The target is to get at least 40 million people vaccinated against Covid-19 in South Africa to have population immunity, but there are various reasons why people aren't going to get jabbed. Peter Benjamin examines the issue of trust and the role high-profile people, like Dr Susan Vosloo, play in increasing vaccine hesitancy.
I assume you, dear reader, are a rational, informed person who knows a great deal about Covid-19, how vaccination protects individuals (while not being perfect), and the importance of vaccinating at least 40 million people in SA to have population immunity. (If not, there are lots of other great articles on News 24 for you to read).
Good news: After problems and delays, the supply is improving, with millions of doses of Covid-19 vaccines in the country and more coming. We have enough to reach that 40 million target. Over nine million people are vaccinated (at least one dose).
But there's bad news too – the number of people coming for vaccination has declined, with pictures of empty vaccination sites (though there has been a good response recently as youth are now able to vaccinate). Getting enough people to vaccinate is the critical factor in whether the vaccine rollout will be a success. It's about persuading enough people to vaccinate – it's a demand problem.
There is a lot of good public health information out there – so why don't people believe it and do the right thing?
You probably have heard some crazy myths – Covid-19 vaccines are poisons to depopulate Africa, they make your arm magnetic, they'll definitely kill you in an hour or within two years, you will become infertile, or, if pregnant, have a miscarriage, it's Bill Gates becoming the global overlord, or the work of the Anti-Christ 666. Do I need to tell you that all of these are lies?
However, myths and disinformation aren't the main problem.
Various surveys show that under 10% of South Africans buy into the conspiracies. Many more people have 'rational' concerns, such as does the vaccine work? Is it safe? How come it was developed so fast? There are answers to all these questions.
The government and others are trying to get the information out through leaflets, social media, TV and Radio. There's an impressive national Covid-19 hotline (0800 029 999) and an innovative Covid-19 WhatsApp system used by millions. The issue is whether the information will reach people everywhere in the country in the right language and format, whether it will be believed, and whether it will be easy enough for most people to get vaccinated.
Distrust of government and authorities
The most crucial word in public health communications is trust.
If the source of information is not trusted, it doesn't matter what is said. Many people distrust government and authorities. People wonder why the government is putting so much effort and resources into the vaccine campaign that many people aren't very concerned about, while they do not care about providing what most people need - food, water, land and jobs.
That's why it matters when people who are already trusted and influential – faith leaders, scientists, sports stars, politicians and many others – are publicly being vaccinated.
It is very destructive when well-known people, such as Rev Kenneth Meshoe, Professor Tim Noakes or Dr Susan Vosloo, make statements that undermine the vaccine rollout. I think it is appropriate that Dr Vosloo has been reported to the Health Profession Council of South Africa. Health communication experience shows that the most influential people are those you already know and trust in your own community – friends, family and local leaders.
Sometimes what is said isn't actually the main issue: someone who says 5G telecommunications causes Covid-19 will not be persuaded by a physics lecture on non-ionizing radiation; they are probably expressing their mistrust of government, corporations, new technology and a fear of being lied to. Other communities remember times when pharmaceutical corporations have abused people with experimental drugs, especially in Africa.
What motivates someone to get vaccinated?
The best way I've found for understanding whether people actually get vaccinated comes from the World Health Organisation's Behavioural and Social Determinants of Vaccination (BeSD) model.
It says: "What people think and feel", together with "social processes", leads to whether someone is actually motivated to get vaccinated. Then there are all the "practical issues" of EVDS registration, knowing when and where to go, transport hassles, cost, childcare and time off work, to overcome to get to the clinic or other vaccination site.
Finally, the vaccine experience matters – are you turned away, the queue hours long, or are the nurses rude or disrespectful? All of these things influence whether you actually are vaccinated yourself and will encourage others to do so.
We can win this – we can persuade over 40 million people in SA to vaccinate.
Various credible surveys (such as those by University of Johannesburg and HSRC, and also NIDS-CRAM) suggest that over 70% of adults in SA are already willing to be vaccinated. This is much higher than in many countries, like the DRC, where vaccines were destroyed because they couldn't be used (here and here).
However, in SA, it is not widely known that a large majority of people support the Covid-19 vaccination drive – the 'anti-vaccination' crowd is just much 'louder'.
The World Health Organisation talks about Infodemics (Information and epidemics), the overabundance of information (some accurate, much not) that surrounds a health crisis like the Covid-19 pandemic.
Infodemiology (Information and epidemiology) attempts to manage this fire-hose of information, conspiracies, questions and misinformation that we all are bombarded by. They suggest not chasing after each myth and conspiracy – there always will be another one, as you are unlikely to persuade the 'hard-core' and the more you talk about the myth, the more people hear the myth being talked about (even if there is a 'not' in the sentence).
Instead, flood people with evidence-based information to encourage vaccination – make it easier to find accurate positive information than the bad.
I'm part of the national social listening team of the Department of Health, though I don't work for the government.
Our job is to get information from all over the country – from broadcast, social media, face-to-masked-face conversations, online and offline – to understand Covid-19 and vaccine sentiment, concerns, questions, myths and disinformation.
Everyone has a role
We don't just listen to the already loud and influential, but try to understand what is encouraging or blocking people from being vaccinated, with different issues in different geographies, communities, languages, ages, affluence levels, religion and other factors. Then we produce actionable information, so communications and the health system delivery of vaccination can improve to make more people able to vaccinate.
Over 40 organisations are involved and we produce a weekly report – please email email@example.com if you'd like to receive it.
The Department of Health is trying hard (though we all know about the Digital Vibes mess).
There is a new Demand Acceleration strategy, with a huge media campaign promoting vaccination coming soon. Real411 is a great place to report myths debunking damaging misinformation.
Everyone has a role here – your friends and family, I'm sure, trust you. Great, you've got a job to do. Tell your neighbours, colleagues, friends and family that you support vaccination. Answer their questions. Explain how vaccination helps, how we have to get over 40 million people to vaccinate, how no one is safe until we all are safe.
Please help end the pandemic; Protect yourself by vaccinating; Encourage your friends and family to do the same; Be a Covid-19 Champion!
- Dr Peter Benjamin is an executive director at HealthEnabled.
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