Southern Africa Labour and Development Research Unit, School of Economics, University of Cape Town, Cape Town, South Africa.
Development Policy Research Unit, University of Cape Town, Cape Town, South Africa.
BMC Public Health. 2023 Sep 11;23(1):1767. doi: 10.1186/s12889-023-16584-w.
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.
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.
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 Χ = 494, p < 0.001); and those who perceived themselves at risk of COVID-19-related illness (Χ = 126, p < 0.01). Vaccine intentions were lower among individuals who believed that the vaccine causes death (Χ = 163, p < 0.001); believed that the vaccine is unsafe for the babies of pregnant/breastfeeding mothers, or the chronically ill (Χ = 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.
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.
尽管南非有大量记录的 COVID-19 感染和死亡病例，但在全国疫苗推出十个月后的 2022 年 3 月，COVID-19 疫苗接种覆盖率仍然很低。本研究提供了疫苗接种意愿、对疫苗接种的态度和对授权的看法的相关因素的证据。
我们使用了第二次 COVID-19 疫苗调查（CVACS）的数据，这是一项于 2022 年 2 月至 3 月间在南非 3608 名自我报告未接种 COVID-19 疫苗的成年人中进行的电话调查。调查工具是与政府、政策制定者和民间社会协商设计的；并将样本分为四个不同的组，具有不同的疫苗接种意愿（与疫苗犹豫水平同义）。Kruskal-Wallis 和 Mann-Whitney 检验用于检查与不同疫苗接种意愿组相关的社会人口统计学特征、态度和行为。对开放式问题的回应进行主题编码，以了解未接种疫苗的原因和对授权的态度。
社会经济地位较低的个体接种疫苗的意愿较高（Mann-Whitney Z=-11.3，p<0.001）；那些认为疫苗能预防死亡的个体（Kruskal-Wallis Χ=494，p<0.001）；以及那些认为自己有 COVID-19 相关疾病风险的个体（Χ=126，p<0.01）。认为疫苗会导致死亡的个体（Χ=163，p<0.001）；认为疫苗对孕妇/哺乳期母亲或慢性病婴儿不安全的个体（Χ=123，p<0.01）；不信任政府关于 COVID-19 和 COVID-19 疫苗的健康信息的个体（Kendall's τ=-0.41，p<0.01）；以及反对授权的个体（τ=0.35，p<0.001）。尽管有 48%的人认为授权将行之有效，但只有 25%的人支持授权，54%的人将个人权利作为反对授权的主要原因。
截至 2022 年 3 月，未接种 COVID-19 疫苗的个体的特征因自我报告的疫苗接种意愿而异，这突出了有针对性的需求创造工作的重要性。本文强调了这些群体之间存在显著差异的几个因素。这些发现可以为未来的疫苗接种运动提供信息，有可能提高其成功的可能性。鉴于广泛的疫苗犹豫，这是一个重要的政策目标，需要进一步研究这一主题。授权仍然是增加覆盖率的一种选择，但需要谨慎考虑，因为反对意见广泛。
