Defend Truth


We need behaviour change communication strategies that earn the trust of a Covid vaccine-hesitant society


Patience Mushamiri-Kuzviwanza is a public health specialist with an interest in mental health, behaviour change communication and health policy. She holds an MA in Neuropsychology and is currently completing a Master of Public Health (MPH) at the University of the Witwatersrand, where she works in research at the SAMRC/Centre of Health Economics and Decision Sciences-Priceless SA.

More than 47% of South Africans surveyed have stated they would not be comfortable with taking the Covid-19 vaccine. With such a high level of mistrust, the message source is of high importance. The messenger needs to be seen as an individual who represents the voice of society and is acceptable within the community.

President Cyril Ramaphosa recently made an announcement pertaining to the country’s strategy to roll out the Oxford-AstraZeneca Covid-19 vaccine. Although he pleaded with individuals across the nation to refrain from spreading conspiracy theories about the vaccine and instead highlight its importance in protecting the health of all South Africans against Covid-19, his announcement has been met with a lot of opposition as many individuals fear potential side-effects.

In the face of the second wave, a solid and comprehensive communication strategy could prove to be more important than acquiring the vaccine itself, for without the buy-in of the communities largely affected, the desired effects of the vaccine in eradicating disease will not be achieved. Mass vaccine hesitancy is likely to result in limited vaccine uptake. The communities in which these vaccines are planned to be administered need to feel engaged and empowered to receive them. There needs to be a sense of ownership on their part in the process and not just a feeling of being directed to do so by government.

Given the rapid spread of the virus, the government had to adopt a very top-down approach in implementing measures to stop the spread of the disease. This included stringent lockdown regulations and the banning of certain gatherings and selling of items. Although at the time this can be seen as the best possible strategy they could have adopted, it was met with mixed feelings among members of the population as many have lost businesses, income and the ability to make a living. Government has come under scrutiny time and time again regarding how best it could have initially handled the spread of the virus. Given this divide and some of the mistrust in government, it came as no surprise that a large percentage of the population was against taking the Covid-19 vaccine.

Results from an Ipsos survey carried out in the country reported that as of mid-December more than 47% of South Africans stated they would not be comfortable with taking the vaccine. Many theories around why one should not take the vaccine have been published on multiple social media forums, with most individuals not trusting the contents of the vaccines, how quickly the vaccine was created and approved (as most clinical trials for vaccines usually take a longer period), and fear of potential side-effects.

A major sentiment floating around social media is also to do with the roll-out strategy. The Ministry of Health has stated that the vaccine will be given to healthcare workers and those working in essential service industries first. Many have asked when politicians and those in Parliament will be required to take the vaccine as well. This position highlights that the resistance to the vaccine may be in part as a result of mistrust with the governing body and experts, and not completely about the vaccine itself, which has been documented as one of the leading causes that fuels vaccine hesitancy in a population where a new vaccine is being introduced. What then can be done to ensure that the vaccine is accepted by individuals in the population?

It has been noted that simply providing people with information does not necessarily lead to behaviour change. There need to be efforts around the use of a combination of participatory behaviour change communication strategies that encourage community engagement, community dialogue and social mobilisation. This can ensure that individuals in communities feel as though they are part of the process of coming up with the solutions to protect their health.

A good first step in coming up with a communication strategy is considering the social norms, beliefs and values of the communities in which this vaccine will be rolled out. Experts in the field of behaviour-change communication, particularly with regards to vaccine hesitancy, have documented how it is important for communication to appeal to the values and beliefs already held in the communities, such as the desire to protect loved ones, instead of bombarding individuals with messaging that largely focuses on scientific facts.

If individuals feel their existing beliefs and concerns are respected and validated this may result in a reduction in fear of the vaccine and encourage uptake.

Mass media campaigns also need to make use of already existing communication and media platforms in communities to ensure no individual in the population is left out. With such a high level of mistrust brewing in the population, the message source, that is, the individual or group of individuals who deliver the message, is also of high importance. The messenger needs to be seen as an individual who represents the voice of society and is acceptable within the community. It needs to be a person people trust or look up to, such as a trusted health professional, celebrity, sportsperson or community leader, who can deliver the message in a manner that engages and appeals to the population.

In summary, it is important that government not only focuses on procuring the vaccine but that it also spends a great deal of time and effort in coming up with a communication strategy that highlights the benefits of the vaccine while considering the concerns of the population.

Although a difficult and complicated task, it is one that is worth investing in as it will go a long way towards encouraging uptake of the vaccine and hopefully lead the country and the world at large towards combating this virus that has globally cost millions of lives. DM


"Information pertaining to Covid-19, vaccines, how to control the spread of the virus and potential treatments is ever-changing. Under the South African Disaster Management Act Regulation 11(5)(c) it is prohibited to publish information through any medium with the intention to deceive people on government measures to address COVID-19. We are therefore disabling the comment section on this article in order to protect both the commenting member and ourselves from potential liability. Should you have additional information that you think we should know, please email [email protected]"

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  • Dennis Bailey says:

    Lack of trust in vaccination is symbolic of a lack of trust in state organs that are encouraging widescale jabbing. Our gov’t isn’t trusted to have the wellbeing of citizens in mind. To make it worse gov’t illustrates repeatedly and continually under lockdown and before, historically and even now in the season of COVID, its utter disdain for the electorate and especially children, the poor and the most vulnerable and susceptible who are the primary targets of its unjust ministrations. Gov’t does absolutely nothing to change that prevalent view, though opportunity after opportunity is provided for it to self-correct, it does nothing to change the prevalent view. Why then would anybody with sense, trust it to jab us?

  • Craig Yeatman says:

    We need more positive stories circulating, and less vaccine negative stories. I would like to see selected vaccine-approving social leaders (active on social media with a high number of South African followers) added to the priority list for vaccinations. Other countries have provided the example (I cannot recall which ones offhand but the author probably knows of them). While humans often resist the advice of “people I dont really identify with” (in our case, politicians), we are often persuaded by and actively follow people we admire. These social leaders could serve as role models by getting vaccinated early, and sharing the experience – which would make them powerful change agents. We might not need more than 50 such leaders to tip the stories people are telling each other about the vaccine.

  • Szivos David says:

    two comments:

    the public leaders of the country as well as respected celebrities should publicly get vaccinated as soon as possible to encourage the population.

    second comment:
    this title is horrible…

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