‘GO GET VACCINATED!’ How to beat vaccine hesitancy ‘Figures are encouraging’

MILLIONS of South Africans are joining the queues to get vaccinated against the Covid 19 virus, but high levels of vaccine hesitancy persist and threaten the lives of many.

Across the globe there are warnings of future pandemics of the unvaccinated but scientists believe a multi-pronged approach could get more people to opt for a vaccine.

In a paper that appeared recently in the journal Expert Review of Vaccines, South African researchers examined the issue of vaccine hesitancy in the country and what could be done to combat it.

They examined different surveys that have been conducted over the period of the Covid-19 pandemic. They found that the results of these studies varied, which they put down to small sample sizes and the changing dynamic of the pandemic.

“We looked at some of these surveys and it did show that there is more vaccine hesitancy in South Africa than in some countries,” says Professor Charles Wiysonge of the South African Medical Research Council, who was an author on the paper.

However vaccine hesitancy is not static, Wiysonge stresses.

“The percentage of people willing to take the vaccine depends on what is going on. Maybe the government stops the Astrazeneca roll-out, for example, then changes to the Johnson and Johnson, then that is suspended.”

These things may make people hesitant, Wiysonge says.

As increasing numbers of people are being vaccinated, the director for the US Centers for Disease

Control and Prevention Dr Rochelle Walensky warned last week about the increased numbers of those who are unvaccinated becoming infected and seriously ill.

This as the US over the last few weeks saw an increase in the number of Covid 19 infections, particularly in states with low vaccination rates.

Parts of the US and Russia, Wiysonge points out, have more vaccine hesitancy than many lowincome countries.

In South Africa, higher education and race have been found to play an important role in vaccine hesitancy.

The Covid-19 Democracy Survey that was conducted in the first week of January found that white adults with higher levels of education were less accepting of vaccines than other race groups.

Research has found that vaccine hesitancy has been a developing phenomenon in South Africa.

Vaccine hesitancy was identified as one of the main challenges facing vaccination programmes in a study conducted in 2009. The study highlighted it as playing a role in a number of measles outbreaks in South Africa between 2003 and 2011.

But while anti-vaxxers have used social media to disseminate their messages, it is the same medium that is now helping combat vaccine hesitancy.

Images on Facebook and Twitter of people celebrating being inoculated has a knock-on effect, believes Professor Francois Venter of Ezintsha in the Wits Reproductive Health and HIV Institute. “It (vaccine hesitancy) has improved and I think a lot of it is people telling their families and friends to go and get vaccinated,” says Venter, who was not a part of the study.

While word of mouth and the power of social media are fuelling the vaccine drive, the problem, according to Wiysonge, is that the government’s communication strategy has not been very effective.

The need, he says, is to have a communications strategy that involves timely and accurate information about vaccines, while including other participants, including churches and other influential organisations and personalities.

To better understand and to measure vaccine hesitancy, Wiysonge and his colleagues are in the process of developing a vaccine hesitancy instrument.

Such instruments are used overseas, but South Africa’s unique demographic and circumstances, believes Wiysonge, require that it has its own.

“Most of the instruments that are used for collecting data on vaccines are based on research conducted in high-income countries, so we have tried to adapt some of them,” explains Wiysonge. “We have also added something like religion, as it is very important in South Africa in terms of people’s decision-making.”

Venter’s concern is that while the vaccine roll-out is going well, with 10% of the population vaccinated, hesitancy is going to slow down the programme.

“The problem is when they hit 25%, that is when it’s going to slow down, and that is what scares me. Now is the time to put foot and get everybody vaccinated, and you can start setting the scene for when you have to tackle the hesitancy.”

But vaccine programmes and Covid are likely to have a major impact on vaccine hesitancy in the future. Just what that impact is, says Wiysonge, is unclear.

“It could go either way. You have all these conspiracy theories and they might apply to other vaccines.

“But I feel that it might have a positive effect, because people are now becoming more literate around vaccines and we could use this in future programmes,” he says.

THE South African Vaccination and Immunisation Centre (Savic) said the adjustment of requirements for over 60s to register for the Covid-19 vaccine may have turned the tide in getting this vulnerable group to sign up in greater numbers.

In the last 48 hours the National Health Department recorded more than 27 500 new vaccine registrations in the over 60s age category.

At the start of the vaccine roll-out, this age group showed the least enthusiasm to vaccinate but the latest figures indicate that many people in this category have had a change of heart.

Savic deputy head Dr Andrew Musyoki said the requirement to have a smartphone and be savvy enough on the gadget proved a challenge as fewer than the expected number of individuals in this age category had registered to get vaccinated.

He added that the decision to allow walk-ins also encouraged the elderly to access vaccination sites and greatly improved the total number registered and vaccinated.

“The majority of South Africans have been willing to get vaccinated. The major hindrance was access. With improved access both through allowing for walk-ins and more age groups now being part of those allowed to register and be vaccinated, the numbers have improved,” he said.

Musyoki added that with the global number of vaccines administered standing at more than 3 billion, most of the anxiety around the Covid-19 vaccines has subsided.

“With the new data clearly showing the risk of hospitalisation and death to the unvaccinated as opposed to the vaccinated, there is now even more reason to be vaccinated. Most high-income countries that succeeded in achieving high vaccine coverage have been able to relax the strict measures imposed to curb the spread of Sars-cov-2,” said Musyoki.

According to a report released by pharmaceutical giant Pfizer, prior to the Covid-19 pandemic, adults faced a 200% higher mortality rate from vaccine-preventable deaths compared to children.

Our immune systems decrease when we are older which makes adults more susceptible to getting diseases. The Pneumococcal Conjugate Vaccine (PCV), which has been available in

South Africa since 2009 has protected adults living with HIV, those that are immuno-compromised, those over 65, smokers, and people with heart and lung diseases as well as diabetes.

It’s against this backdrop that the National Health Department said it’s encouraged by the spike in vaccine registrations in the country across all age groups. The department recorded more than 25 000 new registrations in the 50-59 age category and more than 84 600 registrations in the 35-49 category. Gauteng leads the race in vaccine registrations across all age categories.

Medical manager for vaccines at Pfizer South Africa Dr Thulani Mhlanga warned that adults may have missed being administered a certain vaccine as a child or may be more susceptible to contracting a vaccine-preventable disease for reasons such as being immuno-compromised or living with a chronic illness.

“Vaccines like PCV are crucial as we believe that the only sustainable response to possible infection is prevention. Not only is it important for adults to be vaccinated from a health perspective, it can have a positive impact on local social and economic developments while also having a beneficial ripple effect on the adult’s family, community, and country,” he said.

Mhlanga pointed out that Covid-19 had shone a spotlight on the need for countries to have vaccine manufacturing capacity to improve access and affordability. Being able to manufacture vaccines locally had a positive impact on costs, security of supply, production control and socio-economic development.

“To improve and create access to PCV, Pfizer entered into a public-private partnership (PPP) with the Biovac Institute and the Department of Health in 2015 to manufacture PCV locally as part of the country’s expanded programme on immunisation (EPI). The EPI is one of the most comprehensive programmes of its type on the continent. In addition to its manufacturing and delivery of life-saving vaccines, Biovac plays a critical role in the economy.

“It is the only Southern African human vaccine manufacturer, ensuring the country has the required domestic capacity to respond to both local and regional vaccine needs,” Mhlanga said.

In 2019, the World Health Organization (WHO) listed vaccine hesitancy and vaccine rejection as a top 10 global health threat.

Mhlanga said many countries did not have the data and capacity for evidence-based decision-making around adult immunisation, lacking data, policies, and expertise on issues impacting older adults, and political will and resources. Others may not have systems to reach older adults with vaccines or have systems that were so fragmented that opportunities were missed to recommend vaccines.

“We knew early on that a safe and effective vaccine would be essential to ending the pandemic. So, we combined our industry-leading vaccine development, manufacturing and distribution capabilities with Biontech’s expertise in innovative MRNA technologies to quickly develop, manufacture and distribute large quantities of high-quality Covid-19 vaccines. Given the urgency of the situation, Pfizer self-funded more than $2 billion (about R30bn) at risk to run clinical development and manufacturing processes in parallel and at scale. Collaborating closely with regulatory and health authorities around the world, including the EMA here in Europe, we compressed time lines that typically take years into months, and those that take months into weeks,” he said.

According to the latest statistics, more than 6 million vaccines have been administered across the country, there are currently more than 2.3 million positive cases and 68 625 South Africans have lost their lives.

Health Department spokesperson Popo Maja said they were delighted with the latest registration increases.

“The figures are really encouraging. They also put an end to conspiracy theories about the effectiveness of vaccines,” Maja said.