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Background: South Africa faced challenges while implementing coronavirus disease 2019 (COVID-19) measures such as mass vaccination. Some people rejected or were hesitant to receive government-recommended vaccines. This study explored COVID-19 vaccination hesitancy among unvaccinated individuals in a primary care setting in Pretoria, South Africa., Methods: This was an exploratory phenomenological study that included one-on-one interviews with 12 individuals at Temba Community Health Centre in Pretoria, South Africa., Results: The research revealed five themes: perceptions of COVID-19 disease, perceptions of COVID-19 vaccine, factors related to non-vaccination, information sources about the COVID-19 vaccine, and long-term vaccination decisions. There were seven linked sub-themes., Conclusion: Overall, participants had a good understanding of COVID-19 disease, but limited knowledge about the vaccine, causing hesitancy to get vaccinated. Reasons for not getting vaccinated included health-related concerns, safety concerns, personal experiences, and social and political factors. Safety and health-related concerns were prevalent, with adverse vaccine outcomes being the most common concern. Most participants had experienced a historic encounter with a vaccine-related death or illness.Contribution: Vaccine hesitancy should be viewed as a powerful concern from the community, and a key source of worry for the health authorities over any vaccine-related doubt.

Background: Amidst widespread public health recommendations and availability of COVID-19 vaccinations, half of South African adults are vaccinated against COVID-19. This study investigated the socio-behavioral determinants of vaccine hesitancy in South Africa, where vaccine hesitancy was separated into unwilling ness and uncertainty to take a COVID-19 vaccine., Methods: Data was collected from a large-scale public survey during June-October 2021 that included online and telephonic surveys. Vaccination hesitancy was based on the question "When available, would you take the COVID 19 vaccine?," with responses categorized into those who were willing, unwilling, and uncertain about taking a COVID-19 vaccine. Multinomial regression examined the association between socio-behavioral variables and vaccine hesitancy., Results: Overall, 73.8% reported they would definitely or probably take the vaccine, 16.4% were uncertain and 9.9% reported they probably or definitely would not ( n  = 16,988). Younger age, White and Colored population groups, no influenza vaccination history, previous vaccination refusal, knowing someone who experienced a serious vaccination side-effect, misperceptions about vaccine benefits, cultural or religious discouragement from taking a COVID-19 vaccination, lack of governmental confidence, concerns about side-effects, perceived lack of safety information, and lack of trust in the pharmaceutical industry and in the information from health care providers were all associated with higher odds of being uncertain and unwilling to take a COVID-19 vaccination. Strengths of association for unwillingness and uncertainty varied by the explanatory variables. Concern about effectiveness due to fast development was associated with uncertainty to take the vaccine but not with unwillingness. Concerns about side-effects had stronger associations with uncertainty than with unwillingness, while previous vaccine refusal, misperceptions of the protective benefits of vaccines, White population group, religious/cultural discouragement, and lack of trust in the pharmaceutical industry and health care providers' information had stronger associations with unwillingness than uncertainty., Conclusion: The determinants of COVID-19 vaccine hesitancy should be addressed in interventions to improve vaccine uptake. Public health interventions and health communication can be prioritized and tailored to the different forms of vaccination hesitancy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Sewpaul, Sifunda, Gaida, Mokhele, Naidoo and Reddy.)

Aim: Within the context of increasing mental distress noted since the beginning of the COVID19 pandemic, the study aims at analysing the relationship between mental health, vaccine distrust and vaccine hesitancy in South Africa., Subject and Methods: The study uses nationally representative panel data of 3241 individuals interviewed prior to and during the COVID19 pandemic. The study uses a range of regression techniques including logit, mediation and gradient-boosted causal mediation models to identify the causal relationship while accounting for selection bias., Results: The results of multivariate logit regression reveal that vaccine distrust is the most important predictor of vaccine hesitancy [Coeff: 3.420, CI 3.122, 3.717]. Mental distress is not found to be a significant driver in a fully specified logit model, pointing to the need to analyse the pathways through which mental distress impacts vaccine hesitancy. The mediation regression undertaken for this purpose finds that the mental distress has a positive and significant association with vaccine distrust [Coeff: 0.027, CI: 0.0029, 0.052]. The increased vaccine distrust in turn results in increased vaccine hesitancy [Coeff: 0.661, CI: 0.611, 0.711]. The results of mediation regression therefore indicate strong and significant mediation effects, whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust. These results are robust to the gradient boosted causal mediation model which establishes strong and significant indirect effects [Coeff: 0.015, CI: 0.01, 0.019], whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust., Conclusion: The study concludes that mental health impacts on vaccine intention through the mediating role of vaccine distrust. The findings indicate that individuals at high risk of depression are more concerned regarding the safety of vaccines, which in turn feeds into vaccine hesitancy. Therefore, depressive symptoms impact on vaccine hesitancy through the mediating factor of vaccine distrust., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kollamparambil et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Vaccine hesitancy, long considered a global health threat, poses a major barrier to effective roll-out of COVID-19 vaccination. With less than half (45%) of adult South Africans currently fully vaccinated, we identified factors affecting non-uptake of vaccination and vaccine hesitancy in order to identify key groups to be targeted when embarking upon COVID-19 vaccine promotion campaigns. A cross-sectional, anonymous online survey was undertaken among the South African adult population in September 2021. Our research identified race, interactive-critical vaccine literacy, trust in the government's ability to roll out the COVID-19 vaccination programme, flu vaccination status and risk perception for COVID-19 infection as key factors influencing the uptake of COVID-19 vaccination. Respondents who did not trust in the government's ability to roll out vaccination were almost 13 times more likely to be vaccine-hesitant compared to those respondents who did trust the government. Reliable, easy-to-understand information regarding the safety of COVID-19 vaccines is needed, but it is also important that vaccination promotion and communication strategies include broader trust-building measures to enhance South Africans' trust in the government's ability to roll out vaccination effectively and safely. This may also be the case in other countries where distrust in governments' ability prevails.

Background: To date, COVID-19 vaccine coverage in the African region falls far too short of global goals. Increasing vaccination rates requires understanding barriers to vaccination so that effective interventions that sensitively and effectively address barriers to vaccination can be implemented., Methods: To assess COVID-19 vaccination levels and identify major barriers to vaccine uptake we conducted a population-based, cross-sectional survey among 1662 adults 18 and older from August 25 to October 29 2021 in the Agincourt Health and Socio-Demographic Surveillance System (AHDSS) area, Mpumalanga, South Africa., Results: Half of participants reported receiving a COVID-19 vaccine (50.4%) with 41.1% being fully vaccinated and 9.3% being partially vaccinated; 49.6% were unvaccinated. More women than men were vaccinated (55.5% vs 42.8%, P < 0.001), and older age groups were more likely to be vaccinated than younger age groups (P < 0.001). Among the unvaccinated, 69.0% planned to get vaccinated as soon as possible, while 14.7% reported definitely not wanting the vaccine. Major barriers to vaccination included lacking information on eligibility (12.3%) or where to get vaccinated (13.0%), concerns about side effects (12.5%), and inconvenient hours and locations for vaccination (11.0%). Confidence in the safety and efficacy of COVID-19 vaccines was higher among those vaccinated than unvaccinated (75.3% vs 51.2%, 75.8% vs 51.0%, both P < 0.001, respectively)., Conclusions: Increasing vaccination in South Africa beyond current levels will require a concerted effort to address concerns around vaccine safety and increase confidence in vaccine efficacy. Clarifying eligibility and ensuring access to vaccines at times and places that are convenient to younger populations, men, and other vulnerable groups is necessary., Competing Interests: Competing interests: The authors completed the ICMJE Unified Competing Interest Form (available upon request from the corresponding author) and declare no conflicts of interest. Harry Campbell is the Co-Editor in Chief of the Journal of Global Health. To ensure that any possible conflict of interest relevant to the journal has been addressed, this article was reviewed according to the best practice guidelines of international editorial organisations., (Copyright © 2022 by the Journal of Global Health. All rights reserved.)

Background: Vaccine hesitancy is emerging as a significant challenge in many parts of the world in the fight against the COVID19 pandemic. The continued infection amongst the unvaccinated can lead to a heightened risk of further virus mutation, exposing even those vaccinated to new virus strains. Therefore, there are social benefits in minimising vaccine hesitancy. The objective of this study is to assess the level of COVID19 vaccine hesitancy in South Africa, identify the socio-economic patterns in vaccine hesitancy and highlight insights from the national survey that can inform the development of a COVID-19 vaccination acceptance communication campaign., Methods: The study uses the nationally representative National Income Dynamics Study - Coronavirus Rapid Mobile Survey (NIDS-CRAM) survey. The analysis combines univariate and bivariate statistics, as well as multivariate regression models like binomial/ordinal and multinomial logit., Results: The study finds that vaccine acceptance is lower than that of non-pharmaceutical intervention like face-mask use. Only 55% fully accept the vaccine, while a further 16% are moderately accepting of vaccines. Together, vaccine acceptance is estimated at 70.8%, and vaccine hesitancy against COVID19 is estimated at 29.2% amongst the adult South African population. The study has identified the perceived risk of infection with the mediating role of efficacy as a key predictor of vaccine intention. Higher awareness of COVID19 related information and higher household income are correlated with lower vaccine hesitancy. The non-black African population group has significantly high vaccine hesitancy compared to black Africans., Conclusions: There are other significant differences across socio-economic and demographic variables in vaccine hesitancy. From a communication perspective, it is imperative to continue risk messaging, hand in hand with clearer information on the efficacy of the vaccines., (© 2021. The Author(s).)

Vaccine hesitancy is a widely noted challenge in the struggle against communicable diseases. This was clearly demonstrated in the Covid-19 vaccine drives in South Africa and the world over. While social responses to vaccines are well documented, the literature tells the story of vaccine hesitancy through a singular focus on individuals who, motivated by various reasons, oppose a public health intervention. Such a one-sided exploration perpetuates the "single story" of vaccine hesitancy and overlooks the role of other actors and processes that may have an influence on how people perceive vaccines. My research looks beyond this "single story" of vaccine hesitancy by adding the dimension of an ethnographic exploration of a wide range of public health professionals — epidemiologists, virologist, pathologists, nurses and registrars — who are tasked with safeguarding the population in Gauteng province against the spread of communicable diseases. [ABSTRACT FROM AUTHOR]

The South African (SA) government's roll-out of the COVID-19 vaccine is behind its target, largely owing to concerns about the sideeffects and the effectiveness of the vaccines, and because they have been developed over a very short time frame. Another factor is a lack of trust in government policies regarding COVID-19 and its running of public health. One survey has indicated that for persons seeking a vaccination, the preferred vaccine site would be general practitioners (GPs). GPs have been used in Australia, the UK and elsewhere. In Australia, with a scattered rural population, 5 600 GPs have been vaccinating over one million patients weekly. Calls have been made by the South African Medical Association, among others, for GPs to be allowed to assist with the government's roll-out programme. If ~8 000 GPs in SA participated in a properly administered roll-out programme, and each GP were to vaccinate only 10 people a day, this would yield 400 000 vaccinations a week or ~1.6 million a month. The GPs could invite their patients and others to visit their room for a COVID-19 vaccination, as they do with the annual influenza vaccine.

Historically, vaccine hesitancy (VH) has been a thorn in the side of public health efforts to contain and eradicate infectious diseases. This phenomenon is magnified in light of the current coronavirus disease 2019 (COVID-19) pandemic. Surveys conducted across South Africa since the outbreak of COVID-19 demonstrate the complexity of factors that contribute towards VH in this population. Amidst the negative press that the COVID-19 vaccine has received, especially across social media, understanding and combatting VH remains important to achieve herd immunity. This article aims to shed light on key factors fuelling COVID-19 VH in South Africa and provides a framework from which to address this problem.

Introduction : Acceptance of COVID-19 vaccines is critical to personal health, protecting vulnerable populations, reopening socio-economic life, and achieving population health and safety through immunity. The primary aim of this review was to investigate the extent and determinants of COVID-19 vaccine hesitancy in South Africa to inform the development of strategies to address it. A secondary aim was to enhance understandings of and responses to vaccine hesitancy more generally in South Africa, with potential positive effect on vaccination uptake during and beyond the COVID-19 pandemic. Areas covered : We reviewed the findings from surveys conducted in South Africa from February 2020 to March 2021 that investigated acceptance of COVID-19 vaccines. Surveys were identified through searching electronic databases of peer-reviewed and gray literature and contacting experts. Expert opinion : The review reveals the inherently social nature of COVID-19 vaccine hesitancy in South Africa, potentially influenced by age, race, education, politics, geographical location, and employment. Along with the provision of information, COVID-19 vaccine communication strategies need to form part of broader trust-building measures that focus on relationships, transparency, participation, and justice. The pandemic also provides a unique opportunity to positively intervene and reduce vaccine hesitancy trends more generally in South Africa and potentially elsewhere.

Background: As mortality declined significantly during the fourth and fifth waves compared to previous waves, the question of the future role of COVID-19 vaccination arose among both experts and the public in South Africa. Turning attention away from the general public, now considered to be at very low risk of severe COVID-19 disease, a commonly held view was that the vaccination campaign should focus only on those who remain highly vulnerable to severe disease and death from COVID-19. Primary amongst this group are patients with common chronic diseases attending hospital outpatient departments. We hypothesized that providing COVID-19 vaccinations on-site at a central hospital will increase uptake for the patients with co-morbid chronic conditions who need them most in the Omicron phase of the pandemic. Aim: Evaluate the acceptability, need, and uptake of a hospital-based vaccination site for patients attending the medical hospital outpatient departments. Objectives: To assess vaccination uptake, coverage, and hesitancy in people attending a central hospital, to determine factors associated with and influencing vaccination uptake, and to document implementation and assess acceptability of the vaccination project among staff and persons attending the hospital. Methods: Mixed-methods study using quantitative and qualitative methods. Results: Of the 317 participants enrolled in the study, 229 (72%) had already received at least one dose of the COVID-19 vaccine. A total of 296 participants were eligible for a first vaccination, additional vaccination, or booster vaccination according to the South African Department of Health guidelines. Of those previously vaccinated, 65% opted for an additional dose on the day it was offered (same day). Only 13 previously unvaccinated participants (15% of vaccine naïve participants) opted for vaccination, increasing vaccine coverage with at least one dose from 72% to 76%. Approximately 24% (n = 75) of all participants refused vaccination (vaccine hesitant). Variables tested for an association with vaccination status demonstrated that age reached statistical significance. Emerging themes in the qualitative analysis included perceptions of vulnerability, vaccine safety and efficacy concerns, information gaps regarding vaccinations, the value of convenience in the decision to vaccinate, and the role of health promoters. Conclusions: This study has shown that it is logistically acceptable to provide a vaccination site at a large hospital targeting patients attending outpatient services for chronic medical conditions. This service also benefits accompanying persons and hospital staff. Access and convenience of the vaccination site influence decision-making, increasing the opportunity to vaccinate. However, vaccine hesitancy is widespread with just under one-quarter of all those offered vaccinations remaining unvaccinated. Strengthening health education and patient–clinician engagement about the benefits of vaccination is essential to reach highly vulnerable populations routinely attending hospital outpatient departments with an appropriate vaccination program. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy emerged as a highly contentious public health concern during the Covid-19 pandemic. Despite the pandemic becoming endemic, a proactive reflection on vaccine hesitancy among youth in South Africa is essential for understanding this cohort's vaccine behaviours for informing future public health interventions. Using a narrative review, we explore existing literature on vaccine hesitancy among youth in South Africa. We highlight existing literature on youth vaccine hesitancy using international and local research studies. This was necessary since our findings showed that there is a dearth of evidencedbased literature that has explored vaccine hesitancy among youth in the South African context. This review was challenged by the different age ranges that were used to define youth in different research studies. We conclude with recommendations for mitigating vaccine hesitancy in South African youth. [ABSTRACT FROM AUTHOR]

South Africa recently experienced the third wave of the coronavirus disease 2019 (COVID-19) pandemic. Social media is flooded with polarised conversations, with opinions for and against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. Many people are hesitant, and some are strongly opposed to vaccination. Vaccine hesitancy must be understood in historical, political and socio-cultural contexts. The aim of this study was to offer a valuesdriven approach to vaccine hesitancy conversations. It focusses on ethical dilemmas forthcoming from values violations, interrogating the personal and institutional scripts and rationalisations that prevent resolution, and offering ways of re-scripting these. Values-driven conversations provide safe spaces for vaccine-hesitant individuals to voice their reservations. The manner in which conversations are conducted is as important as the contents being discussed. Healthcare professionals are trusted by the public and should use ways of conversing that do not erode this trust. Creating respectful, compassionate platforms of engagement and incentivising vaccination are important measures for change in vaccine perspectives. [ABSTRACT FROM AUTHOR]

The phenomenon of vaccine hesitancy is a growing threat to public health with far-reaching implications. The widening gap between the vaccinated and the proportion of vaccinated people needed for herd immunity raises two critical research questions that are of interest to practitioners, researchers, and policymakers: (1) What determines one's decision to be vaccinated? (2) What is the implication of COVID-19 vaccine hesitancy for economic recovery? In this study, we use empirical data in the context of South Africa to investigate factors affecting COVID-19 vaccine hesitancy and their implications for economic recovery. Findings reveal key socio-demographic and institutional drivers of COVID-19 vaccine hesitancy, which include age (the youth are more hesitant), inadequate information on the vaccine (those who perceive they have adequate information are vaccinated), trust issues in government institutions, conspiracy beliefs, vaccine-related factors, and perceived side effects associated with the vaccine. Additionally, an individual's decision to remain hesitant about COVID-19 vaccination has implications for businesses and the economy by limiting movement and trade, increasing unemployment, and causing a resurgence of new variants. Based on the findings, action plans such as information dissemination, convenience vaccination centers, consistent communications, and targeted campaign strategies are recommended for improving vaccine uptake and a positive economic recovery. [ABSTRACT FROM AUTHOR]

Background: Vaccine hesitancy and a distrust of the COVID-19 vaccine is widespread in many African nations, stemming from historic medical abuses and low confidence in governments. While studies have examined drivers of vaccine hesitancy in Africa, little is known about vaccine spillover effects: how prior experiences with vaccines influence individuals' confidence in vaccines and future vaccination behaviors., Methods: In a large online survey conducted across three African countries (Kenya, N = 1545; Nigeria, N = 1557; South Africa, N = 1588), we examined five measures of vaccine spillover: how experiences with the COVID-19 vaccination process influenced respondents' confidence in the safety, efficacy, and importance of all vaccines approved for use in their country, and the likelihood of vaccinating themselves or their children in the future. Multivariate binary logistic regression analyses were conducted to determine factors associated with each of the five outcome measures., Results: Large numbers of individuals in all three countries experienced positive vaccine spillover: becoming more likely to vaccinate in the future and experiencing greater confidence in vaccines, due to their prior experiences with the COVID-19 vaccination process. The highest positive spillover effects were observed in Kenya, with 71 % reporting a greater likelihood of vaccinating themselves in the future, compared to just 60.1 % of Nigerian respondents and 51.7 % of South African respondents. Multivariate models provide evidence that demographic correlates of positive vaccine spillover vary across nations; however, prior vaccination, misinformation endorsement, and confidence in government both consistently predict spillover in all three nations., Conclusion: These findings suggest that while drivers of vaccine spillover are country specific, strategies to address COVID-19 misinformation and to strengthen individuals' trust in government may help facilitate greater vaccine uptake in the future., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This project was funded by the Scowcroft Institute for International Affairs at the Bush School of Government and Public Service at Texas A&M University. All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Migrant populations (asylum seekers, permit holders, refugees, and undocumented migrants) living in South Africa face various individual, social, and physical circumstances that underpin their decisions, motivation, and ability to receive the COVID-19 vaccine. We conducted a qualitative study to explore the experiences and perceptions of migrant populations in South Africa on COVID-19 vaccines to inform recommendations for improved COVID-19 immunization., Methods: We conducted an Interpretative Phenomenological Analysis (IPA) with 20 asylum seekers, permit holders, refugees, and undocumented migrants living in South Africa. We applied a maximum variation purposive sampling approach to capture all three categories of migrants in South Africa. Semi-structured interviews were conducted and recorded electronically with consent and permission from the study participants. The recordings were transcribed and analyzed thematically following the IPA using Atlas.ti version 9., Results: Four major reflective themes emanated from the data analysis. (1) While some migrants perceived being excluded from the South African national immunization program at the level of advertisement and felt discriminated against at the immunization centers, others felt included in the program at all levels. (2) Skepticism, myths, and conspiracy theories around the origin of SARS-CoV-2 and the COVID-19 vaccine are pervasive among migrant populations in South Africa. (3) There is a continuum of COVID-19 vaccine acceptance/hesitancy ranging from being vaccinated through waiting for the chance to be vaccinated to refusal. (4) Accepting the vaccine or being hesitant follows the beliefs of the participant, knowledge of the vaccine's benefits, and lessons learned from others already vaccinated., Conclusion: COVID-19 vaccine inclusiveness, awareness, and uptake should be enhanced through migrant-aware policies and actions such as community mobilization, healthcare professional training, and mass media campaigns., Competing Interests: Declarations Ethics approval and consent to participate Ethics approval was obtained from the Humanities and Social Sciences Research Ethics Committee of the University of the Western Cape (HS20/6/6). The following ethical conditions were adhered to after obtaining ethics clearance: Informed consent was signed by each participant before participating in the in-depth interviews. Before they signed the informed consent form, each participant was debriefed on the research purpose, aims, and objectives of the study and the research process. The participants were also informed of their rights to withdraw from the study and the interview at any time they wanted without any consequences, like being reported to the authorities of their immigration status. Participants were encouraged to ask questions to obtain clarity about the study. Permission was obtained from the different social organizations where the participants were sampled. Participants also agreed that the interview sessions should be audio recorded. To ensure confidentiality, we only used the first names of the participants and their countries of origin when reporting excerpts from their interviews. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Healthcare workers (HCWs) were the first population group offered coronavirus disease 2019 (COVID-19) vaccines in South Africa because they were considered to be at higher risk of infection and required protecting as they were a critical resource to the health system. In some contexts, vaccine uptake among HCWs has been slow, with several studies citing persistent concerns about vaccine safety and effectiveness. This study aimed to determine vaccine uptake among HCWs in South Africa whilst identifying what drives vaccine hesitancy among HCWs. We adopted a multimethod approach, utilising both a survey and in-depth interviews amongst a sample of HCWs in South Africa. In a sample of 7763 HCWS, 89% were vaccinated, with hesitancy highest among younger HCWs, males, and those working in the private sector. Among those who were hesitant, consistent with the literature, HCWs raised concerns about the safety and effectiveness of the vaccine. Examining this further, our data revealed that safety and effectiveness concerns were formed due to first-hand witnessing of patients presenting with side-effects, concern over perceived lack of scientific rigor in developing the vaccine, confidence in the body's immune system to stave off serious illness, and both a general lack of information and distrust in the available sources of information. This study, through discursive narratives, provides evidence elucidating what drives safety and effectiveness concerns raised by HCWs. These concerns will need to be addressed if HCWs are to effectively communicate and influence public behaviour. HCWs are key role players in the national COVID-19 vaccination programme, making it critical for this workforce to be well trained, knowledgeable, and confident if they are going to improve the uptake of vaccines among the general population in South Africa, which currently remains suboptimal. [ABSTRACT FROM AUTHOR]

Whilst many lessons were learned from the COVID-19 pandemic, ongoing reflection is needed to develop and maintain preparedness for future outbreaks. Within the field of infectious disease and public health there remain silos and hierarchies in interdisciplinary work, with the risk that humanities and social sciences remain on the epistemological peripheries. However, these disciplines offer insights, expertise and tools that contribute to understanding responses to disease and uptake of interventions for prevention and treatment. In this Perspective, using examples from our own cross-disciplinary research and engagement programme on vaccine hesitancy in South Africa and the United Kingdom (UK), we propose closer integration of expertise, research and methods from humanities and social sciences into pandemic preparedness., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Frampton, Orievulu, Matthews, Giubilini, Hordern, Burns, Elias, Friederich, Majozi, Martin, Stevenson, Vanderslott and Seeley.)

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Introduction: Despite a high number of recorded COVID-19 infections and deaths in South Africa, COVID-19 vaccine coverage remained low in March 2022, ten months into the national vaccine roll-out. This study provides evidence on the correlates of vaccine intentions, attitudes towards vaccination and opinions about mandates. Methods: We used data from the second COVID-19 Vaccine Survey (CVACS), a telephone survey conducted February-March 2022 among 3,608 South African adults who self-reported not being vaccinated against COVID-19. The survey instrument was designed in consultation with government, policymakers, and civil society; and segmented the sample into four distinct groups with different vaccine intentions (synonymous with vaccine hesitancy levels). Kruskal-Wallis and Mann-Whitney tests were used to examine the sociodemographic characteristics, attitudes and behaviours associated with the different vaccination intentions groups. Thematic coding of responses to open-ended questions elicited insights on reasons for not being vaccinated and attitudes towards mandates. Results: Intentions to get vaccinated were greater among individuals with lower socio-economic status (Mann–Whitney Z = -11.3, p < 0.001); those believing the vaccine protects against death (Kruskal–Wallis Χ2 = 494, p < 0.001); and those who perceived themselves at risk of COVID-19-related illness (Χ2 = 126, p < 0.01). Vaccine intentions were lower among individuals who believed that the vaccine causes death (Χ2 = 163, p < 0.001); believed that the vaccine is unsafe for the babies of pregnant/breastfeeding mothers, or the chronically ill (Χ2 = 123, p < 0.01); those not trusting government health information about COVID-19 and the COVID-19 vaccine (Kendall's τ = -0.41, p < 0.01); and those in opposition to mandates (τ = 0.35, p < 0.001). Only 25% supported mandates, despite 48% thinking mandates would work well, with 54% citing individual rights as their main reason for mandate opposition. Conclusion: The profile of individuals not vaccinated against COVID-19 as of March 2022 varied markedly by self-reported vaccination intentions, underscoring the importance of tailored demand-creation efforts. This paper highlights several factors which differ significantly across these groups. These findings could inform the design of future vaccination campaigns, potentially increasing their likelihood of success. This is an important policy objective given widespread vaccine hesitancy, and further work is required on this topic. Mandates remain an option to increase coverage but need to be carefully considered given extensive opposition. [ABSTRACT FROM AUTHOR]

Current WHO/UNICEF estimates of routine childhood immunization coverage reveal the largest sustained decline in uptake in three decades with pronounced setbacks across Africa. Although the COVID-19 pandemic has induced significant supply and delivery disruptions, the impact of the pandemic on vaccine confidence is less understood. We here examine trends in vaccine confidence across eight sub-Saharan countries between 2020 and 2022 via a total of 17,187 individual interviews, conducted via a multi-stage probability sampling approach and cross-sectional design and evaluated using Bayesian methods. Multilevel regression combined with poststratification weighting using local demographic information yields national and sub-national estimates of vaccine confidence in 2020 and 2022 as well as its socio-demographic associations. We identify declines in perceptions toward the importance of vaccines for children across all eight countries, with mixed trends in perceptions toward vaccine safety and effectiveness. We find that COVID-19 vaccines are perceived to be less important and safe in 2022 than in 2020 in six of the eight countries, with the only increases in COVID-19 vaccine confidence detected in Ivory Coast. There are substantial declines in vaccine confidence in the Democratic Republic of Congo and South Africa, notably in Eastern Cape, KwaZulu-Natal, Limpopo, and Northern Cape (South Africa) and Bandundu, Maniema, Kasaï-Oriental, Kongo-Central, and Sud-Kivu (DRC). While over 60-year-olds in 2022 have higher vaccine confidence in vaccines generally than younger age groups, we do not detect other individual-level socio-demographic associations with vaccine confidence at the sample sizes studied, including sex, age, education, employment status, and religious affiliation. Understanding the role of the COVID-19 pandemic and associated policies on wider vaccine confidence can inform post-COVID vaccination strategies and help rebuild immunization system resilience.

While vaccines are a well-established method of controlling the spread of infectious diseases, vaccine hesitancy jeopardizes curbing the spread of COVID-19. Through the Vaccine Information Network (VIN), this study explored barriers and motivators to COVID-19 vaccine uptake. We conducted 18 focus group discussions with male and female community members, stratified by country, age group, and—for Zimbabwe only—by HIV status. Participants' median age across both countries was 40 years (interquartile range of 22–40), and most (65.9%) were female. We conceptualized the key themes within the World Health Organization's Strategic Advisory Group of Experts on Immunization (SAGE) 3C (convenience, confidence, complacency) vaccine hesitancy model. Barriers to vaccine uptake—lack of convenience, low confidence, and high complacency—included inaccessibility of vaccines and vaccination sites, vaccine safety and development concerns, and disbelief in COVID-19's existence. Motivators to vaccine uptake—convenience, confidence, and low complacency—included accessibility of vaccination sites, user-friendly registration processes, trust in governments and vaccines, fear of dying from COVID-19, and knowing someone who had died from or become infected with COVID-19. Overall, vaccine hesitancy in South Africa and Zimbabwe was influenced by inconvenience, a lack of confidence, and high complacency around COVID-19 vaccines. [ABSTRACT FROM AUTHOR]

In combatting COronaVIrus Disease 2019 (COVID-19), immunization is the most prominent strategy. However, vaccination hesitancy—meaning delays in accepting or denying inoculation regardless of availability—has been identified as an essential threat to global health. Attitudes and perceptions play a pivotal role in vaccine acceptability. Meanwhile, uptake in South Africa's rollout has been particularly disappointing among youths. For that reason, we explored attitudes and perceptions of COVID-19 in 380 youths in Soweto and Thembelihle, South Africa, between April and June 2022. A staggering hesitancy rate of 79.2 percent was recorded (301/380). We found negative attitudes and confounded perceptions of COVID-19 to be fueled by medical mistrust and misinformation, with online channels as the main sources of non- and counterfactual claims stemming mostly from unregulated social media popular with youths. Understanding its underpinnings—and enhancing means of curbing vaccine hesitancy—will be paramount in boosting uptake in South Africa's immunization program, particularly among youths. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic had a significant impact on the mental health of individuals globally, and primary healthcare (PHC) nurses play a critical role in providing mental healthcare services. However, limited research has explored the experiences of PHC nurses in providing mental healthcare services during the COVID-19 pandemic. This study explored the experiences of PHC nurses in providing mental healthcare services during the pandemic in Durban, South Africa. The aim was to identify the challenges faced by healthcare providers and the potential for innovative approaches to improve access to care. A qualitative, exploratory design guided the study, and data were collected through in-depth interviews with twelve PHC nurses purposively selected. Thematic analysis was used to analyze the data. Findings from interviews with PHC nurses reveal that the pandemic exacerbated existing challenges, including medication adherence issues, fear and uncertainty among patients, vaccine hesitancy, decreased clinic visits, and the mental and emotional toll on both patients and healthcare workers. PHC nurses adapted their services by increasing outreach efforts, prioritizing patient care, and utilizing technology and non-governmental organizations' (NGOs) support. Challenges included reduced patient visits, complexities in healthcare provision, and a lack of adequate support. Positive changes observed include increased mental health awareness among healthcare professionals and younger generations. Recommendations include implementing outreach and awareness campaigns, providing accurate information about COVID-19 and vaccinations, and promoting cultural sensitivity in mental healthcare provision.

Introduction: At the onset of COVID-19 diagnostic radiographers from Gauteng, South Africa, shared their experiences of the new workflow and operations, their well-being and their resilience during this time. They experienced emotional, physical and financial fatigue. It is now over two years later, and South Africa has experienced four waves of COVID-19. Therefore, this study explored diagnostic radiographers' experience of COVID-19 after two years and four waves., Methods: A qualitative explorative, descriptive and contextual study was conducted by collecting data through nine virtual individual in-depth interviews. Responses from the diagnostic radiographers in Johannesburg, Gauteng, South Africa, underwent thematic analysis., Results: Thematic analysis revealed two themes and related categories. Theme one: participants shared synchronistic experiences with the four COVID-19 waves, the heterogeneous vaccination ideologies and their support and coping skills. Theme two: lessons learnt and the way forward., Conclusion: Participants shared feeling overwhelmed at the onset of COVID-19 and feared infecting their family, friends and colleagues. However, their anxiety and fear decreased with time. They experienced the Delta variant as the worst and felt supported by their colleagues more than by management. They recounted observations of vaccine hesitancy but acknowledged that vaccination had alleviated some of the fear and anxiety. Participants' coping skills varied, and reflecting on their experience, they shared the lessons learnt and the way forward., (Copyright © 2022. Published by Elsevier Inc.)

We assessed willingness to accept vaccination against coronavirus disease 2019 (COVID-19) among healthcare workers(HCWs) at the start of South Africa's vaccination roll-out. We conducted a cross-sectional survey among HCWs in Cape Town in March-May 2021 and assessed predictors of vaccination intentions. We recruited 395 participants; 64% women, 49% nurses, and 13% physicians. Of these, 233(59.0%) would accept and 163 (41.0%) were vaccine hesitant i.e. would either refuse or were unsure whether they would accept COVID-19 vaccination. People who did not trust that COVID-19 vaccines are effective were the most hesitant (p = 0.038). Older participants and physicians were more likely to accept vaccination than younger participants (p < 0.01) and other HCWs (p = 0.042) respectively. Other predictors of vaccine acceptance were trust that vaccines are compatible with religion (p < 0.001), consideration of benefits and risks of vaccination (p < 0.001), willingness to be vaccinated to protect others (p < 0.001), and viewing vaccination as a collective action for COVID-19 control (p = 0.029). COVID-19 vaccine hesitancy is high among HCWs in Cape Town. Reducing this would require trust-building interventions, including tailored education. [ABSTRACT FROM AUTHOR]

Unprecedented in scale, immense COVID-19 immunization programs have been rolled out globally. This article explores aspects of hypothetical vaccine acceptability in Soweto, South Africa, shortly before such vaccines became available. Whereas hypothetical acceptance was normative, this has not translated into uptake today, which remains concerningly low in South Africa, especially in Soweto. For that reason, we mobilize anthropological concepts to analyze acceptance, hesitancy, and denial to gauge public proclivity to inoculate. We found that COVID-19′s haphazard mediatization generated a 'field of suspicion' towards authorities and vaccination, which, amplified by dis- and misinformation, fostered othering, hesitancy, and denialism considerably. Further, we demonstrate that stated intent to immunize cannot be used to predict outcome. It remains paramount during vaccination rollouts to unveil and address aspects detrimental to vaccine confidence and selectivity, especially in lower-income groups for underlying context-specific cultural, spiritual, historical, and socioeconomic reasons. Appropriate mediazation alongside a debunking of counterfactual claims is crucial in driving forward immunization. [ABSTRACT FROM AUTHOR]

Safe and efficacious COVID-19 vaccines exist, but their success against the disease depends on public willingness to receive them. Vaccine hesitancy is one major obstacle to the achievement of herd immunity. On 25 June 2021, about 2000 supporters of the Economic Freedom Fighters (EFF) (the third biggest political party in South Africa) marched to the offices of the national regulatory authority (NRA) supporting COVID-19 vaccination and demanding approval of two additional vaccines (Sputnik V and Sinovac) in South Africa. The march was led by EFF leader, Julius Malema. By then, only three COVID-19 vaccines had received emergency use authorization in the country-the Janssen, AstraZeneca and Pfizer-BioNtech vaccines. It is worth noting that NRAs should only approve a vaccine if they are satisfied that its benefits outweigh any potential risks and not through political pressure. Nevertheless, we believe that this march might have increased COVID-19 vaccine acceptance and uptake among EFF supporters. The endorsement of COVID-19 vaccines by Malema, an influential political figure in South Africa, probably convinced some vaccine hesitant South Africans that COVID-19 vaccination is important. Therefore, we suggest vaccine endorsement by influential individuals in South Africa as one of the strategies to increase COVID-19 vaccine uptake.

This paper provides an introduction to this Special Issue of Development Southern Africa that evaluates the impact of COVID-19 in South Africa, one year into the pandemic. All of the papers use evidence from the National Income Dynamics Study – Coronavirus Rapid Mobile Survey (NIDS-CRAM), a five-wave longitudinal survey conducted from April 2020 to July 2021. As we write this article in June 2022, South Africa has just returned to the same level of GDP that it had at the end of 2019. This two-year period marks one of the most tumultuous in the country's economic history. We showcase results pertaining to employment, income support, hunger, schooling, early childhood development, mental health, and vaccine hesitancy. We also reflect on the policy learnings that can be gleaned in each of these domains and draw on some of the international lessons learnt to point to the way forward. [ABSTRACT FROM AUTHOR]

Amidst the COVID-19 vaccination, Twitter is one of the most popular platforms for discussions about the COVID-19 vaccination. These types of discussions most times lead to a compromise of public confidence toward the vaccine. The text-based data generated by these discussions are used by researchers to extract topics and perform sentiment analysis at the provincial, country, or continent level without considering the local communities. The aim of this study is to use clustered geo-tagged Twitter posts to inform city-level variations in sentiments toward COVID-19 vaccine-related topics in the three largest South African cities (Cape Town, Durban, and Johannesburg). VADER, an NLP pre-trained model was used to label the Twitter posts according to their sentiments with their associated intensity scores. The outputs were validated using NB (0.68), LR (0.75), SVMs (0.70), DT (0.62), and KNN (0.56) machine learning classification algorithms. The number of new COVID-19 cases significantly positively correlated with the number of Tweets in South Africa (Corr = 0.462, P < 0.001). Out of the 10 topics identified from the tweets using the LDA model, two were about the COVID-19 vaccines: uptake and supply, respectively. The intensity of the sentiment score for the two topics was associated with the total number of vaccines administered in South Africa ( P < 0.001). Discussions regarding the two topics showed higher intensity scores for the neutral sentiment class ( P = 0.015) than for other sentiment classes. Additionally, the intensity of the discussions on the two topics was associated with the total number of vaccines administered, new cases, deaths, and recoveries across the three cities ( P < 0.001). The sentiment score for the most discussed topic, vaccine uptake, differed across the three cities, with ( P = 0.003), ( P = 0.002), and ( P < 0.001) for positive, negative, and neutral sentiments classes, respectively. The outcome of this research showed that clustered geo-tagged Twitter posts can be used to better analyse the dynamics in sentiments toward community-based infectious diseases-related discussions, such as COVID-19, Malaria, or Monkeypox. This can provide additional city-level information to health policy in planning and decision-making regarding vaccine hesitancy for future outbreaks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ogbuokiri, Ahmadi, Bragazzi, Movahedi Nia, Mellado, Wu, Orbinski, Asgary and Kong.)

A review of the intellectual and policy environment announces the absence of transparency and rational discourse in assessing the prevailing Covid-19 policy measures. Contextually, propaganda thrives in times of political uncertainty as it serves to either amplify confusion, induce moral dilemmas, or disguise meanings. To this end, this study examines the quality of political communication, underpinning South Africa's public policy response to the Covid-19 pandemic. It aims to trace the influence of propaganda in informing policy origins and efficacy as it concerns the lethality of Covid-19. Importantly, informational irregularity must be treated with greater accountability and intellectual inquiry as it concerns masking and vaccine hesitancy. Following a qualitative approach and case study research strategy, this study begins by outlining the propagandistic assault on truth and rationality. Next, it confronts the seeming normality, with which the state, media, intellectual and scientific community have nonchalantly dismissed inconvenient truth in the name of misinformation. Of significance is the war on truth and the growing intellectual appetite for ideological realignment that esteems emotional triumph over empirical soundness. Ultimately, the research shows that scientific rationale has been demoted in favor of social solidarity. Finally, propagandist techniques and elements of deception theory entice the analytical appetite by exposing the modus operandi of deceptive operations at work in both masking and vaccine campaigns. The key findings indicate the use of propaganda and deception tactics at play in perception management with a view of influencing public action, corrupting public discourse and delegitimizing the need for factual accountability, concerning compliance with incoherent Covid-19 policy measures. [ABSTRACT FROM AUTHOR]

Background:  South Africa is aiming to achieve herd immunity against the coronavirus disease 2019 (COVID-19) by the first quarter of 2022. The success of the COVID-19 vaccination roll-out depends primarily on the willingness of the population to take the vaccines., Aim:  This study aimed to examine the willingness to take the COVID-19 vaccine, along with the factors of concern, efficacy and preferences of the individual, which may increase the willingness to be vaccinated., Setting:  This study was conducted at the University of the Witwatersrand, Johannesburg, amongst adult students and academic and professional staff., Methods:  A cross-sectional online survey from 27 July 2021 to 14 August 2021 was conducted. We performed descriptive and inferential analysis to determine the factors associated with willingness to take the COVID-19 vaccine., Results:  A total of 2364 participants responded to a survey link and 82.0% were students, 66.8% were in the 18-29 years age band and females represented 64.0%. A total of 1965 participants (83.3%) were willing to receive a COVID-19 vaccine, the most preferred vaccines were Pfizer (41%) and JJ (23%), local pharmacy (29%) and General Practitioner (GP) (17%) were the preferred places for vaccination and the trusted sources of information on COVID-19 vaccines were the general practitioners (40.6%) and specialists (19.2%). Perceptions that vaccines are safe (adjusted odds ratio [aOR] = 31.56, 95% confidence interval [CI]: 16.02-62.12 for affirmative agreement) and effective (aOR = 5.92, 95% CI: 2.87-12.19 for affirmative agreement) were the main determinants of willingness to taking a COVID-19 vaccine., Conclusion:  It is imperative to reinforce the message of COVID-19 vaccine safety and efficacy and to include the GPs and the community pharmacies in the vaccination roll-out in South Africa.

Background: Following the rollout of several effective vaccines against coronavirus disease 2019 (COVID-19), many countries have introduced vaccination passports or certificates as a means of certifying that an individual has been vaccinated against, is immune to, or is presently uninfected with COVID-19. An extensive ethical debate has ensued. Aim: To determine the perspectives of South African healthcare workers (HCWs) on the implementation of COVID-19 vaccination passports (C19VPs) in South Africa (SA). Setting: Healthcare workers working in various fields and practice settings throughout SA were invited to complete an online questionnaire. Methods: An online questionnaire was distributed using convenience sampling via social media platforms to HCWs over a 1-month period, collecting demographic details and responses to 8 Likert-type items regarding agreement with C19VPs, ethical issues and feasibility. Each item was graded from 1 (strongly disagree) to 5 (strongly agree), with grouping of 4 of the 8 items exploring a common theme of C19VPs being a good idea, constituting a score out of 20. Non-parametric tests were performed to determine differences in responses between groups. Results: One thousand HCWs responded to the survey and fulfilled inclusion criteria. The majority (83.2%) of respondents were medical practitioners (MPs). Overall, most (73.5%) respondents agreed that C19VPs are a good idea. Older respondents agreed more strongly than younger respondents (medians 18 and 17, respectively, p = 0.001), and respondents in private practice agreed more strongly than those in state practice (medians 18 and 16, respectively, p = 0.042). The median response was neutral (3) in response to the ethics of C19VPs considering variations in vaccine access and tending towards disagreement (2.5) in disadvantaging poorer people. Most respondents disagreed that vaccine hesitancy would make C19VPs unethical, and responses from provinces with the highest vaccination proportions disagreed more than others with lower vaccination proportion (median 2 compared with 3, p < 0.001). There was uncertainty about the feasibility of C19VPs in SA, with older HCWs, non-students, senior MPs and those who thought C19VPs are a good idea being more likely to consider them feasible. Conclusion: The perspectives of HCWs, mainly MPs, about C19VPs in SA were obtained. Further research should focus on vaccine hesitancy and its factors in HCWs and the effect of C19VPs on restrictions, reduction in transmission and benefits on economies and mental health. Contribution: To the authors' knowledge, this is the first survey data published on the perspectives of South African HCWs on C19VPs in the country. Healthcare workers are trusted influencers of vaccination decisions, and their opinion on vaccination certificates may also influence the South African public's perception and acceptance thereof. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has underscored the need for increased vaccine availability and uptake, with vaccine hesitancy posing a significant barrier, particularly among young adults. Evidence from various countries highlight high levels of hesitancy among young people, necessitating targeted interventions. Engaging young adults as key stakeholders in shaping public health strategies is crucial, as their perspectives can enhance vaccine acceptance. This study aimed to assess the overall acceptability of the COVID-19 vaccine among young people and to explore the factors influencing their willingness or reluctance to be vaccinated now and in the future., Methods: This study used qualitative data from 165 young adults in Nigeria, South Africa, and Zambia, to explore their suggestions for policies and strategies aimed at enhancing the acceptance of the Covid-19 vaccination among their age group. Data collection involved focus groups and interviews that explored participants' perceptions and recommendations regarding COVID-19 vaccination acceptability. Thematic analysis was used to analyse the data., Results: Thematic analysis identified several factors influencing vaccine acceptability among young people and suggested recommendations to improve it. The themes included developing targeted communication strategies for accurate vaccine information, offering alternative vaccination methods, promoting vaccine education in schools, and using trusted public figures to share accurate information., Conclusions: Persistent dissatisfaction with vaccine information dissemination underscores the need for more targeted communication strategies among young adults. Recommendations include developing non-injection vaccine options, incorporating vaccine education into school curricula and community programs, and leveraging influential public figures to build credibility. These insights are valuable for designing future programs to enhance vaccine acceptance among adolescents., Competing Interests: Declarations Ethics approval and consent to participate Ethical approval for this study was obtained from the Biomedical Research Ethics Committee of the University of the Western Cape (BM21/10/39). The research was conducted in accordance with the Declaration of Helsinki. We obtained written consent from all participants, with additional consent obtained from parents or guardians for participants under 18 years of age. Consent forms were translated into the relevant local languages and explained verbally to participants. As a token of appreciation for their involvement in the research, IDI participants received airtime compensation, while the FGD participants were provided with snacks and a hot meal and reimbursed for their transport expenses. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: COVID-19 vaccination rates in South Africa remain low at 51% of the adult population being fully vaccinated, defined as having two shorts of the COVID-19 vaccine with or without a booster. To improve vaccine uptake, a community-based intervention was tested in a high vaccine hesitancy community in South Africa. Trained community youths used social media, face to face interactions, door to door and neighbourhood outreach activities to deliver the intervention., Methods: To assess if the intervention had an impact, data was collected before the intervention and after the intervention in two districts, Wentworth an intervention site and Newlands East a control site. Both districts are in KwaZulu Natal Province, South Africa. The following outcomes, changes on perceptions and knowledge about COVID-19, intention to get vaccinated for those who were not fully vaccinated and vaccination uptake were assessed using difference-in-difference methods applied through Augmented Inverse-Probability Weighting and contrasts of Potential Outcome Means (POM)., Results: One thousand, one hundred and fifty (1 150) participants agreed to take part in the study at baseline, and 916 (80%) were followed up after the 9-week intervention period. Intention to get vaccinated for COVID-19 was higher (difference-in-difference, DID 20%, 95% CI 6% - 35% higher), more people were fully vaccinated (DID 10%, 95% CI 0% - 20%) or partially vaccinated (DID 16%, 95% CI 6% - 26%) in Wentworth the intervention site compared to Newlands East, the control site. There were noticeable increases on the percentage of study participants indicating trust on the Government's COVID 19 programme, from 24% at baseline to 48% after the intervention in the intervention group than in the control group, 26% baseline and 29% at follow-up. There was a 10% (absolute) increase on the percentage of participants' saying they believed health care workers provided reliable information, 58% at baseline and 68% at follow-up in the intervention group, but there was little change in the control group 56% and 57% for baseline and follow-up respectively., Conclusion: The youth-led intervention implemented in Wentworth, a community with a high rate of vaccine hesitancy, was effective in increasing vaccination uptake. Given the low COVID-19 vaccine coverage in South Africa and across the African region, as well as the new emerging variant of concern (XBB 1.5), there is an urgent need to scale up such intervention at the community level to address persistent misinformation and promote vaccine equality., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Science teachers could play a vital role in promoting health literacy and safe behaviors to limit the spread of communicable diseases. However, there is limited research concerning their attitudes and behavioral intentions toward diseases, such as COVID-19. Using the theory of planned behavior as a framework, we employed a non-experimental survey to compare the behavioral intentions towards adopting COVID-19 preventative measures among pre-service science teachers from South African (n=87) and Indonesian (n=93) universities. Data were collect data using a closed-ended questionnaire. Results show that the behavioral intentions toward COVID-19 between South African and Indonesian pre-service science teachers are similar. Safe attitudes, subjective norms, perceived behavioral control, behavioral, and normative beliefs that support safe behavioral intentions toward COVID-19 were reported, even though vaccine hesitancy may occur. We extrapolate that interventions should be implemented to enhance pre-service teachers' behavioral intentions and enhance their role in health education. [ABSTRACT FROM AUTHOR]

Background: Phase III trials, corroborated by early post-marketing data globally show that COVID-19 vaccination reduces the risk of severe disease, hospitalisation and death. Despite this, vaccine hesitancy persists amongst some healthcare workers. This study aimed to assess the acceptability of the COVID-19 vaccine amongst South African pharmacists and highlight vaccine-related concerns and predictors of vaccination hesitancy. Methods: Nested within an online survey (14 April 2021 to 18 May 2021) assessing the mental health of South African pharmacists during the COVID-19 pandemic, vaccine acceptability and vaccine-related concerns were studied. A multivariate logistic regression analysis identified factors associated with vaccine hesitancy. Results: From 2 454 registered South African pharmacists sampled, 755 responded to the vaccine acceptability survey (response rate: 30.8%). Vaccine acceptability was 71.9%, while 72.4% and 53.3% were concerned about serious COVID-19 vaccine-related side effects and the lack of vaccine safety data, respectively. Pharmacists aged 20-30 years were more likely to be vaccine-hesitant compared to those aged > 60 years (aOR 3.2, 95% CI 1.1-9.6). Compared to their Caucasian colleagues, Black/African pharmacists were twice as likely to be vaccine-hesitant (aOR2.2, 95% CI 1.2-4.0). Conclusion: COVID-19 vaccine hesitancy among South African pharmacists exists amongst a small but significant proportion. Targeted interventions to address concerns are necessary. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy is considered one of the biggest global health threats. The prevalence of false information about vaccines on social media amplifies this challenge, making it more urgent. This study examines the relationship between social media use, trust in information sources, beliefs about vaccination rates, and willingness to adopt vaccines using data gathered in late 2023 from 975 respondents in South Africa. Our results suggest that people who rely on social media as their primary news source are more hesitant to get vaccinated for themselves and their children. Trust, which includes various sources including confidence in the government, is positively linked to vaccination decisions. Trust is especially important when it comes to less traditional vaccines such as COVID-19 and flu vaccines for both adults and children. We also note gender differences, with South African men showing more reluctance to get vaccinated as adults. Additionally, there is a negative correlation between social media use and the willingness of males to get vaccinated, but this relationship is not evident among females. Our research highlights the need for targeted interventions aimed at improving vaccine uptake, taking into account the links with information sources about vaccination and government trust. • We examine predictors of vaccine hesitancy for a range of vaccines. • Reliance on social media as primary news source was associated with greater hesitancy. • Trust in government was associated with greater likelihood of vaccination. • The role of trust is particularly important in less traditional vaccines (COVID-19 and flu). • South African men showed greater hesitancy than women, particularly with social media. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic represented a global public health emergency. Existing studies support the view that vaccination and mass immunization are among the most effective means of containing the outbreak and promoting health. However, negative attitudes toward vaccination and the related vaccine hesitancy among many groups have created a significant barrier to effectively managing the health crisis. Having a valid and reliable tool to assess attitudes toward vaccination remains imperative so that factors underlying vaccine refusal can be identified and public health interventions can be facilitated. The current study examined the psychometric properties of the Vaccination Attitudes Examination Scale (VAX) in South Africa., Methods: Participants (n = 322) completed the VAX. Confirmatory factor analysis and ancillary bifactor indices were used to examine the hypothesized factor structure (a total scale and four subscales) of the scale. Inter-item correlations, factor loadings, and average variance extracted were used to examine the validity of the scale. Predictive validity was examined by comparing those who had received the COVID-19 vaccine and those who had not. The reliability of the scale was examined in terms of both Cronbach's alpha and composite reliability., Results: Confirmatory factor analysis provided support for the conceptualization of the scale as consisting of a total scale and four subscales, and ancillary bifactor indices indicated that the subscales accounted for a sufficient amount of variance (44%) after the variance explained by the total scale was considered. Overall, the analysis indicated that the scale had satisfactory reliability (alpha and composite reliability = 0.70) and provided evidence for the construct, convergent, and predictive validity of the VAX., Conclusions: The sound psychometric qualities of the scale, when used in a low- to middle-income country, have the potential to advance research and immunization policy within these settings and facilitate more targeted interventions to promote vaccine uptake., (© 2023. The Author(s).)

Background: In Malawi, only 1 072 229 people out of a national target population of 13 546 324 had received at least one dose of the AstraZeneca COVID‑19 vaccine by 26 December 2021, and only 672 819 people were classified as fully vaccinated. Phalombe District in Malawi had particularly low COVID‑19 vaccine uptake, with only 4% (n=8 538) of 225 219 people being fully vaccinated by 26 December., Objectives: To explore reasons for vaccine hesitancy and refusal among people living in Phalombe District., Methods: This cross-sectional qualitative study employed six focus group discussions (FGDs) and 19 in-depth interviews (IDIs) to collect data. We purposefully selected two traditional authorities (TAs), Nazombe and Nkhumba, as study areas, and conducted FGDs and IDIs in 6 randomly selected villages in these two TAs. Participants were religious leaders, traditional leaders, youths, traditional healers and ordinary community members. We explored reasons for vaccine refusal and hesitancy, how contextual cultural beliefs influenced people's decision to receive the COVID‑19 vaccine, and which sources of information were trusted in the community. Data were analysed using thematic content analysis., Results: We conducted 19 IDIs and six FGDs. Themes that emerged from the data were reasons for vaccine refusal and hesitancy, contextual cultural beliefs affecting the decision whether to be vaccinated, ways to improve COVID‑19 vaccine uptake, and means of communicating information about COVID‑19 vaccines. Participants mentioned that myths contributing to vaccine refusal and hesitancy circulated in the community through social media. With regard to contextual cultural beliefs, most participants believed that COVID‑19 was a disease of rich people, while others believed that it signalled the end of the world and that it could not be cured., Conclusion: Health systems should recognise and acknowledge the reasons leading to vaccine hesitancy and refusal and address these appropriately to improve vaccine uptake. Effective community sensitisation and engagement should be enhanced to clarify myths and address misinformation about the COVID‑19 vaccine.

As South Africa debates the implementation of mandatory vaccination policies to address coronavirus disease 2019 (COVID-19) vaccine hesitancy, many adults remain unpersuaded of the need and benefits of vaccination. Several surveys suggest that this is particularly true for younger adults and for those living in low-income communities. Therefore, we sought the views of youth training to become community health workers (CHWs) as a youth group at the intersection of the community and the health system. This research was conducted in a township of South Africa, a country with a long history of political mistrust. Using semi-structured interviews and an interview guide, we explored young CHWs' perceptions (n = 20) of vaccine hesitancy for themselves, their peers and the community. Audio-recorded interviews were transcribed, and thematic analysis was undertaken. Findings suggest widespread COVID-19 vaccine hesitancy in this community, especially amongst young people. Reported reasons for this hesitancy appear linked to a complex interrelated network of factors, including 'uncertainty' about the outcome and effectiveness of the vaccines; 'fear' of the vaccines, driven by a myriad of rumours and conspiracy theories within the community; a 'lack of control' over other people's behaviour and a desire not to be controlled especially by the government but at the same time a resignation towards impending mandatory vaccine policies and a 'lack of trust' particularly in the government's intentions with vaccine roll-out and their health messaging. While mandatory vaccination policies in several organizations have shown success, with South Africa's complex social history and recent civil unrest, the roll-out of any mandatory vaccination policy will require careful health messaging with a focus on trust-building between communities, health systems and authorities through more personalized approaches that consider contextual nuances., (© The Author(s) 2022. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Vaccine hesitancy is one of the 10 greatest threats to global health according to the World Health Organisation(2019). Increasing uncertainty around vaccines could disrupt efforts to minimise Covid-19 and future pandemics’ impacts. The South African Government (2021a) planned to have 67% of the population vaccinated by the end of 2021. According to the Department of Health (2022), 51% of the adult population in South Africa has been vaccinated as of 27 November 2022. This aligns with the increasing trend of vaccine hesitancy globally and in South Africa. [ABSTRACT FROM AUTHOR]

We evaluated COVID-19 stigma and medical mistrust among people living with HIV in South Africa. We conducted telephone interviews with participants in a prospective study of a decentralized antiretroviral therapy program. Scales assessing medical mistrust, conspiracy beliefs, anticipated and internalized stigma, and stereotypes specific to COVID-19 were adapted primarily from the HIV literature, with higher scores indicating more stigma or mistrust. Among 303 participants, the median stigma summary score was 4 [interquartile range (IQR) 0-8; possible range 0-24] and 6 (IQR 2-9) for mistrust (possible range 0-28). A substantial proportion of participants agreed or strongly agreed with at least one item assessing stigma (54%) or mistrust (43%). Higher COVID-19 stigma was associated with female gender and antecedent HIV stigma, and lower stigma with reporting television as a source of information on COVID-19. Further efforts should focus on effects of stigma and mistrust on protective health behaviors and vaccine hesitancy., (© 2021. The Author(s).)

Introduction: The outbreak of novel COVID-19 caught the world off guard in the first quarter of 2020. To stem the tide of this pandemic, there was acceleration of the development, testing and prelicensure approval for emergency use of some COVID-19 vaccine candidates. This led to raised public concern about their safety and efficacy, compounding the challenges of vaccine hesitancy. The onus of managing and administering these vaccines to a sceptical populace when they do become available rests mostly on the shoulders of healthcare workers (HCWs). Therefore, the vaccine confidence levels of HCWs become critical to the success of vaccination endeavours. This proposed study aims to estimate the level of vaccine confidence and the intention to receive a COVID-19 vaccine among future HCWs and their trainers at a specific university in Cape Town, South Africa, and to identify any vaccination concerns early for targeted intervention., Methods and Analysis: This proposed study is a cross-sectional survey study. An online questionnaire will be distributed to all current staff and students of the Faculty of Medicine Health Sciences of Stellenbosch University in Cape Town, South Africa. No sampling strategy will be employed. The survey questionnaire will consist of demographic questions (consisting of six items) and vaccine confidence questions (comprising six items in Likert scale format). Log binomial models will be employed to identify factors associated with vaccine confidence and intention. The strength of association will be assessed using the OR and its 95% CI. Statistical significance will be defined at a p value <0.05., Ethics and Dissemination: Ethics approval has been obtained for the study from Stellenbosch University (Human Research Ethics Committee reference number S19/01/014 (PhD)). The results will be shared with relevant health authorities, presented at conferences and published in a peer-reviewed journal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Although human challenge studies (HCSs) have been widely employed in vaccine development for malaria, dengue, typhoid and cholera, the role of this research design in COVID-19 remains controversial. While the potential social value of HCSs in the context of a pandemic is clear, bioethicists are divided on the ethics, given that effective treatment for COVID-19 has eluded us to date. While compelling ethics arguments have been offered on both sides of the debate, scientific and regulatory complexities may not have been fully appreciated. Furthermore, accelerated development of efficacious vaccine candidates in traditional clinical trials has diluted some of the arguments in favour of HCSs. In low- and middle-income country settings, including South Africa, the need for robust patient care conditions for the conduct of HCSs, coupled with considerations such as perceptions of risk, consent processes, remuneration, vaccine hesitancy, fear of exploitation and access to vaccines, makes HCSs challenging to justify.

South Africa became one of the first African countries to receive the COVID-19 vaccine. As the rest of Africa prepares to receive COVID-19 vaccines, most countries in Africa have set up national-level coordination committees for developing national vaccination deployment plans. While the main focus of these committees has been on setting up strategies that facilitate the swift distribution of COVID-19 vaccines once they are available, the role of effective public health awareness should not be ignored. Countries must devise strategies on how best to enhance public understanding and curb misinformation about the vaccines. With this viewpoint, we unpack the threat of COVID-19 vaccine hesitancy and offer recommendations for COVID-19 vaccine communication strategies in the South African and Zimbabwean contexts. [ABSTRACT FROM AUTHOR]