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Positive attitudes towards COVID-19 vaccines: A cross-country analysis

A study led by South African researchers has shed light on the growing reluctance in many parts of the world to be vaccinated, with World Health Organization (WHO) citing rising vaccine hesitancy as one of the top 10 threats to global health.

Talita Greyling of the University of Johannesburg and Stephanie Rossouw, formerly of North-West University but now at the Auckland University of Technology in New Zealand, devised an attitude index based on tweets over the course of six months from February last year.

Their research covered SA, Italy, Australia, New Zealand, Belgium, The Netherlands, Spain, the UK, France and Germany, reports the Sunday Times.

“The attitude improved in only two countries, namely Belgium and The Netherlands. For the remaining countries, the trend was negative over time,” the researchers said. They looked at each country individually and said SA “faced problems such as capacity issues, mistrust in the government, and anti-vaccination campaigns”.

These contributed to growing scepticism about vaccines. “From as early as December 2020, it seemed that the [vaccination] strategy was haphazard,” they say.

On 1 February last year the first delivery of AstraZeneca was made to SA and even by then “it seemed that the government did not have a clear vaccination policy”.

The health ministry “created confusion” when it put the rollout on hold after it came to light that AstraZeneca “did not demonstrate efficacy against mild to moderate COVID”.

The decision raised the ire of local scientists and flew in the face of WHO advice, because the vaccine could still have prevented severe disease and death. Failure to use the AstraZeneca shots put 17m high-risk people in a vulnerable position; during the winter months from June to September last year, COVID was blamed for 25,660 deaths in SA.

The researchers say the vaccine mess could have been avoided “if the South African government had not been plagued by corruption and mismanagement during its response to the pandemic”.

By August 2021, vaccine apathy in the country was clear “as the number of people coming forward to be vaccinated dropped below 200,000 a day, falling short of the set target of 300,000”.

In their study, published in peer-reviewed science journal PLOS ONE, the researchers conclude that the general “downward trend in positive attitudes is partly due to a fear of the side effects” but that “many other factors also contribute”.

These include procurement problems, corruption, resistance to mandatory vaccination and COVID passports, and dissatisfaction with the government’s rollout plan.

However, local experts say SA has reached the point where a mandatory policy or passports are the only weapons left in trying to get sufficient numbers of people vaccinated.

Shabir Madhi, professor of vaccinology at Wits University, told the Sunday Times: “Unvaccinated individuals are unlikely to be coming forward in large numbers unless there is some level of compulsion. An example is the requirement for mandatory vaccination in engaging in indoor gatherings.”

Wolfgang Preiser, a professor of virology at Stellenbosch University, said sceptics adopt a narrative about the vaccine and then stick to it regardless of what the science says.

“In many countries, self-confessed hesitants said they were waiting for ‘the traditional vaccine’, which is a scientifically unsound term anyway. Now it is licensed there, and available, but they are still ‘hesitant’.”

Dr Stavros Nicolaou from Aspen Pharmacare said every effort should still be made to get people to vaccination sites.

“Although we are in a lull phase at the moment, we will invariably have other variants. We just don’t know the timing and severity but another upsurge in the winter months is very likely. We want to avoid a variant that is destructive to both the economy and public health, and that is why vaccination is still needed.”

He said that if the government were reluctant to impose a policy of mandatory shots for all, “what works effectively is restricted access to venues”.

Foster Mohale, a spokesperson for the national Health Department, told the Sunday Times that the government was continuing “to explore various strategies to increase vaccine uptake”, but gave no details.

Study details
Positive attitudes towards COVID-19 vaccines: A cross-country analysis

Talita Greyling, Stephanié Rossouw.

Published in PLOS ONE on 10 March 2022

COVID-19 severely impacted world health and, as a consequence of the measures implemented to stop the spread of the virus, also irreversibly damaged the world economy. Research shows that receiving the COVID-19 vaccine is the most successful measure to combat the virus and could also address its indirect consequences. However, vaccine hesitancy is growing worldwide and the WHO names this hesitancy as one of the top ten threats to global health. This study investigates the trend in positive attitudes towards vaccines across ten countries since a positive attitude is important. Furthermore, we investigate those variables related to having a positive attitude, as these factors could potentially increase the uptake of vaccines.

We derive our text corpus from vaccine-related tweets, harvested in real-time from Twitter. Using Natural Language Processing (NLP), we derive the sentiment and emotions contained in the tweets to construct daily time-series data. We analyse a panel dataset spanning both the Northern and Southern hemispheres from 1 February 2021 to 31 July 2021. To determine the relationship between several variables and the positive sentiment (attitude) towards vaccines, we run various models, including POLS, Panel Fixed Effects and Instrumental Variables estimations.

Our results show that more information about vaccines’ safety and the expected side effects are needed to increase positive attitudes towards vaccines. Additionally, government procurement and the vaccine rollout should improve. Accessibility to the vaccine should be a priority, and a collective effort should be made to increase positive messaging about the vaccine, especially on social media. The results of this study contribute to the understanding of the emotional challenges associated with vaccine uptake and inform policymakers, health workers, and stakeholders who communicate to the public during infectious disease outbreaks. Additionally, the global fight against COVID-19 might be lost if the attitude towards vaccines is not improved.


PLOS ONE article – Positive attitudes towards COVID-19 vaccines: A cross-country analysis (Open access)


Sunday Times Pressreader article – Anti-vaxxers on the rise (Restricted access)


See more from MedicalBrief archives:


SAMJ: Vaccine hesitancy has little to with the rantings of a cardiac surgeon


SA's stop-start vaccine roll-out has increased hesitancy — Nids-Cram Survey


IPSOS Survey: High degree of vaccine hesitancy in SA


Thousands of unvaccinated South Africans believe vaccines harmful


Sale of AstraZeneca vaccines ‘resulted in up to 22,000 deaths’ of SA elderly


Debate continues over SA's ditching of the AstraZeneca vaccine



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