Experts explain why so many young adults in SA don’t want Covid-19 vaccine

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  • Complacency and misinformation are playing a role in vaccine hesitancy in younger adults.
  • The reasons why this age group needs to be vaccinated need more clarity and effort, experts believe.
  • South Africa will likely experience a fourth wave soon, with case numbers expected to start rising in Gauteng.

In South Africa, people over the age of 18 years became eligible to get the Covid-19 vaccine in August. However, uptake in the 18–34-year-old group has been particularly low.

READ | Covid-19 is surging in Europe: Why is this happening, and should we be worried in SA?

On 12 November, health minister Joe Phaahla said during a Covid briefing: “The uptake by young adults 18–34 years is worrisome at 24.8%. It is clear that fake news in the social media space has huge impacts…”

As of 21 November, 24.6 million doses of vaccine had been administered across the country. Of these, only 4.3 million doses were administered among this group. 

Like Phaahla, acting director-general (DG) of the health department, Dr Nicholas Crisp, told Health24 that there are many anecdotal reports of why uptake among young adults is so low.

“What we pick up is that many young people believe the disinformation spread on social media,” said Crisp. “They have greater access to social media and are easily influenced. Whatever is holding young people back is not in their interests at all,” he added.

Dis- and misinformation on social media

Since the beginning of the rollout of the vaccines, social media has been rife with posts and “superspreader” accounts making dubious claims about the virus and vaccines.

In August, Facebook said it had removed 20 million pieces of Covid misinformation and more than 3 000 accounts, groups, and pages that spread vaccine misinformation, Forbes reported. The social media giant said that it has noticed global signs of an overall decline in vaccine hesitancy among its users. 

Various reasons

“Obviously, it’s disappointing that when vaccines start becoming available that the uptake is not as good as it should be,” Professor Shabir Madhi, Dean of the Faculty of Health Sciences and Professor of Vaccinology at the University of the Witwatersrand (Wits), told Health24. 

The reasons for this are likely multifactorial, he said, and cited the younger age group as the one being most tuned into social media. “It may well be that they’re buying into the misinformation that’s being spread on social media.”

Crisp also commented that many young adults believe that the vaccines will reduce their fertility, whereas, “in fact, there is no evidence that Covid infection may reduce fertility”, he said. 

Crisp cited a study, published in The Lancet, which found no connection between reduced fertility and the AstraZeneca vaccine. Madhi was a co-author of the study. Guidance published in The British Medical Journal also concluded that there was no evidence of the vaccines affecting fertility.

Outreach needs to be better

“I think the low uptake among young adults is disappointing but should not be surprising,” Professor Landon Myer, Director and Head of the School of Public Health & Family Medicine at the University of Cape Town, told Health24.

He added:

Health-related behaviours in this age group are notoriously difficult to influence at these ages, when young people can be enjoying independence and other aspects of life loom large while morbidity and mortality seem like distant considerations.

To make matters more challenging, Myer explained that this was not a population that engages with healthcare services as frequently as older individuals, which makes outreach crucial to enable vaccine access.

One strategy that might work

One strategy to promote vaccination uptake in 18–34-year-olds is to regard vaccination as part of routine wellness, said Myer, where it encompasses a core part of being physically fit, taking care of ourselves and our bodies to stay healthy. 

“This kind of messaging may resonate more, along with messages around keeping communities and those around us safe, rather than messages about preventing disease and death (as these are not always front-of-mind for many young people),” he said.  

Linked to this, Myer believes South Africa will need different access strategies to promote vaccination in the younger adult population, such as mobile or “pop-up” vaccine centres placed at major sporting and entertainment events, gyms, or other recreation spaces.

Key opinion leaders, including entertainers and sportspeople being vaccinated in a public setting, and speaking about the benefits of vaccination, may also be a beneficial strategy to help increase vaccine uptake in this age range, he said.

Young adults considered a low-risk group

Recent reporting by Bhekisisa notes that a democracy survey – conducted by the University of Johannesburg and the Human Science Research Council – found that overall acceptance of the vaccines had increased among adults, but that acceptance among those aged between 18 and 25 years had declined from 63% to 55%. One of the reasons they are hesitant to get the jab is because  they are considered a low-risk group. 

Madhi commented on this: “There is an issue surrounding their perception of risk of Covid. Within the 18–34 years age group, it’s less likely that they will know people or friends of theirs that have been hospitalised because that age group is relatively protected against severe Covid. 

“So there is a sort of complacency in a sense, in that they don’t recognise themselves to be at high risk of developing severe disease – which is true – but at the same time … the main reason we’re asking that group to be vaccinated is to reduce the potential of spreading the virus.”

Data show that people with breakthrough infections (an infection after vaccination) are less likely to transmit the virus to others than those who are unvaccinated and contract Covid.

Messaging concerning

Madhi drew attention to official channels of communication making incorrect claims about the vaccines, which he cautioned had dire consequences. He referenced a radio ad that aired for a while, claiming that the vaccines do not prevent infection, despite him requesting them to rectify their message. 

He said:

Covid vaccines do protect against infection, although not as well as against severe disease. But it reduces the risk of infection by 30-40% and even when there is a breakthrough infection, those people are less likely to transmit the virus by up to 70%.

Madh added: “Put together, those factors would prevent a huge additional number of infections. Now that type of a narrative is not being adequately addressed in South Africa,” he added.

On the point of poor communication about the vaccines, Madhi remarked that messaging as to why the 12–17-year-old group is currently being offered only a single dose has been “completely absent”. Vaccinating this group is not about individual protection, but about community-level protection, he explained.

Changing the messaging

Professor Francois Venter, director of Ezintsha and deputy executive director of Wits RHI, also believed that there has been an issue around poor communication.

He told Health24: “Demand creation has been universally low, not just in this age group. It speaks volumes about the poor vaccine communication and delivery programme, sadly, and it's particularly tragic as we have so many lessons from the HIV testing and male circumcision programmes. 

“You can’t just be passive and wait for people to turn up. There are heroic coalface attempts to take vaccines to people but I don’t understand why this isn’t the norm, rather than the exception."

Urging people to get vaccinated

The resurgence of Covid cases is expected to start in Gauteng within the next two weeks, said Madhi at the time of the interview, where we can expect to start seeing a significant increase in numbers. 

On 23 November, AFP reported that infections were on the rise in the country, with the National Institute for Communicable Diseases (NICD) reporting a "sustained" increase over the past seven days. The majority of cases were detected in Gauteng, it said. A News24 article suggested that the increase may have been driven by a cluster outbreak among students at the Tshwane University of Technology in Pretoria.

Reducing transmission in a sustainable way

"What we’re trying to do, and the reason we want the 18–34 year age group to be vaccinated, is to get as much reduction in transmission of the virus, in a sustainable way,” said Madhi.

Wearing face masks and implementing other public health measures are not long-term sustainable strategies, and people hardly adhere to them the way they should, he said, adding:

The main reason you’re wanting them [young adults] to be vaccinated is to do the socially responsible thing, and that is that they don’t become vectors of transmission of the virus.

“It’s about bringing about a reduction in the transmission of the virus as much as we can, and it’s much more sustainable to be doing it through vaccination than to be enforcing lockdowns, restrictions on gatherings, and everything else that goes with what the government tries to do to bring about the reduction in transmission,” said Madhi.

In the Covid briefing, Phaala said: “The message is simple and straightforward. If we all vaccinate we can have a safe and enjoyable festive season unlike what happened in December 2020 and January 2021.”

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