Just ten months ago, South Africans were desperate to gain access to Covid-19 vaccinations and there was a sense of hopelessness that the country would not receive vaccines in time to stem the third and fourth waves of the pandemic. Fast forward to October, 2021 and only about 10,8 million people (18,1%) had been fully vaccinated.

Why is it that South Africans who were so desperate to get a vaccine ten months ago find themselves hesitant to get vaccinated now?

This was the question posed during a ‘Fireside Chat’ webinar, held on 20 October to mark World Evidence-Based Healthcare Day 2021.

The event, hosted by the Centre for Evidence-Based Health Care (CEBHC), focused on the need for access to factual, evidence-based information during the ‘infodemic’, which has arisen from people receiving floods of information – often false or misleading – about the virus and the vaccine.

The aim of the discussion was to bring together a range of perspectives to understand how the infodemic has affected the move from vaccine desperation to vaccine hesitancy in South Africa, and to look at how various actors have helped to dispel myths and enhance understanding.

Zengeziwe Msimang, chief engagement officer of Harambee Youth Accelerator, who moderated the event, said vaccine hesitancy was not unique to South Africa – only about 36% of the world is currently vaccinated, even though vaccines are freely available in many countries. She said people around the world had received a “tsunami of information consisting of a combination of facts and myths, making it difficult to separate facts from fiction.

“In an era where fake news and alternate facts seem to be the order of the day, what measures can we take to ensure we turn this around and get as much of an uptake of the vaccine as possible,” Msimang said.

Farai Mzungu, programme manager at Youth Health Africa, who supported the national health department in its communications strategy on Covid-19 and vaccinations, said she believed “poverty in medical knowledge” among the general public had been a major factor in causing South Africa to go from “vaccine desperation to vaccine hesitancy, apathy and resistance”.

“This gap was filled with misinformation, not only about the vaccine, but early into the Covid outbreak, we heard different conspiracy theories about the origins of Covid. There has been a rapid uptake of this information to what we call an infodemic.”

Mzungu said the country’s high youth unemployment rate, coupled with the problem of expensive data, meant that young people were unable to access the facts they needed to verify information which worsened the infodemic among that group.

Mia Malan, the founding editor-in-chief of the Bhekisisa Centre for Health Journalism, described how the media outlet dealt with the rapid movement of scientific information on Covid-19 and filtered all the information they received to ensure the real facts went out.

“At Bhekisisa, pre Covid, we mainly used peer reviewed studies, so we would compare studies against each other and make sure journalists understood the methodology. But Covid changed everything as there were more preprints than peer reviewed studies coming out. A preprint study that hasn’t been peer reviewed makes it harder for journalists to know if a study is credible,” Malan said.

“So we started to rely on scientists more than ever to fact check the stories …”

“When you get something wrong during a pandemic it can literally have consequences of life and death and there are a lot of wrong facts currently going out in the media.”

Malan said the public spat between the Ministerial Advisory Committee (MAC) and the government while South Africa waited for the vaccines to arrive, had contributed to vaccine hesitancy.

“It had an impact on the level of trust that people have in the government to procure vaccines and design and implement policies. People’s trust in vaccines depend heavily on the provider of the vaccines, and if you don’t have a lot of trust in the provider, the uptake is reduced.”

Prof Hassan Mahomed, Public Health Specialist in the Western Cape Department of Health, said the provincial department also relied on trusted scientists to counter the effects of the infodemic.

They also made use of information from ‘credible organisations’, such as the World Health Organisation (WHO) and the US CDC, as well as South Africa’s NICD.

“We had to ensure we kept in line with the best evidence available.”

Mahomed said various national and local surveys had found there is not a lot of trust in the government as a source of information, although many people do trust their local doctor or nurse and community and religious leaders. He said other barriers to vaccine uptake are a lack of access to the vaccine and the lack of technology to use the electronic system to register for the vaccine.

“We found through our surveys that the number of people completely opposed to the vaccine is actually small – about 10 to 15%. A large percentage of people are just unsure. They want information from a trusted source.

“The key issue is trust – trust in science, trust in government, trust in local leaders. This is something that must be developed further – and it takes time. It’s something government has struggled with.”

Yaseen Theba, chairman of the Muslim Association of South Africa (MASA), a non-profit organisation that has successfully collaborated with the Gauteng authorities to assist in the vaccination campaign, said the pandemic had highlighted the problem of information overload.

He agreed that the issue of trust is key in promoting vaccine uptake. “When ward councillors, community leaders or faith-based leaders drove campaigns to get people vaccinated, we saw a big uptake in vaccinations and that’s because those people are trusted. For example, when people were vaccinated in a community centre like a mosque, it changed their perception and drove them towards getting vaccinated as it was happening in a place they were familiar with and among community members they trusted.”

FMHS Marketing & Communications – Sue Segar