Community-based Case Studies of Vaccine Hesitancy and the COVID-19 Response in South Africa; The VaxScenes Study

Abstract

Background South Africa has reported more than half of all COVID-19 cases and deaths in Africa. The South African government has launched a large COVID-19 immunization campaign with the goal of reaching more than 40 million individuals. Nonetheless, certain international, largely internet-based surveys have shown a significant proportion of vaccine hesitancy in South Africa. This study aims to determine and co-create with local stakeholders a comprehensive understanding of vaccine hesitancy and opportunities to support the promotion of other COVID-19 health-promoting behaviours at community level. Methods and design A mixed-methods, multiple case-study design; informed by the socio-ecological model of behaviour change. Four socio-economically diverse communities across South Africa will be selected and data collection will take place concurrently through three iterative phases. Phase 1 will provide insights into community experiences of COVID-19 (response) through desktop mapping exercises, observations, in-depth interviews, and focus group discussions (FGDs) designed as expression sessions with local stakeholders. Phase 2 will explore the extent and drivers of community acceptance of COVID-19 vaccines. This phase will comprise a quantitative survey based on WHO’s Behavioural and Social Drivers of Vaccination tool as well as further FGDs with community members. Phase 3 will involve cross-case study syntheses and presentation of findings to national role-players. Discussion This study will provide ground up, locally responsive, and timeous evidence on the factors influencing COVID-19 health-seeking behaviours to inform ongoing management and mitigation of COVID-19 in South Africa. It will also provide insights into the applicability of a novel vaccine hesitancy model in Africa.

Community-based case studies of vaccine hesitancy and the COVID-19 response in South Africa - study protocol

“…We also deposited an earlier version of the study proposal in a preprint server. 46 Data availability Extended data Figshare: Questionnaires for the "Community -based case studies of vaccine hesitancy and the COVID-19 response in South Africa" https://doi.org/10.6084/m9.figshare.21548826.v1. 47 This project contains the following extended data: -Data_BeSD_in_RSA_Wiysonge_14nov2022.docx (All interview, focus group and questionnaire tools) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).…”

A Qualitative Analysis of Social-Ecological Factors Shaping Childhood Immunisation Hesitancy and Delay in the Eastern Province of Saudi Arabia

“…Rural communities, with fewer providers and limited facilities, also struggle to access healthcare services, impacting immunisation rates [ 18 , 29 , 30 ]. Social norms perpetuate false narratives and vaccine conspiracy theories, reducing the intention to immunise [ 21 , 31 ]. Myths within communities, such as concerns about live viruses or autism links, contribute to negative perceptions of vaccines.…”

Addressing COVID-19 vaccine hesitancy in South Africa- moving beyond a reliance on information-based responses

“… 13 For example, we have found that practical challenges around access and logistical issues pertaining to vaccination services are major contributors to COVID-19 vaccine hesitancy in the country. 6 , 7 Specifically, questions of geography, transport and other (opportunity) costs associated with accessing vaccination services, long queues and waiting times at vaccination services, and difficulties around navigating the online registration system all impacted on people’s unwillingness to get vaccinated. There is therefore a need for ongoing and enhanced strategies which target the structural and service-level factors that hinder access and convenience around COVID-19 vaccination.…”

“…We have also found that experiences of poverty and marginalization may provide a fertile ground for COVID-19 vaccine hesitancy in South Africa. 6 The pandemic has had dire economic consequences, including generating or exacerbating poverty, food insecurity, a lack of social support, unemployment and a real sense of hopelessness for so many individuals and communities. 27 Context matters.…”

“…Our and others’ research has also highlighted how the ongoing geopolitics surrounding COVID-19 and COVID-19 vaccines – persistent vaccine nationalism, vaccine diplomacy, donor dependency, patent laws – are an additional driver of vaccine hesitancy in South Africa. 6 , 28 Such geopolitics have produced outrageous inequities in COVID-19 vaccine access between the Global North and Global South, including South Africa. 29 They are also stark reminders of a painful history of (medical) colonialism and more recent incidences of patent laws and commercial interests denying communities access to the very drug treatments which were tested on them as research participants (antiretroviral treatment for HIV is a case in point in this regard).…”