Background
COVID-19 vaccine hesitancy has threatened the ability of many countries worldwide to contain the pandemic. Given the severe impact of the pandemic in South Africa and disruptions to the roll-out of the vaccine in early 2021, slower-than-expected uptake is a pressing public health challenge in the country. We examined longitudinal changes in COVID-19 vaccination intent among South African adults, as well as determinants of intent to receive a vaccine.
Methods
We used longitudinal data from Wave 4 (February/March 2021) and Wave 5 (April/May 2021) of the National Income Dynamics Study: Coronavirus Rapid Mobile Survey (NIDS-CRAM), a national and broadly representative panel survey of adults in South Africa. We conducted cross-sectional analyses on aggregate and between-group variation in vaccination intent, examined individual-level changes between waves, and modeled demographic predictors of intent.
Results
We analysed data for 5629 (Wave 4; 48% male, mean age 41.5 years) and 5862 (Wave 5; 48% male, mean age 41.6 years) respondents. Willingness to get a COVID-19 vaccine significantly increased from 70.8% (95% CI: 68.5–73.1) in Wave 4 to 76.1% (95% CI: 74.2–77.8) in Wave 5. Individual-level analyses indicated that only 6.6% of respondents remained strongly hesitant between survey waves. Although respondents aged 18–24 years were 8.5 percentage points more likely to report hesitancy, hesitant respondents in this group were 5.6 percentage points more likely to change their minds by Wave 5. Concerns about rushed testing and safety of the vaccines were frequent and strongly-held reasons for hesitancy.
Conclusions
Willingness to receive a COVID-19 vaccine has increased among adults in South Africa, and those who were entrenched in their reluctance make up a small proportion of the country’s population. Younger adults, those in formal housing, and those who trusted COVID-19 information on social media were more likely to be hesitant. Given that stated vaccination intent may not translate into behaviour, our finding that three-quarters of the population were willing to accept the vaccine may reflect an upper bound. Vaccination promotion campaigns should continue to frame vaccine acceptance as the norm and tailor strategies to different demographic groups.
In response to COVID-19 most governments used some form of lockdown policy to manage the pandemic. This required making iterative policy decisions in a rapidly changing epidemiological environment resulting in varying levels of lockdown stringency over time. While studies estimating the labour market effects of lockdown policies exist in both developed and developing countries, there is limited evidence on the impact of variation in lockdown stringency, particularly in developing countries. Such variation may have large heterogenous effects both on aggregate and between worker groups. In this paper, we estimate the causal effect of lockdown stringency on employment probabilities, adopting a quasi-experimental design on unique labour force panel data from South Africa. South Africa is a useful case study given its upper-middle-income status and relatively small informal sector, thus serving as an example to a variety of developing and developed country economies. We find that the negative employment effects of the country’s lockdown policy were driven by effects on the informal sector. Furthermore, we observe important effect heterogeneity by employment formality as the stringency of the country’s lockdown regulations changed over time. We find that more stringent lockdown levels negatively affected informal, but not formal sector employment, while less stringent levels negatively affected formal, but not informal sector employment. From a policy perspective, evidence of such heterogeneity can inform decisions around the optimal targeting of support as the pandemic progresses and lockdown policies are reconsidered.
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