/ 21 August 2021

Low vaccination rates due to access issues and misinformation

Daily Life As Lockdown Dims South Africas Economic Outlook
Local residents wearing protective face masks wait at a bus stop in the Imizamo Yethu township area of Hout Bay, in Cape Town. (Photographer: Dwayne Senior/Bloomberg via Getty Images)

Being working-class, not having access to transport and not belonging to a medical aid scheme are some of the major factors stopping people from getting vaccinated. In a series of surveys looking at current vaccine acceptance and hesitancy rates, researchers from the University of Johannesburg (UJ) and the Human Sciences Research Council (HSRC) and  found that those living in rural areas, informal settlements and townships were less likely to get vaccinated because they were less likely to have their own transport.

The vaccine acceptance rate increased from 67% to 72% in round four of the multipart surveys.

“Access intersected very unfortunately with class. So if you have a car that works, you are slightly more likely to have been vaccinated than someone who doesn’t have access to a car,” said the director of the Centre for Social Change at UJ, Professor Carin Runciman. “A similar issue comes up related to medical aid, with medical aid, we have twice the rate of vaccination compared to those without medical aid.” 

Why are younger people hesitant?

Those aged 55 years and above had a high acceptance rate of 85%, compared to just 55% of young people between the ages of 18 and 34 years old.

“It does seem like younger people have a slightly larger concern with side-effects. In our analysis, most people said their reasons for hesitancy were around concerns over the side-effects and the effectiveness of the vaccine,” explained Runciman.

“Younger people have a slightly larger belief that they are less likely to be at risk of Covid-19. They have higher levels of being uncertain about taking the vaccine, which tells us that the hesitancy is not that entrenched.” 

The department of health’s 16 August South Africa Covid-19 and Vaccine Social Listening Report stated that supply outstripped demand for vaccines. According to the report, South Africa’s highest daily vaccination rate was on 21 July, when 273 011 people got their jabs. On 13 August only 153 999 people turned out at the various vaccination sites. This is a decline of about 50% from a month ago. Only 181 862 adults were vaccinated on 17 August,  increasing the number of partially vaccinated people to 9.75-million people (10.8% of the population) while 126 434 received their second Pfizer jabs on that day, increasing the number of fully vaccinated adults to 4.33-million.

Are men really hesitant?

Only 40% of eligible men had been vaccinated, compared to close to 60% of women, by 17 August. But this does not necessarily mean that men were hesitant, especially in the 60+ age group. 

“One factor is that in the over-60 cohort, there are more women, three out of every five people in that group are women. A second factor is around access; men are more likely to be employed in the formal labour market. What other findings in the report suggest is that although people who either work part-time or full-time have high levels of acceptance, we have slightly lower rates of vaccination,” Runciman elaborated.

She added that the findings suggested that men were struggling to access vaccination sites on weekdays.

Dr Andrew Musyok from the Sefako Makgatho Health Sciences University shares that sentiment. “Generally, studies have shown that men more than women have poor health-seeking behaviour. Seeing more women than men being vaccinated does not necessarily mean men are not as pro-vaccination as women,” he said.

The lack of information was found to also drive vaccine hesitancy and people who had not actively engaged credible sources were more likely to fall for misinformation.

Can pregnant women and children get vaccinated?

Pregnant women and children are ineligible for vaccination following vaccine trials. But one study in the South African Medical Journal recommends the vaccination of pregnant women following the findings of ICU admissions of pregnant women with Covid-19 and non-pregnant counterparts. Pregnant women infected with Covid-19 were found to have an increased need of invasive ventilation and the risk of mortality was shown to be 70% higher. The virus also increased the risk of adverse pregnancy outcomes (stillbirths and miscarriages) and preterm deliveries.

“Yes, it is safe for pregnant women to get vaccinated. Pregnant women have been identified as a high-risk group and have a higher mortality rate and more severe complications than women who are not pregnant. For this reason, pregnant women are encouraged to vaccinate from 14 weeks onwards,” said Professor Salome Maswime, an associate professor and head of the global surgery division at the University of Cape Town. 

Dr Benjamin Kagina, who is a senior research officer for the Vaccines For Africa Initiative at the University of Cape Town’s faculty of health sciences, said that based on new data, everyone was eligible for vaccination and that people with severe allergic reactions to past vaccines should inform the healthcare provider prior to the vaccination.

“Everyone aged 17 years and older is eligible. There is new evidence showing that the vaccines are safe and effective in 12 years old and above. Children under the age of 12 years are not eligible for vaccination,” Kagina said.

The National Institute for Communicable Diseases (NICD) reported in its July monthly Covid-19 update that by mid-June, children 19 years or younger accounted for 13.4% of tests conducted, while 10.2% of new cases were reported.

At least 4.2% of them were hospitalised for Covid-19-related illnesses and 0.7% of Covid-19-associated deaths were reported.  

South Africa is currently not vaccinating children under the age of 18 years while adults in the 18-to-34-year age group are expected to be eligible from 1 September. 

How do the vaccines work?

South Africa’s roll-out strategy relies on the Pfizer (mRNA) vaccine, and the viral vector vaccine from Johnson & Johnson (J&J).

The US’s Centers for Disease Control (CDC) state that viral vector vaccines use a modified version of a different virus (the vector) to deliver important instructions to our cells. The vector uses the cell’s machinery to produce a harmless piece of the virus (spike protein) that causes Covid-19.

The immune system then recognises the spike protein as a foreign object and this triggers the immune system to produce antibodies and other immune cells to fight off what appears to be an infection. The body has now learned how to protect itself against future infection from the virus that causes Covid-19.

The Pfizer vaccine, unlike most vaccines, uses new technology that teaches cells to produce their own spike protein. 

Once the messenger RNA (mRNA) enters the muscle cells, the cells receive instructions to make the protein piece, which then gets broken down and discarded by the cell. The cell then displays the protein piece on its surface, where the immune system recognises the foreign protein and begins building an immune response and makes antibodies that learn how to protect the body against future infection.

“This technology has been in development for a long time, 10 to 15 years,” says Dr Ernest Darkoh, a public health expert and cofounder of BroadReach. “This kind of vaccine platform has been studied for flu, rabies, and the Zika virus. One of the reasons why mRNA vaccines seemed to appear out of nowhere for most people is because so many resources were made available to conduct simultaneous clinical trials, and there were so many cases of Covid-19 that it took less time than with other viruses to collect data on how effective the vaccines were in preventing it.”

Kagina adds that mRNA vaccines have undergone a rigorous process of safety and efficacy tests, as is done with all other types of vaccines. 

“A major advantage of this technology is the production process does not involve culture and hence, risks of contamination are minimal. It is quick and rapid to scale up the production using this technology. And technology transfer to manufacturers in lower-middle income countries is quicker.”

What about blood clots and blood thinners?

In April this year, six women from the US were reported to have developed rare blood clots known as cerebral venous sinus thrombosis after getting vaccinated with the J&J vaccine. This resulted in a pause of the vaccine roll-out by the US Food and Drug Authority.

At the time, 6.8-million vaccines had already been administered and according to Yale Medicine, by 9-million doses, the number of reported thrombosis cases grew to 28, and three people had died from the rare condition.

This led to a warning sign being put on the vaccine about the uncommon but potentially serious blood clotting disorder.

“Blood clots were reported on rare occasions. In fact, scientists have not been able to decipher that causality with vaccination. It is worth pointing out that clotting is much more common following Sars-CoV-2 infection. Taking blood thinners before vaccination is not recommended and could even put a person at risk of developing the clots after vaccination,” said Kagina.

Darkoh emphasised that there is an extremely low chance of developing blood clots as a result of vaccines.