“Almost half (47%) of those who ‘disagreed strongly or somewhat or did not know’ in February or March 2021 subsequently changed their minds over the following two months and either had been vaccinated or agreed to be vaccinated when asked again in April or May,” wrote Stellenbosch University’s Professor Ronelle Burger and colleagues in a paper published with the new data. The paper has not been published in a peer-reviewed journal.

The National Income Dynamics Study Coronavirus Rapid Mobile Survey (NIDS-CRAM), released on Thursday, is a collaboration between more than 30 researchers from several universities and research organisations. It involves a nationally representative panel of about 7,000 people being surveyed by phone in five waves. The latest data are from the fifth wave in which just under 5,000 people were surveyed.

The researchers found that two-thirds of respondents strongly agreed in April/May 2021 with the statement: “If a vaccine for Covid-19 were available, I would get it.” This is just more than a 10-percentage point increase from the 55% recorded in February/March 2021.

When asked what may be behind the increase, Burger told Spotlight: “It most likely is a variety of factors. Our data does not tell us what is driving this, but many countries have seen the same gradual uptick in vaccine acceptance alongside the vaccine roll-out. Much of this may be driven by hearing of others being vaccinated without major fiascos or notable side-effects. For most people, news from neighbours and ordinary people trump social media fearmongering.”

A quarter of people surveyed in April/May strongly or somewhat disagreed that they would get a vaccination if one became available to them, or did not know. A further 10% only somewhat agreed with the statement.

A graph showing the difference in vaccine acceptance between NIDS-CRAM waves four and five. (Shared by Professor Ronelle Burger)

“Campaigns to increase vaccine registration and uptake should promote the fact that vaccine acceptance is the norm. Spreading the message that most people say they will accept a vaccine has proven to increase Covid-19 vaccination rates worldwide. Conversely, while it is clearly important to address myths and rumours, frequently discussing vaccine scepticism can perversely give credence to myths by creating the impression that these beliefs are widespread and that there is a valid reason to be concerned about getting vaccinated,” wrote Burger and colleagues.

Willing but not registered?

The researchers also underlined the difference between a willingness to get jabbed and taking the steps to register on the Electronic Vaccination Data System (EVDS) and being vaccinated.

“After more than two months, the proportion of the elderly who have registered for vaccination is much lower than their willingness to be vaccinated asserted in surveys, which provides a signal that we need to consider the time, costs and burden associated with registration,” wrote Burger and colleagues. “Getting people motivated is not enough; we need to make the process as easy as possible for people to translate their intentions into action. Providing hassle-free access and removing impediments are likely to be even more important among the rest of the population, given that the survey shows that vaccination demand in the <60-year group is significantly lower.” 

The researchers also found that vaccine acceptance is higher among respondents living in traditional settlements, among isiZulu, isiTsonga and Setswana speakers, and among black respondents. On the other hand, vaccine acceptance was found to be significantly lower among respondents living in urban formal residential housing, Afrikaans speakers and white and coloured respondents. Users of social media and young people were found to be more likely to show low vaccine acceptance.

Conspiracy theories do not seem to be a major impediment to South Africa’s vaccination programme. Only 1% of respondents in NIDS-CRAM wave five said that they ‘worry about vaccine safety due to national or global plots’ and ‘fewer than 1% are concerned about vaccine safety because they fear it may alter their DNA or that it is a fraudulent corporate attempt to extract profits’. (Photo: patientengagementhit.com/Wikipedia)

As previously pointed out by Professor Kate Alexander and Bongani Xezwi of the University of Johannesburg, writing on Daily Maverick, a higher percentage of insured than uninsured people have been vaccinated. They quoted a presentation dated 21 June which showed the proportion of insured people over 60 who had been vaccinated was 48% and the proportion of uninsured people in that age group who had been vaccinated was 26%. In other words, vaccination rates at that point were higher in the groups where willingness appears to be lower. Alexander and Xezwi argued that the challenge is principally one of delivery by the government rather than demand from the people.

Reasons for hesitancy

Conspiracy theories do not seem to be a major impediment to South Africa’s vaccination programme. Only 1% of respondents in NIDS-CRAM wave five said they “worry about vaccine safety due to national or global plots” and “fewer than 1% are concerned about vaccine safety because they fear it may alter their DNA or that it is a fraudulent corporate attempt to extract profits”.

Instead, vaccine hesitancy appears to be driven mainly by safety concerns. “The most widespread reason for believing that vaccines are unsafe is that vaccines had not been adequately tested,” wrote Burger and colleagues. “A third of individuals who thought vaccines are unsafe said they believed this because vaccine testing was rushed.”

The two vaccines currently being used in South Africa (from Johnson & Johnson and Pfizer/BioNTech) have been tested in large trials and have been used by many millions of people in other countries. (Spotlight previously reported on how to report vaccine-related adverse events.)

The researchers also found that one in five of those who believed vaccines were unsafe or could harm them reported that this was because of side-effects. While side-effects are common with the Covid-19 vaccines being used in South Africa, they are generally mild and pass within a day or two. DM/MC