Tackling vaccine hesitancy


By Dr Juno Thomas Head of the Centre for Enteric Diseases

Mental Health Matters, Volume 8, No 5





I was vaccinated in March 2021 during the healthcare worker vaccination rollout, and it was an unexpectedly emotive experience. I was excited beforehand; afterwards, I was comforted by the thought that I would soon have effective antibodies, and because I was among the relatively few South Africans at the time who had the privilege to claim a vaccine, I felt both grateful and guilty. I did experience side effects sore arm, fever and malaise, but wasn’t concerned. There was a positive communal response to vaccination at my workplace; groups of colleagues went together on a vaccination outing, the ‘I was just vaccinated’ photos were peppering WhatsApp, and those who had side effects commiserated with each other. Working at the NICD, we all received the daily COVID19 situation updates, and the communications team were proactive in sharing relevant COVID19 disease and vaccine related information. I naively assumed that all NICD coworkers would be vaccinated within the first phase of the rollout, and so was shocked and stupefied to find that some, including a few in the team I work in, who were vaccine hesitant.


I had one on one discussions with my hesitant team members and thought it would be a fairly straightforward task to address any concerns and set them to rights. I knew the science and recited the facts and figures. I reminded them that of all the NICD coworkers who’d been vaccinated, nobody had experienced severe side effects and in fact, many experienced none. But I was completely unprepared for the response; my facts and figures were simply no match for the misinformation that had already taken hold. I was incredulous that such educated, informed individuals who worked in the very public health institute intimately involved in responding to the COVID19 pandemic could possibly believe and very likely propagate such utter nonsense and said as much though I did try to couch it in slightly softer terms. Needless to say, I failed dismally!


There’s no better teacher than experience; after making the effort to read around vaccine hesitancy and inform myself about misinformation, it was clear that the dice were loaded at the outset I missed almost all the ladders and landed on every snake. I’m glad to say that I’ve since reformed my approach to vaccine hesitancy and have had some success.


In 2019 predating the COVID19 era, the World Health Organization WHO included ‘vaccine hesitancy’ on their list of the ‘Top Ten’ threats to global health. Vaccine hesitancy is defined as the delay in acceptance or refusal of vaccines despite the availability of vaccine services. There is a spectrum of vaccine attitudes, ranging from total acceptance vaccine advocates to complete refusal people with extreme antivaccine views and fringe conspiracy theorists, with vaccine hesitant individuals sitting squarely in the middle.

Vaccine hesitancy is complex and context specific. Researchers have broadly grouped the drivers of vaccine hesitancy into the ‘5 Cs’: confidence, complacency, convenience or constraints, risk calculation, and collective responsibility.


Because vaccine hesitancy is so nuanced and context specific, we need to understand the main drivers at a local level in order to guide interventions. South African researchers have highlighted the intensely social nature of COVID19 vaccine hesitancy in our country, with attitudes potentially influenced by age, race, education, politics, geographical location, and employment. Every healthcare professional needs to learn how to become an effective vaccine advocate in their own right and tackle vaccine hesitancy, one hesitant person at a time.


Practical recommendations for developing your own approach to discuss vaccine hesitancy with patients include

  • Start the conversation about COVID19 vaccination with your patients but remember to be an active listener.
  • Quality healthcare professional patient communication places the patient at the Centre of care. Respect and respond to the patients’ preferences, needs and values; it’s the patient’s values which guide medical decision making, not yours
  • Particular strategies to build trust and facilitate patient involvement in the relationship can include encouragement, joint agenda setting, and nonverbal behaviours conveying empathy and warmth.
  • Uncertainty is particularly relevant in the context of COVID19 vaccination, because vaccines are still relatively new and there are some unpredictable side effects. Evidence about COVID19 disease itself and its serious complications including long COVID19 continually increases and improves. Stay up to date with evidence around the disease itself, as well as vaccine efficacy, side effects, and current scientific controversies or debates. Reputable journals like NEJM, JAMA and Lancet have dedicated COVID19 resource centres with excellent reviews, podcasts, and even tailored information for patients. Useful websites include the US Centers for Disease Control and Prevention www.cdc.gov, the WHO www.who.int , and the NICD nicd.ac.za
  • Mis disinformation is a moving target. Stay up to date with South African vaccine mis disinformation themes and trends so you’re prepared. The Centre for Analytics and Behavioural Change publishes a weekly vaccine mis disinformation report that summarises social media conversation themes in the country cabc.org.za.

Lastly, don’t forget to start the conversation with colleagues; we can learn collectively from our successes and failures and become better vaccine advocates. References available on request.


Dr Juno Thomas is Head of the Centre for Enteric Diseases. Her areas of expertise include communicable disease epidemiology, surveillance, and outbreak response. She leads the Centre activities, which include syndromic and laboratory-based surveillance for priority enteric bacterial and viral pathogens. Dr Thomas oversees and actively participates in the food and waterborne disease outbreak investigation and response activities of the centre, providing key epidemiological and laboratory support to the South African National Department of Health. She teaches and trains health professionals and health officials and supervises postgraduate students

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