Why unvaccinated South Africans refused Covid shots



SALDRU conducted two surveys of unvaccinated South Africans and found that hesitancy about a Covid-19 vaccine is not only high but deeply rooted.


South Africa is currently facing a new wave of infections associated with the much higher transmissibility of the Omicron Covid-19 variant and its sub-variants.

The latest surge of Covid-19 had the same characteristics as the fourth wave in January 2022: the increase in infections was not accompanied by a similar increase in hospitalizations and deaths.

These changes present a challenge for policy makers trying to improve vaccine use, especially among vulnerable groups.

People more vulnerable to severe Covid-19 illness include the elderly and those with underlying medical conditions.

Vaccination in South Africa

The South African government has goal vaccination of 67% of the population by the end of 2021. But the pace is much lower than that.

As of May 22, 2022 only 31.4% population has been vaccinated.

Understanding the depth of vaccine hesitancy and the reasons behind the lack of response is critical to preventing more deaths, infections and continued damage to the economy.

The adoption of a vaccine is particularly important for the country due to HIV prevalence rate 13% and the fact that it has the highest TB-TB/HIV association in the world.

Both are known correlates of mortality from Covid-19.

Vaccine hesitancy in South Africa

We participated in research to understand the level of vaccination hesitancy in the country, to get an idea of ​​how vaccine use can be increased, especially among high-risk groups.

Two Polls unvaccinated South Africans. The first was from November 15 to December 15, 2021.

The Omicron variant was announced a few weeks earlier.

second poll consisted of 3608 unvaccinated persons, about half of whom were re-interviewed during Survey 1, and 386 persons vaccinated between Surveys 1 and 2.

The dataset cannot be considered a prevalence survey or nationally representative.

However, this was a diverse sample, covering a wide range of race, eligible age groups, province, income level, and geographic area.

We found that vaccine distrust in our sample was high and ingrained since December 2021.

We also tested the likely success of messaging and information campaigns, as well as how the information was designed and disseminated.

Understanding the exact reasons for vaccine mistrust is key to designing these interventions.

Vaccine hesitancy in South Africa

Most of the people we spoke to didn’t want to get vaccinated. A small part is still undecided.

Fewer than one in five intended to get vaccinated as soon as possible, half of that number reported in December 2021.

More than a third definitely did not intend to be vaccinated. A quarter of respondents said they would only get vaccinated if mandated to do so.

It is worrying that those with chronic diseases have been vaccinated no more than others. Vaccine refusal was very high among older respondents.

And we found that access did not figure at all as a reason for not vaccinating among the most resistant (large group).

Vaccine awareness is vital

Our results showed that there is a need to spread the word about the need for a vaccine, despite the current context of Omicron.

Few of the respondents we spoke to thought they needed a vaccine, and many cited a very low personal risk of becoming seriously ill with Covid-19.

Many also thought the vaccine didn’t work and could kill them.

Few thought it would protect them from death.

Few believed the vaccine was safe for pregnant women, breastfeeding mothers, or the chronically ill.

distrust of the government

And only one in four of our entire sample says they have a lot of confidence in government information about Covid-19.

A very large number of respondents opposed the vaccination mandate (nearly 75% of the entire sample), although about half thought the mandate would work well.

Opponents overwhelmingly cited that it was the right of the individual to decide, with some saying that the President had said vaccination would not be mandatory.

Next steps

Given that mandates are likely to be used at work or school, with high unemployment rates in South Africa, mandates may not lead to significant increases in vaccination rates and should be approached with caution.

Messaging campaigns are a tool often used to improve response and are attractive because of their low cost.

We checked two messages about vaccine promotion (which is part of the decision to end the pandemic or vaccinate for more freedom) and found little effect on vaccine intentions.

The project also included proof of concept testing political messaging and getting results quickly.

Our results indicated that targeted campaigns would be needed among groups with greater hesitation or risk taking.

The surveys allowed us to identify some of the key determinants of vaccination levels and established that policies should not stop after vaccination – further communication should ensure that people return for re-vaccination and share their positive vaccination experience with others.

Concerns about the safety of the vaccine must be allayed, and building confidence in its effectiveness is critical to boosting vaccination rates.

This information will need to come from innovative sources, given the low credibility of government information about Covid-19.


Kathryn Eyal, Research Fellow, South African Labor and Development Research Group (SALDRU), University of Cape Town.

This article is republished from The Conversation under a Creative Commons license. Read original article.