COVID19 Vaccine Intentions in South Africa: Health Communication Strategy to Address Vaccine Hesitancy

Abstract Background: Widespread vaccine acceptance is key to achieving herd immunity through vaccination against COVID19, especially because the available vaccines do not have 100% efficacy. The continued infection amongst the unvaccinated can lead to heightened risk of further virus mutation, exposing even those vaccinated to new virus strains. Therefore, there are social benefits in minimising vaccine hesitancy. The objective of this study is to assess the level of COVID19 vaccine hesitancy in South Africa, identify the socio-economic patterns in vaccine hesitancy and to develop a targeted health communication strategy based on the HBM and EPPM models in order to improve vaccine acceptance. Methods: The study uses the nationally representative National Income Dynamics Study - Coronavirus Rapid Mobile Survey (NIDS-CRAM) survey. The analysis combines univariate and bivariate statistics together with multivariate regression models like binomial/ordinal logit and seemingly unrelated regressions.Results: The study finds that vaccine acceptance is lower than that of non-pharmaceutical intervention life face-mask use. Only 55% are fully accepting of the vaccine, while a further 16% are moderately accepting of vaccines. Together, vaccine acceptance is estimated at 70.8% and vaccine hesitancy against COVID19 is estimated at 29.2% amongst the adult South African population. The reasons cited for vaccine hesitancy are primarily due to concerns regarding the side-effects and efficacy of vaccine. the study has identified perceived risk of infection with the mediating role of efficacy as a key predictor of vaccine intention. Apart from vulnerability to infection, those perceiving higher severity of risk (elderly and those with chronic illness) have lower hesitancy. Higher awareness of COVID19 related information and higher household income are correlated with lower vaccine hesitancy. The non-black African population group has significantly high vaccine hesitancy compared to black Africans. Males on average have lower hesitancy compared to females, and unmarried/unpartnered individuals are found to have higher hesitancy. Conclusions: There are other significant differences across socio-economic and demographic variables in vaccine hesitancy. From a communication perspective, it is imperative to continue risk messaging, hand in hand with clearer information on the efficacy of the vaccines