THE JABS CHALLENGE
Nids-Cram data reveals that those who are hesitant about vaccination aren’t particularly religious, but that they are often younger and tend to believe social media is a trustworthy source of information
The arrival of the first Johnson & Johnson vaccines at OR Tambo International Airport in February signalled a new chapter in SA’s fight against the pandemic.
It meant the focus could shift from containing the virus to eliminating it.
And yet, uncertainty about when future batches will arrive and how they’ll be rolled out as well as a hesitancy to get the vaccine are jeopardising SA’s bid to subdue the virus this year.
The results of the Nids-Cram survey in February and March do at least offer some reason for optimism. And they provide a reliable sense of who exactly is reluctant to get the jab.
In particular, it is encouraging that 71% of South Africans say they would be vaccinated if a vaccine was available.
This is the highest estimate of vaccine intent to date, and slightly higher than other studies (which range from 64% to 67%). But given Nids-Cram’s robust sampling, this is arguably the most reliable indication yet.
The survey also provides a window into understanding who the doubters — 29% of respondents — might be.
Notably, we observed much higher hesitance among young people (aged 18 to 24), which is presumably driven partly by their much lower likelihood of becoming seriously ill with Covid. The elderly and those with reported HIV, TB, lung conditions, heart problems or diabetes are far more willing to accept a vaccine.
However, we don’t find that obese or hypertensive respondents are more inclined to be vaccinated — suggesting that the government has work to do in reaching out to these groups.
Congruent with the perception that “antivaxxer” theories are shared via social media networks, those who see social media as a “trusted source of information” are seven percentage points more likely to be hesitant.
We also found that people who consider health workers or government information as “trusted source of information” were not less hesitant to get the vaccine — even if this group was more likely to wear masks and adhere to social distancing rules.
We noticed large variations in vaccine hesitancy by districts, by language group and by religion — and not in the expected ways.
For instance, contrary to what we see in the US, we didn’t find that people who are overtly religious, or Christian, were more reluctant to be vaccinated.
Instead, we saw a large variation by language groups: those who speak Afrikaans at home were more likely to be vaccine hesitant (42%) compared with the national average (29%).
All of this creates many challenges, because, unlike the wearing of masks, which can be mandated, vaccination will be voluntary. There can be no short cuts to get people to accept it as necessary.
Those in positions of influence will have to build trust, work to explain how safe vaccines are and how they work, and raise awareness of how our vaccination choices affect others. This will need to happen from the bottom up, in communities. We can’t rely solely on sharing scientific findings, but instead need to think about people’s subjective motivations.
This isn’t a particularly strong suit of our public health campaigns. But to build trust amid misinformation, we need a government that is humble about what it knows and doesn’t know, is clear about the challenges, open to changing plans and willing to answer questions.
And lastly, we need to rethink the artificial dichotomy between saving lives and saving livelihoods.
For many South Africans who are young, healthy and not at risk of dying, the best argument for getting a vaccine may be that it will help the economy recover and boost the likelihood that we can bring back some of the jobs we have lost, especially in the tourism and hospitality sectors.
Communicable Diseases (NICD). Yet about 3,000 children in this age group die annually from other causes. Children this age are about 1,000 times less likely to die from Covid than people aged 60 to 64.
But what about the teachers? Our paper uses administrative data to estimate the number of deaths among publicly employed teachers due to Covid. We compare the numbers of deaths among teachers reported in 2019 to the numbers reported during the pandemic.
Sadly, we do see excess deaths among teachers during the pandemic — but, critically, these occurred mainly when schools were closed, as infection rates were peaking. Meanwhile, we don’t see many excess teacher deaths between September and November, when all grades were attending school.
This is consistent with international research, and the NICD’s finding, which was that there were “no consistent changes in incidence trends associated with the timing of opening or closing of schools”.
But the cost of closing schools is immense. Last year, the children in grades that were the last to be reopened ended up losing about 60% of all their potential school days.
Using data from reading tests covering thousands of children across
Mpumalanga, the North West, the Eastern Cape and KwaZulu-Natal, we can see that during 2020, children learnt less than half what they normally learn in a year of schooling.
A great deal of teaching time (and learning) is still being lost as schools use “rotational timetabling” to allow for social distancing, in which children attend school on alternate days.
From this point, it could take a decade or more to return to the trajectory SA was on — and the children may never recover what was lost at a critical time in their early learning development.
Another persistent challenge is the increase in child hunger. The percentage of households with children receiving meals at school is still less than 50% — compared to 65% before the pandemic — partly due to the disruption of “rotational timetabling”.
The research shows that when children are receiving meals at school, adults tend to be less worried about them returning to school.
What needs to happen next? The issues at stake are critical.
While the government did the best it could initially, there is now a strong case for going back to full-scale school attendance.
The Covid risk associated with schooling is relatively low, while the evidence of serious educational and nutritional harm is mounting. Given the low risk faced by younger children, this could first be implemented in primary schools — with safety measures such as masks, frequent sanitising and screening.
And there needs to be widespread support from all quarters — parents, teacher unions, health authorities, political leadership and the media. The alternative — keeping children out of school — is a cost too great to pay.