Understanding COVID-19 Vaccine Hesitancy among Healthcare Workers in South Africa

Abstract

Healthcare workers (HCWs) were the first population group offered coronavirus disease 2019 (COVID-19) vaccines in South Africa because they were considered to be at higher risk of infection and required protecting as they were a critical resource to the health system. In some contexts, vaccine uptake among HCWs has been slow, with several studies citing persistent concerns about vaccine safety and effectiveness. This study aimed to determine vaccine uptake among HCWs in South Africa whilst identifying what drives vaccine hesitancy among HCWs. We adopted a multimethod approach, utilising both a survey and in-depth interviews amongst a sample of HCWs in South Africa. In a sample of 7763 HCWS, 89% were vaccinated, with hesitancy highest among younger HCWs, males, and those working in the private sector. Among those who were hesitant, consistent with the literature, HCWs raised concerns about the safety and effectiveness of the vaccine. Examining this further, our data revealed that safety and effectiveness concerns were formed due to first-hand witnessing of patients presenting with side-effects, concern over perceived lack of scientific rigor in developing the vaccine, confidence in the body’s immune system to stave off serious illness, and both a general lack of information and distrust in the available sources of information. This study, through discursive narratives, provides evidence elucidating what drives safety and effectiveness concerns raised by HCWs. These concerns will need to be addressed if HCWs are to effectively communicate and influence public behaviour. HCWs are key role players in the national COVID-19 vaccination programme, making it critical for this workforce to be well trained, knowledgeable, and confident if they are going to improve the uptake of vaccines among the general population in South Africa, which currently remains suboptimal.

The Social Ecological Model: A Framework for Understanding COVID-19 Vaccine Uptake among Healthcare Workers—A Scoping Review

“…Subsequent studies reported HCWs’ acceptance towards the COVID-19 vaccines [ 43 , 57 , 65 , 68 , 74 , 75 , 78 , 86 , 87 , 89 , 90 , 93 , 95 ]. Among these ten studies, over half of the participants were vaccinated with at least one dose (see Figure 2 ).…”

“…Within the theme of COVID-19 vaccines, ten sub-themes were identified, all acting as barriers to vaccine uptake. The most prominent sub-theme was safety concerns, which was reported as the primary barrier [ 23 , 25 , 43 , 47 , 50 , 51 , 55 , 56 , 57 , 60 , 61 , 65 , 66 , 67 , 68 , 69 , 70 , 72 , 74 , 75 , 76 , 77 , 78 , 81 , 82 , 83 , 84 , 85 , 86 , 88 , 90 , 91 , 92 , 95 ]. However, only three studies mentioned confidence in the COVID-19 vaccines, facilitating uptake [ 47 , 52 , 88 ].…”

“…However, only three studies mentioned confidence in the COVID-19 vaccines, facilitating uptake [ 47 , 52 , 88 ]. Numerous studies [ 23 , 47 , 55 , 56 , 61 , 66 , 68 , 69 , 70 , 74 , 75 , 77 , 81 , 82 , 85 , 90 , 91 ] highlighted the prevalent mistrust in science among HCWs, often rooted in the belief that the COVID-19 vaccine has not undergone sufficient clinical trials. Concerns about the vaccine’s effectiveness were reported in 16 studies [ 23 , 25 , 65 , 67 , 69 , 70 , 76 , 77 , 78 , 82 , 84 , 85 , 86 , 88 , 92 , 95 ], with some expressing doubts about its ability to protect against COVID-19, particularly in Africa.…”

Predictors of COVID-19 vaccine uptake among adults in South Africa: multimethod evidence from a population-based longitudinal study

“…Subgroup analyses were then conducted by replicating the models of potential predictors of COVID-19 vaccination uptake among two groups with perceptions or beliefs that have been shown to act as barriers to COVID-19 vaccine intentions: (1) those not trusting the safety of the vaccine5 11 12 31–33 and (2) those not believing the vaccine to be effective 14 34. The subgroup analyses aimed to identify factors that could potentially be leveraged to encourage vaccine uptake among individuals with common concerns about the vaccine.…”

“…The unprecedented pace of COVID-19 vaccine development contributed to widespread concerns over vaccine efficacy and safety 8–10. A growing body of evidence points to greater reluctance to get vaccinated among those concerned about the safety of COVID-19 vaccines5 11–13 and among those who do not believe they are effective 14 15…”