Infecting Minds? The past, present and future of vaccine hesitancy in South Africa

In 2019 the World Health Organisation listed vaccine hesitancy as one of the top ten threats to global health. In the midst of 2020/21s global Covid-19 pandemic, from which vaccination may be a fundamental exit strategy, vaccine hesitancy re-emerged at the forefront of public health. Vaccine hesitancy is a complex interplay of beliefs and behaviour, underpinned by historical events, diverse cultural, political, and religious perspectives and media representation, as well as practical issues such as accessibility to vaccines and limited resources for communication strategies. The Infecting Minds study investigated population beliefs, perceptions, and behaviours towards vaccines (and vaccination) in the KwaZulu-Natal province. To achieve this aim, the study is set around three major objectives: (1) To investigate the historical backdrop to vaccination and vaccine hesitancy in South Africa; (2) To understand the beliefs, behaviours, and acceptance of vaccines in urban and rural communities in KwaZulu-Natal; and (3)To identify implications and recommendations for health care policy and practice. The study focused on vaccines in general but also sought to understand how people experienced, perceived, and engaged the Hepatitis B vaccines (HBV), Tuberculosis vaccine (TBV), Measles (MMR) vaccines. The study population included ONLY adults (aged 18 and above) willing to share their opinions about vaccines. This included ordinary citizens, traditional leaders, traditional healers, and healthcare practitioners, including nurses. Data collection (qualitative interviews from 17 May to 21 October 2022) was conducted in IsiZulu, covering topics centred on the social context of vaccine perception and engagement, including: the religious and cultural context to vaccine uptake and vaccine hesitancy; specific cultural framings of vaccine uptake and vaccine hesitancy; participants' response to: incentives for vaccination, or penalties for not vaccinating; and to public education campaigns; the impact of/knowledge of the global circulation of anti-vaccination claims; dissemination of vaccination campaigns in urban and rural sites; how the results can inform recommendations for healthcare practice and policy, as well as effectively engage public audiences; and learning for current Covid-19 vaccine trials/roll out.