Predictors of COVID-19 Vaccine Hesitancy in South African Local Communities: The VaxScenes Study

Abstract

South Africa launched a mass COVID-19 vaccination campaign in May 2021, targeting 40 million adults. Understanding predictors of COVID-19 vaccine intentions was required to achieve this goal. We conducted a population-based survey in June–July 2021 using the WHO Behavioral and Social Drivers (BeSD) of COVID-19 Vaccination tool to determine predictors of vaccine hesitancy, defined as intention to refuse or uncertainty whether to accept COVID-19 vaccination. There were 1193 participants, mean age 39 (standard deviation 15) years, and 53% women, of whom 58% trusted information provided by healthcare workers and 32% were vaccine hesitant. Independent predictors of vaccine hesitancy included concerns about side effects (odds ratio (OR) 11.41; 95% confidence interval (CI) 3.5–50.80), lack of access to the online vaccine registration platform (OR 4.75; CI 2.15–10.37), distrust of government (OR 3.0; CI 1.33–6.77), belief in conspiracy theories (OR 3.01; CI 1.32–6.77), having no monthly income (OR 1.84; CI 1.12–3.07), and depending on someone else to make vaccination decision (OR 2.47; CI 1.06–5.77). We identified modifiable predictors of vaccine hesitancy at the start of South Africa’s COVID-19 vaccination rollout. These factors should be addressed by different stakeholders involved in the national immunization program through tailored communication and other effective strategies that increase vaccine literacy, reach low-income households, and engender confidence in government.

COVID-19 Vaccine Hesitancy in South Africa: Lessons for Future Pandemics

“…The main reason for not having had a COVID-19 vaccine, or for being unsure of whether to have a vaccine, was related to concerns about possible side effects of the vaccine. This finding is in line with international [ 35 ], regional African [ 36 ] and local South African [ 17 , 23 ] studies conducted since the roll-out of COVID-19 vaccine programmes. Even while COVID-19 vaccines were still under development, fear of possible side effects was cited as a key reason for not having a vaccine once it became available [ 13 , 14 , 37 ], indicating that risk perception is a major barrier to uptake of COVID-19 vaccination.…”

“…Our study, supported by similar research, highlights that the following key factors need to be taken into consideration when targeting vaccine hesitancy: race [ 14 , 15 , 16 ]; interactive–critical vaccine literacy [ 27 , 29 ]; trust in the government’s ability to roll out the COVID-19 vaccination programme [ 17 ]; flu vaccination status [ 13 ]; and risk perception for COVID-19 infection [ 39 ]. With regard to race, compared to persons who self-identified as White, persons who self-identified as African/Black or Coloured were less likely to have had a COVID-19 vaccine, but were more likely to be in favour of having a COVID 19 vaccine in the future.…”

“…Our research identified factors associated with uptake of COVID-19 vaccination as well as vaccine hesitancy so as to identify key groups to target when promoting vaccines. While there have been other South African studies investigating vaccine intent (including hesitancy) and predictors thereof [ 17 , 23 , 31 ], ours is one of the first studies to collect data at a time when all adult citizens were eligible for a COVID-19 vaccine. Vaccine intent as measured by two earlier studies in 2021 (both using the same database) found that the intent to accept the COVID-19 vaccine among the adult population in South Africa increased from 71% in February/March 2021 to 76% in April/May 2021 [ 23 , 31 ], while Katoto et al, (2022) [ 17 ] reported that 32% of their respondents were vaccine-hesitant in a study undertaken during June/July 2021.…”

“…While there have been other South African studies investigating vaccine intent (including hesitancy) and predictors thereof [ 17 , 23 , 31 ], ours is one of the first studies to collect data at a time when all adult citizens were eligible for a COVID-19 vaccine. Vaccine intent as measured by two earlier studies in 2021 (both using the same database) found that the intent to accept the COVID-19 vaccine among the adult population in South Africa increased from 71% in February/March 2021 to 76% in April/May 2021 [ 23 , 31 ], while Katoto et al, (2022) [ 17 ] reported that 32% of their respondents were vaccine-hesitant in a study undertaken during June/July 2021. Our research, conducted a few months later in September 2021, found that three out of five respondents had not vaccinated against COVID-19, and of these respondents, 44.6% were hesitant (either said no or were unsure) about whether they would vaccinate in future, which is slightly higher than that reported in the above-mentioned studies.…”

“…A systematic review of factors that contribute to vaccine hesitancy and acceptance during previous pandemics/epidemics—influenza A/H1N1 pandemic and Ebola virus disease—identified the following: demographic factors including race, age, sex, education and employment; costs; access; risk perception; trust in health authorities; safety and efficacy of the vaccine; and (mis)information about the vaccine [ 12 ]. Research on COVID-19 vaccine hesitancy identified similar reasons for not wanting to vaccinate: demographic factors including age [ 13 , 14 ], gender [ 14 ], race [ 14 , 15 , 16 ], education [ 14 , 15 ] and income [ 15 , 17 ]; conspiracy theories and misinformation [ 13 , 17 , 18 , 19 ]; concerns about vaccine safety [ 13 , 20 , 21 , 22 , 23 ] and side effects [ 17 , 19 ]; distrust of the government [ 17 ]; poor health literacy [ 24 ]; lack of access to an online vaccination registration platform [ 17 ]; and not taking the seasonal flu vaccine [ 13 ].…”