A Covid-19 Vaccine Survey (CVACS) 2 by the Southern Africa Labour and Development Research Unit (SALDRU) at the University of Cape Town (UCT), led by Dr Brendan Maughan-Brown and Dr Katherine Eyal, has found that vaccine hesitancy is becoming entrenched among a sample of unvaccinated South Africans, with few believing that the vaccine is needed, or that it is effective.
The study also investigated attitudes to mandates and their likelihood of success.
Survey 2 attempted to re-interview the original CVACS Survey 1 sample of 3 510 individuals, first surveyed in November/December 2021. Around 1 772 individuals were successfully re-interviewed, with 386 vaccinated between the surveys (self-reported), and 1 386 remaining unvaccinated. A new top-up sample of 2 222 unvaccinated individuals was interviewed to achieve a total sample of 3 608 unvaccinated individuals. Survey 2 interviews were conducted from 23 February to 25 March 2022.
According to Dr Maughan-Brown, attitudes towards vaccination are becoming entrenched. He says that the majority do not intend to get vaccinated. When asked about their intentions to vaccinate, 36% said “definitely not” and 24% said “only if required”. Only 18% in Survey 2 intend to get vaccinated “as soon as possible”.
“We observed a significant shift in intentions among the unvaccinated since CVACS Survey 1 (November – December 2021), when the majority said either ‘as soon as possible’ or ‘wait and see’. In Survey 2, when asked directly, only 29% thought they would be vaccinated by May 2022, which is significantly lower than future intentions stated in Survey 1,” says Maughan-Brown.
“Among unvaccinated respondents interviewed in Surveys 1 and 2, only 44% planning to vaccinate ‘as soon as possible’ in Survey 1 still have the same intention in Survey 2. More of this group now fall into the harder to vaccinate category (23% will get vaccinated ‘only if required’, and 8% will ‘definitely not’). Many of the ‘wait and see’ and vaccinate ‘only if required’ groups have become less likely to vaccinate. Encouragingly, 1 in 4 of the ‘definitely not- group have become more willing to vaccinate,” he said.
Maughan-Brown says that high-risk groups such as respondents with chronic conditions are not more likely to want to be vaccinated than those without chronic conditions.
“Only 19% of respondents with a chronic illness intend to get vaccinated as soon as possible, and nearly one in three definitely do not intend to be vaccinated, a proportion only slightly lower than respondents with no chronic illnesses (37%),” he says.
The longitudinal nature of the CVACS study allowed the team to gain insights about the reasons why some respondents did choose to be vaccinated between Survey 1 and 2, although the sample size of the vaccinated group was small (only 386 individuals).
Maughan-Brown comment: “Proximity to other vaccinated individuals, and positive beliefs in the efficacy and safety of the vaccine were strongly associated with higher rates of vaccination. Individuals who lived with a vaccinated person, and those who believed that the vaccine helps prevent death were more likely to vaccinate. Individuals who believed that the vaccine could kill were less likely to vaccinate.”
Dr Katherine Eyal, who also led the study, says: “Access and incentives are still important for vaccination. Nearly 60% stated a closer vaccination site, and nearly 50% stated after work or on weekends availability, as one of the reasons for getting vaccinated. Almost 1 in 3 of the age-eligible (50-plus) for a Vooma Voucher reported that the shopping voucher incentive influenced their decision.
“Other, but less common, predictors of vaccination included seeing or becoming aware of others getting vaccinated; becoming aware of, or seeing first-hand, the negative health impacts of Covid-19; and a change in physical status, including improved health or no longer being pregnant or breastfeeding,” she adds.
The CVACS team were also able to investigate the likelihood of mandates succeeding to increase vaccination rates. Eyal says individuals got vaccinated to keep their jobs and when looking for employment.
The survey found that mandates had the greatest influence on decisions, with one in five vaccinated because of employment-related mandates, and one in 10 because of other mandates.
Despite almost half of respondents believing that mandates would work fairly or very well to increase vaccine coverage, Eyal says there is strong opposition to mandates among the vaccine hesitant.
“Opposition is driven mainly by the belief that it is an individual’s right to decide to get vaccinated or not, with about 5% of those in opposition citing that the president said that vaccination would not be mandated. A further 15% were opposed because they believed that the vaccine is not needed, the vaccine may harm people, or the vaccine is not effective,” she says.