This is how we are trying to reverse vaccine hesitancy

Getting South Africans vaccinated against Covid is frustrating work. But it’s vital, life-saving work.

In the midst of so much uncertainty, the terrain is complex enough as it is. But the detection last week of Omicron — a new, potentially more infectious variant — signals yet another obstacle in the fight to get the pandemic under control, particularly given the lack of knowledge about its form and impact.

And so, as SA prepares for another rapid rise in new Covid cases — particularly among young, unvaccinated people — the need for effective and credible communication about the public health consequences of low vaccine uptake has never been greater.

Sadly, in SA, the initial fizz about vaccination has started to fade. Even though almost 14-million South Africans were fully vaccinated by the end of November 2021, this accounts for only 23.5% of the population.

Of course, vaccine hesitancy is not unique to SA. A survey across 15 countries by the Africa Centre for Disease Control, for example, found that vaccine hesitancy ranged from 4% to 38%, severely hampering the successful rollout of vaccines. Namibia, Zimbabwe, Mozambique and Malawi have, like SA,  asked vaccine manufacturers to hold off on sending more vaccines because they can’t use the supplies they have, largely due to hesitancy.

In India, vaccine hesitancy sits at about 50% of the population, according to the International Growth Centre, and at 48% in Russia, according to a recent survey by Morning Consult.

But that’s no reason for comfort in SA, particularly as we are entering the “festive season” — characterised by interprovincial travel, large and frequent gatherings, and an accompanying festive and communal spirit — while we are still miles short of the target of 70% vaccination.

This should fill us all with anxiety and concern.

It’s worth remembering where we were a year ago. Infection rates skyrocketed in December 2020, going from 2,295 daily infections reported on December 1  2020, to 8,725 by December 18 and a then record-breaking 11,500 infections on December 26.

Because a rise in death statistics generally lags behind increases in infections, the deadly impact of the December 2020 festive season was only really felt in January 2021: by January 15, for example, deaths reported had almost trebled — from 210 a day to 615.

This must be a cautionary tale as we contemplate warnings of a fourth wave, because even though daily cases and deaths may still be relatively low today, precaution fatigue is setting in. And this December could completely undo the gains that have been made in vaccine access and justice as vaccination, the most powerful tool to control the impact of Covid, is hampered by vaccine hesitancy, fear and misinformation.

The government seems to be doing what it can, where it can. But the response has been disappointing, and perhaps indicates a more serious problem. Some of the interventions — the Vooma Vaccine Weekend once a month, for example, with high-profile involvement from governing party politicians — resulted in a slight, short-term uptake in vaccinations. But there has been nothing like the vaccination increase we need.

Recently, the government has tried initiatives such as the Vaccine Champs project (where vaccinated people are encouraged to sign up and “tell their friends”) and “incentives” such as a R200 shopping voucher, entry in a R2m national lottery or a free Uber ride. The response to these, too, has been underwhelming.

It seems a rethink is needed. But what is to be done?

Covid Comms, a social enterprise formed to help the national effort to communicate about the coronavirus, has gone for a more ground-up approach. We’ve developed a “Community Vaccination Conversations toolkit”, for example, which is used by authentic community leaders in workshops with small groups of young unvaccinated people. Here, we get to grips with the problem of vaccine hesitancy and try to pierce through it by providing facts and figures in mother tongue, using plain language, in the form of conversations rather than lectures.

We developed this tool and community-based methodology because we believe that at the heart of vaccine hesitancy is mistrust of the available information. Social listening tools have confirmed that many people feel Covid vaccinations are shrouded in secrecy and that people with questions are silenced.

In addition, health-care workers are overwhelmed and often too busy to be the trusted ambassadors for vaccination. Government officials, while well-meaning, are not only facing trust deficits with communities but are often not well placed to engage in authentic dialogue that responds to people’s concerns.

Community members, family and friends who are vaccinated thus become the ideal trusted sources with the time and interest to help minimise the fears of those they love and live with. But they do not always have the answers to the questions people ask.

Our Community Vaccination Toolkit empowers those people with researched, plain language information, in all 11 South African languages, that can help them have an informed conversation at home, with friends or with community members.

The results from these sessions, run in partnership with Youth Lab, have been encouraging.

More than 50 Covid-compliant workshops have been held across SA so far, using a grant from the Solidarity Fund, and the turnout has been impressive. By the end of this project, we will have held more than 100 workshops and reached more than 4,000 young people who are able to influence their peers as they move on to become ambassadors for the vaccine within their own communities. And, as communication is Covid Comms’s core function, we’re converting the testimony from these workshops into a series of “vaccine diaries”, which are shared on a multitude of WhatsApp groups and social media platforms and, hopefully, on mainstream media platforms.

The response has been overwhelming, both from people wanting to act as facilitators and from people wanting to attend. There is an appetite for knowledge, we have found, when it is presented face-to-face and in a usable format, by young people who are seen as genuine influencers rather than people who blow R20,000 a night at Konka nightclub.

What these workshops are also reinforcing is the fact that the trust deficit between politicians and their constituencies is increasing rather than decreasing.

Local government elections haven’t helped close the trust deficit. The poor voter turnout, the self-interested horse-trading that has ensued, has only increased the distance between young people and their political representatives. Young people who already feel the government has turned its back on them — consigning them to lifelong unemployment, grant dependency, and a profound loss of dignity — have found little in the government’s recent conduct to make them believe. Add to this the lack of visible leadership, or doublespeak on key societal issues affecting the marginalised (such as universal basic income grants), the countless personal protective equipment scandals, the Digital Vibes saga and the lack of accountability for all those involved in profiteering from the pandemic, and you have a toxic mess: a government that needs to be able to convince society that it has a credible message, and a society that increasingly seems to doubt its government’s credibility.

So, to repeat the question: what is to be done?

Civil society, labour, faith-based leaders, worker organisations and cultural organisations may not have the budget that the government has. But they have constituencies, and they have credibility in those constituencies. Maybe it’s time to flip the dial and focus more on engagement. This means ensuring that those who have constituencies — and the credibility to engage with them — have the resources to reach, engage, empower and convince.

This probably means recognising that gimmicks and “bribes” are not having the desired effect. It also means acknowledging the fruitlessness of beautiful yet toothless advertising campaigns that are unconnected to grassroots campaigns. And confronting the reality that politicians swanning about communities in high heels or pointy shoes once a month is unlikely to increase vaccination rates on the scale required.

We need to get real. We need direct engagement with people who do not want to get vaccinated, for whatever reason. We need to hear them, counter their arguments, and persuade them to get vaccinated. And quickly.

• Vick and Dooms are members of Covid Comms, a nonprofit organisation doing public health education about Covid. Details are at covidcomms.org.za