SA’s vaccine hesitancy could undermine the millions invested, say experts

Vaccine hesitancy has the potential to undermine all the efforts that have gone into vaccine development, and the way forward will be finding the right people with direct influence in different communities.

So said Tian Johnson, speaking on behalf of the Vaccine Advocacy Coaliton, at a webinar organised by the AfroCentric Group, a health-care investment company.

He said we can “invest millions in the right cold chain, and have all our science and infrastructure right, but if communities aren’t excited or are fearful of buying into it, it jeopardises all the work done so far”.

Most importantly, messaging has to be done in ways that are suitable to the cultural context, while “the best way to build trust and integrity is through transparency.”

Johnson said a positive move in the Covid-19 context, compared to research done for HIV, was that “there had been a huge opening up of science not seen before.”

Research has always been “traditionally very white and closed and exclusive in this country, but with Covid-19, we have seen scientists really opening up about their work”.

The best way to build trust and integrity is through transparency.

—  Vaccine Advocacy Coaliton's Tian Johnson

However, that alone won’t be enough: it doesn’t help to just “give out info”, he said. “Evidence shows that dishing out information does not counter hesitancy — a lot rests on the messenger and their potential to influence those around them.”

It is also important that the government doesn’t “engage directly with anti-vaxxers”, he said, as all this does is amplify anti-vaxxer power and give it a larger platform.

Also speaking at the webinar was Prof Greg Hussey, director of Vaccines for Africa at the University of Cape Town.

He agreed “the biggest conundrum” is whether people “will accept the vaccines or not”.

“A poll done a month ago in 27 countries found that 74% of people said they would accept a vaccine, but in SA it was only 64%. That means 36% would refuse, and reasons included worrying about the side effects or believing the vaccine was not going to be effective. Others were simply against vaccines in general, and still others said they were not at risk of contracting Covid-19 and thus did not need a vaccine,” he said.

Safety and efficacy undergo rigorous analysis at the trial stage, and despite the speed at which vaccines have been developed, this has not been compromised.

However, said Hussey, there are certain unknowns that require more time before a definitive answer is found: “What we do not yet know about these vaccines is how long the immunity conferred can last after someone’s been vaccinated. Also, while we know that they have reduced Covid-19 disease and severity, we don’t yet know if they [the vaccines] can stop community transmission. The most hopeful in this case is the Oxford-AstraZeneca vaccine.”

He said data from the Cape metro in the Western Cape and Mombasa in Kenya suggested 40% of adults had antibodies by now, which would suggest that they’re protected, “but we don’t know for a fact”.

If they were, then theoretically only 60% of the population would need to get shots, but that is now how immunisation programmes work.

With the exception of Dengue Fever in certain contexts, “there is no vaccine programme in the world that first checks who has antibodies before vaccinating”.

The department of health’s Dr Anban Pillay said perhaps some people had shied away from the vaccines that used mRNA (messenger RNA) technology as it had been described as “new”.

Both the Pfizer-BioNTech and the Moderna Covid-19 vaccines use mRNA technology.

This means that genetic material called messenger RNA is introduced into the body and instructs human cells how to make coronavirus spike proteins.

These vaccines, using lipid nanoparticles, deliver the mRNA into muscle cells, and from there, the muscle cells make a spike protein which then readies the immune system to guard against infection.

This differs from more traditional vaccines which introduced a non-harmful version of a pathogen into the body so that the immune system could mount a response.

In Pillay’s words, “with mRNA, a viral genetic code is introduced into a cell and consequently stimulates the immune system”.

But, he says to those who fear this “new technology”, it is not in fact new.

“It is not an entirely new concept in medical science but it is the first time it is being used in vaccines. We should really not be overly alarmed that it’s ‘new’.”