As South Africa approaches its 5th wave of COVID-19 the number of people getting vaccinated has stagnated. Government missed its target to vaccinate 70 percent of the population by the end of last year. Currently, just 44% of adults have had one COVID-19 vaccine.

Over 34 million people have been vaccinated since the beginning of the vaccine roll out. Of that number, just over 21 million people have received their first dose only.

A group of experts recently gathered for a panel discussion, hosted by BroadReach Health Development, to discuss what is preventing vaccine uptake and how to solve this.

Jane Simmonds, a South African Medical Research Council public health specialist, said vaccine hesitancy needs to be redefined within the context of social barriers  and determinants of getting vaccinated.

“It (currently) places the responsibility on the individual and says that the individual chooses to be scared and anxious about getting the vaccine or the individual chooses to be hesitant about getting the vaccine. (Instead of) possibly looking at what we can do structurally to address what we refer to as vaccine hesitancy, barriers to access and the reasons why,” she said.

A story behind the numbers

Dr Lesley Bamford, the National Health Department’s chief director of the child health programme said while the initial challenge has been limited vaccine supply, over the last six months the problem had become poor demand fuelled by vaccine hesitancy.  Bamford has been playing a key role in the vaccine roll out at the department since January 2021.

“In terms of demand, we have always understood that there are two things that we can do to generate the demand – We can increase the value that people attribute to vaccination to get them to understand why it is important; and, at the same time, reduce the barriers to accessing the vaccine.”

She said the department has noted three groups in SA contributing to the low vaccine update. This includes anti-vaxxers and those who face high barriers to actually access the vaccines.

Bamford admitted the department still has to understand the issues around barriers to access. A lack of trust in government has also hampered progress.

“Misinformation circulating is also still a very frustrating problem. One of our key strategies has to be to increase the messages around vaccination from trusted sources. We think healthcare workers can play a role here at their local health facilities,” she said.

Integrating health services

Bamford said the department still plans to vaccinate 70% of the adult population in SA, but it’s unclear when this target will be reached.

“Our two key strategies in terms of service delivery need to be; to integrate vaccination into routine health services. We know that’s where we see people who are at highest risk, those with chronic conditions and pregnant women. We also need to vaccinate the many people who don’t routinely come to our health facilities.”

Simmonds has been working with the department of health since April last year to get people who SASSA grant queues to get vaccinated.

She said that framing the conversation to look at what the new norm will be in population groups that are resistant to the vaccines as opposed to being hesitant.

“We have a lot of useful data that helps us pinpoint where people are getting vaccines, where they are not getting vaccines. We have GPS locations. We can look and see how many people in a grant queue got a vaccine. SASSA can tell us how many people go to a grant queue a day in over 1200 vaccine sites.”

She said this data can help determine the structures and support needed to make it easier for an individual to access a vaccine.

BroadReach programme manager Dhirishna Naidoo said they have implemented two strategies in rural areas in KwaZulu-Natal to increase vaccination numbers

“The first one, placing vaccination sites in facilities where people are already going into the clinic to get a service, and getting facilitators, local influencers and people to share information about it. The other one was moving into communities and taking the services into communities.”

Naidoo said that people in these communities were saying that it was the first time that they had someone talking to them directly about the issues regarding vaccine access, in a language of their own. She said public health needs a collaborative effort.

“We need to leverage between national and regional structures. Then we had to move towards the more local influencing – target local leaderships within the communities. This is because with matters that are personal in nature, we go to people who we trust – we go to Ndunas, priests, activists.”  – Health-e News.