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Public confidence in social, health and communication interventions during the pandemic

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South Africa, already battling with enormous social and economic challenges after decades of colonialism and apartheid — and more recently corruption and social turmoil — has been particularly hard hit by the Covid-19 pandemic. 

The social and economic impacts of the first 12 months of the pandemic have been severe. During the last quarter of 2020, the official unemployment rate rose to 32.5% — its highest level to date.  This translates to 7.2-million people unemployed, with 2.2-million jobs lost in the second quarter of 2020 alone.  Of those in employment, 11% did not receive pay during lockdown in late 2020, and 16.5% of those who received pay during lockdown were paid reduced salaries in the fourth quarter of 2020.  

Hunger and food insecurity, already high before the Covid-19 pandemic, have worsened.  Food insecurity and child hunger improved in mid-2020 as the economy reopened, but increased again in October, when 41% of households reported running out of money for food. Sixteen percent of households reported that one or more children went hungry in November and December 2020.

Government, health professionals, scientists and society in general have done remarkably well in mitigating the effects of this devastating pandemic over the past 12 months. The health systems interventions, socio-behavioural measures and clinical programmes implemented were based on rigorous science and have followed World Health Organisation guidelines and globally evolving best practices. 

However, at this stage of the pandemic, it is important that legitimate concerns are not aggravated by some of the types, methods and styles of information to which the public are exposed.  Alongside the logistical and health systems aspects of the vaccine rollout strategy and other Covid-19 interventions, health education and science communication have a vital role to play. 

When possible, controversies and debates concerning the technicalities of science and strategy should be treated discreetly, as they could increase confusion and fear and affect public trust. Governments and healthcare organisations need to find a balance between giving citizens the information they need, and engaging in public debate that might cause uncertainty or alarm and adversely affect adherence to public health measures.

The USA and the UK, which have had two of the worst epidemics so far, show how severely unclear or false messaging about the use of face masks and social distancing can hamper the pandemic response.

Doubts about vaccination 

Vaccination is one of the most effective infectious disease prevention measures. Myths concerning vaccines are damaging, as it is no use to have vaccines available if people do not accept vaccination owing to fear or a sense of distrust.  In many media the negative aspects of vaccination get more publicity than the positive aspects.  For example, an internet-based Medline search for keywords “vaccine risks” scored 2 655 hits over the past five years, while the search for “vaccine benefits” scored only 557 hits.  

The rollout of Covid-19 vaccinations in South Africa resulted in over 50 000 healthcare workers being vaccinated in the first week.  We know that at least 67% of the adult population must be vaccinated in order to stop the pandemic, but 33% have already expressed doubts about receiving the vaccine.  It is therefore extremely important that messages from government, scientists, healthcare professionals, celebrities and opinion-makers are clear and backed by science.  

It is important that, as the number of vaccinations increases, there is clear communication about the importance of sticking to non-pharmaceutical interventions.  People need to be reminded that they must continue to wear face masks, keep a safe social distance, wash their hands frequently, ensure that indoor areas are well ventilated, and keep social gatherings small.  Until a minimum of 67% of the population (40-million people) have been vaccinated, socio-behavioural measures remain key to the pandemic response.  

It should be noted that the 67% of the population targeted for vaccination in phases 1 to 4 does not include the 18- to 30-year olds who have been the nexus of infections in super-spreader events. 

Furthermore, if communication about the pandemic, new developments and the need for vaccines falls off, “lockdown fatigue” will gain ground and adherence to non-pharmaceutical interventions will be reduced.  This will allow new, more infectious and more virulent strains to continue developing. 

South Africa responded swiftly and decisively with measures to reduce the impact of the pandemic. Now, with the vaccination programme commencing, we need to ensure that public confidence in government’s risk mitigation interventions and vaccination efforts is sustained. 

Professor Priscilla Reddy is the Strategic Lead: Health and Wellbeing in the Human Sciences Research Council Department of Human and Social Capabilities

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