608 unvaccinated individuals, of which approximately half were re-interviewed by survey 1, as well as 386 vaccinated individuals between survey 1 and 2.

The dataset cannot be considered a nationally representative or prevalence survey.

However, this was a diverse sample with broad coverage across breed, vaccine-eligible age categories, province, income levels, and geographic area.

We found that vaccine hesitation in our sample was high and had taken root since December 2021.

We also tested the likely success of messaging and information campaigns and how information should be framed and distributed.

Understanding the precise drivers of vaccine hesitation is key to designing these interventions.

Vaccination hesitancy in SA

Most of the people we spoke to didn’t want to be 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 absolutely did not intend to be vaccinated. A quarter of respondents said he would only be vaccinated if required by a warrant.

Worryingly, those with chronic illnesses were no more likely to be vaccinated than others. Vaccine rejection was very high among older respondents.

And we found that access was by no means a reason not to get vaccinated among the most reluctant (a large group).

Awareness of the vital vaccine

Our results showed that it is crucial to raise awareness of the need for the vaccine, despite the current context of Omicron.

Few of the respondents we spoke to thought they needed the vaccine and many cited a very low personal risk of becoming seriously ill from Covid-19.

Many also thought the vaccine didn’t work and could kill them.

Few thought it would protect them from death.

Few people believed the vaccine was safe for pregnant women, nursing mothers, or the chronically ill.

Distrust of the government

And only one in four of our entire sample say they trust government information on Covid-19 very much.

A very large number of respondents opposed a vaccination mandate (nearly 75% of the entire sample) even though about half thought the mandates would work well.

Opponents overwhelmingly cited that it was an individual’s right to decide, with some arguing that the president said vaccination would not be mandatory.

Next steps

Given that 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 addressed with care.

Messaging campaigns are an often used tool for improving adoption and are attractive due to their low-cost nature.

We tested two vaccine promotion messages (being part of the solution to ending the pandemic or getting vaccinated for more freedom) and found some small impacts on vaccine intentions.

The project also included a proof of concept to test policy messaging and receive results quickly.

Our results showed that targeted campaigns between groups with greater hesitation or risk would be needed.

The surveys have allowed us to identify some key determinants of vaccination levels and have determined that political action should not stop after vaccination: further communication should ensure that people come back for boosters and share their positive vaccination experiences. with the others.

Vaccine safety concerns need to be allayed, and improving belief in its efficacy is key if vaccination rates are to be increased.

This information will have to come from innovative sources given the lack of confidence in the Covid-19 government information.


Katherine Eyal, Research Associate, Southern Africa Labor and Development Research Unit (SALDRU), University of Cape Town.

This article was republished by The Conversation under a Creative Commons license. Read the original article.

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