COVID-19 vaccine hesitancy and barriers to vaccination in South Africa

The COVID-19 pandemic created significant social, economic and health-related challenges. The rapid development of vaccines that could help curb transmission and mortality from the virus was vital. The University of Johannesburg/Human Sciences Research Council (UJ/HSRC) COVID-19 Democracy survey was established as a cross-sectional online and telephone survey designed to provide rapid response data to inform the pandemic response. Between December 2020 and November 2021, the survey fielded questions about vaccine acceptance, hesitancy and structural barriers to vaccination. Drawing from the Strategic Advisory Group of Experts on Immunization (SAGE) Vaccine Hesitancy Determinants Matrix, this article explores the intersection of contextual and individual reasons for COVID-19 vaccine hesitancy. We find that young people, particularly those aged 18–24 years, were the most vaccine-hesitant. Also, White adults exhibited more than double the odds of hesitancy of Black African adults, yet were also much more likely to be vaccinated. The article explores this seeming paradox by analyzing explanations for vaccine hesitancy as well as considering structural barriers to vaccination. Explanations for vaccine hesitancy mostly related to concerns about side effects, the effectiveness of the vaccine and distrust in the vaccine and/or government. In contrast, structural barriers, such as a lack of information about where to receive a vaccination and vaccination sites being inaccessible, may have deterred those who were broadly favorable about vaccination from accessing one. Overall, our analysis illustrates the importance of understanding health crises as more than medical problems but as fundamentally social problems. It is therefore vital that social science research informs future responses to public health emergencies.