Hesitancy: threatens global health

Once South Africa was lucky enough to secure adequate amounts of vaccines, we were faced with a baffling dilemma. How to get our residents to actually take it?

In trying to understand the psychology behind vaccine hesitancy, it is interesting to note that the World Health Organisation listed vaccine hesitancy (delaying or refusing vaccination) as one of the top 10 threats to global health – well before the Covid pandemic.

To understand why people who are otherwise reasonable, conscientious and informed individuals would refuse or resist vaccination, it is helpful to look at the 4C model.

The first aspect is confidence – the extent to which the person trusts that the vaccine is safe and will, in fact, do what it is said to do.

Confidence is also affected by the level of trust the individual has in the system that dispatches the vaccine. Individuals who are hesitant are likely to be suspicious of authority figures and structures.

Another factor is the number of constraints that individuals face in accessing the vaccine.

If there are many barriers (unable to afford transport to the vaccination site, unable to take time off work, etc) in terms of the calculation of costs-vs-benefits, obviously it would be easier to delay or refuse vaccination. Interestingly, perceived
scarcity makes items/events more desirable. Perhaps it is the very fact that the vaccine is free and available that makes people not interested in receiving it.

Having a sense of collective responsibility and altruism are important characteristics in those who submit to vaccination.

People who refuse vaccination tend to be more individualistically orientated and less motivated by the greater good, than by their own personal preferences.

And this brings us to the final C, which is complacency. People who perceive the risk of Covid as low tend to feel less urgency to vaccinate. Unfortunately, these are the patients who admit to Covid ward front-line workers that they now regret not getting vaccinated when they had the chance. They frequently come to this realisation once their prognosis is terminal and they are facing the harrowing reality of dying, separated from their loved ones.

And then we all know someone who believes in an “alternative” explanation for the virus and its vaccine.

There are many hypotheses as to why people prefer conspiracy theories over scientific truth – some of which include the fact that the science behind understanding viruses and their prevention is quite abstract and too complicated for lay people to understand. Unless they witness the devastating impact of the virus first hand, it may be difficult to comprehend that an invisible entity can do so much damage.


Angie Vorster – Clinical psychologist in the School of Clinical Medicine, University of the Free State

Another explanation is that the truth of a natural disaster which can occur at any time, catching humanity off guard, is just too frightening to accept.

So, it makes us feel safer to believe that humans are, in fact, in control and created Covid for some larger sinister goal.

Otherwise, we are left to contemplate how vulnerable we all really are. Instead, we deny reality and substitute it with something that makes us feel better.

So, how do we encourage all citizens to get vaccinated in order for our society to regain some pre-pandemic normality?

Force, anger and frustration (undoubtedly justified, particularly in those who work on the frontline and those who have lost loved ones) are not going to get us there.

Instead, we need religious and other leaders to set the example and publicly advocate for vaccination.

We need to tailor information to those who are not science literate, making it accessible and understandable in their home language.

Unfortunately, a significant percentage will not be swayed, and for these fellow South Africans I have the following message: It does not matter anymore whether or not Covid is the product of a global conspiracy and whether or not the companies that create vaccines do so only for financial gain.

It does not matter that this all happened very fast and that we all realise how terribly weak and vulnerable the human body is.

What does matter is that this virus is here. In our homes, our schools, cities, and country. And the only way to get rid of it, or at least to continue our lives alongside it, is for all of us to be vaccinated.

We have science – facts, not opinions, feelings, theories or beliefs – to tell us vaccines are safe and effective.

In 10 years from now, this will be the plague of 2020.

I hope that you will be able to say you were brave, even though you were scared, even though you were unsure, even though you might have been fine without the vaccine, but that you were strong enough and kind enough and human enough to do this small thing for the greater good of humanity.

And our children will thank you for restoring connection and hugs, concerts, and playtime at school without distancing and sanitiser and masks.

You will have done something important. For your community, your country and, in fact, the world.

This is your chance to be part of a great victory of humanity over a seemingly insurmountable tide of death and suffering.

Our hope lies in you. Take this great responsibility, wear it with pride and importance, and meet us at the other side.