Health minister Zweli Mkhize inspects vaccination sites in Johannesburg. Picture: FREDDY MAVUNDA
Health minister Zweli Mkhize inspects vaccination sites in Johannesburg. Picture: FREDDY MAVUNDA

The arrival of the first Johnson & Johnson vaccines at OR Tambo International Airport in February signalled a new chapter in SA’s fight against the pandemic.

It meant the focus could shift from containing the virus to eliminating it.

And yet, uncertainty about when future batches will arrive and how they’ll be rolled out as well as a hesitancy to get the vaccine are jeopardising SA’s bid to subdue the virus this year.

The results of the Nids-Cram survey in February and March do at least offer some reason for optimism. And they provide a reliable sense of who exactly is reluctant to get the jab.

In particular, it is encouraging that 71% of South Africans say they would be vaccinated if a vaccine was available.

This is the highest estimate of vaccine intent to date, and slightly higher than other studies (which range from 64% to 67%). But given Nids-Cram’s robust sampling, this is arguably the most reliable indication yet.

The survey also provides a window into understanding who the doubters — 29% of respondents — might be.

Notably, we observed much higher hesitance among young people (aged 18 to 24), which is presumably driven partly by their much lower likelihood of becoming seriously ill with Covid. The elderly and those with reported HIV, TB, lung conditions, heart problems or diabetes are far more willing to accept a vaccine.

However, we don’t find that obese or hypertensive respondents are more inclined to be vaccinated — suggesting that the government has work to do in reaching out to these groups.

Congruent with the perception that "antivaxxer" theories are shared via social media networks, those who see social media as a "trusted source of information" are seven percentage points more likely to be hesitant.

We also found that people who consider health workers or government information as "trusted source of information" were not less hesitant to get the vaccine — even if this group was more likely to wear masks and adhere to social distancing rules.

We noticed large variations in vaccine hesitancy by districts, by language group and by religion — and not in the expected ways.

For instance, contrary to what we see in the US, we didn’t find that people who are overtly religious, or Christian, were more reluctant to be vaccinated.

Instead, we saw a large variation by language groups: those who speak Afrikaans at home were more likely to be vaccine hesitant (42%) compared with the national average (29%).

All of this creates many challenges, because, unlike the wearing of masks, which can be mandated, vaccination will be voluntary. There can be no short cuts to get people to accept it as necessary.

Those in positions of influence will have to build trust, work to explain how safe vaccines are and how they work, and raise awareness of how our vaccination choices affect others. This will need to happen from the bottom up, in communities. We can’t rely solely on sharing scientific findings, but instead need to think about people’s subjective motivations.

This isn’t a particularly strong suit of our public health campaigns. But to build trust amid misinformation, we need a government that is humble about what it knows and doesn’t know, is clear about the challenges, open to changing plans and willing to answer questions.

And lastly, we need to rethink the artificial dichotomy between saving lives and saving livelihoods.

For many South Africans who are young, healthy and not at risk of dying, the best argument for getting a vaccine may be that it will help the economy recover and boost the likelihood that we can bring back some of the jobs we have lost, especially in the tourism and hospitality sectors.

*Burger is a professor in the department of economics at Stellenbosch University and a researcher at Research on Socioeconomic Policy. She is the health lead of the Nids-Cram study


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