Predictors of COVID-19 Vaccine Hesitancy in South African Local Communities: The VaxScenes Study

Patrick D M C Katoto; Saahier Parker; Nancy Coulson; Nirvana Pillay; Sara Cooper; Anelisa Jaca; Edison Mavundza; Gregory Houston; Candice Groenewald; Zaynab Essack; Jane Simmonds; Londiwe Deborah Shandu; Marilyn Couch; Nonkululeko Khuzwayo; Nobukhosi Ncube; Phelele Bhengu; Heidi van Rooyen; Charles Shey Wiysonge

doi:10.3390/vaccines10030353

Predictors of COVID-19 Vaccine Hesitancy in South African Local Communities: The VaxScenes Study

Vaccines (Basel). 2022 Feb 25;10(3):353. doi: 10.3390/vaccines10030353.

Authors

Patrick D M C Katoto^{1

2

3}, Saahier Parker⁴, Nancy Coulson^{5

6}, Nirvana Pillay^{5

7}, Sara Cooper¹, Anelisa Jaca¹, Edison Mavundza¹, Gregory Houston⁴, Candice Groenewald^{4

8}, Zaynab Essack^{4

9}, Jane Simmonds¹⁰, Londiwe Deborah Shandu⁴, Marilyn Couch^{4

9}, Nonkululeko Khuzwayo⁴, Nobukhosi Ncube⁵, Phelele Bhengu^{1

11}, Heidi van Rooyen^{4

12}, Charles Shey Wiysonge^{1

2

13}

Affiliations

¹ Cochrane South Africa, South African Medical Research Council, Cape Town 7501, South Africa.
² Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa.
³ Centre for General Medicine and Global Health, Department of Medicine, University of Cape Town, Cape Town 7505, South Africa.
⁴ Human Sciences Research Council, Cape Town 8000, South Africa.
⁵ The Sarraounia Public Health Trust, Johannesburg 2193, South Africa.
⁶ Wits Mining Institute, University of the Witwatersrand, Johannesburg 2050, South Africa.
⁷ School of Public Health, University of the Witwatersrand, Johannesburg 2050, South Africa.
⁸ Department of Psychology, Rhodes University, Grahamstown 6140, South Africa.
⁹ South African Research Ethics Training Initiative (SARETI), University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa.
¹⁰ South African Medical Research Council, Cape Town 7501, South Africa.
¹¹ Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa.
¹² SAMRC-Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa.
¹³ School of Public Health and Family Medicine, University of Cape Town, Cape Town 7935, South Africa.

Abstract

South Africa launched a mass COVID-19 vaccination campaign in May 2021, targeting 40 million adults. Understanding predictors of COVID-19 vaccine intentions was required to achieve this goal. We conducted a population-based survey in June-July 2021 using the WHO Behavioral and Social Drivers (BeSD) of COVID-19 Vaccination tool to determine predictors of vaccine hesitancy, defined as intention to refuse or uncertainty whether to accept COVID-19 vaccination. There were 1193 participants, mean age 39 (standard deviation 15) years, and 53% women, of whom 58% trusted information provided by healthcare workers and 32% were vaccine hesitant. Independent predictors of vaccine hesitancy included concerns about side effects (odds ratio (OR) 11.41; 95% confidence interval (CI) 3.5-50.80), lack of access to the online vaccine registration platform (OR 4.75; CI 2.15-10.37), distrust of government (OR 3.0; CI 1.33-6.77), belief in conspiracy theories (OR 3.01; CI 1.32-6.77), having no monthly income (OR 1.84; CI 1.12-3.07), and depending on someone else to make vaccination decision (OR 2.47; CI 1.06-5.77). We identified modifiable predictors of vaccine hesitancy at the start of South Africa's COVID-19 vaccination rollout. These factors should be addressed by different stakeholders involved in the national immunization program through tailored communication and other effective strategies that increase vaccine literacy, reach low-income households, and engender confidence in government.

Keywords: SARS-CoV-2; behaviors; immunization; social drivers; vaccine acceptance.