Investigating vaccine hesitancy in the City of Cape Town Metropolitan District

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Stellenbosch : Stellenbosch University
ENGLISH SUMMARY: Vaccine hesitancy, previously defined as the delay in acceptance or refusal of vaccination despite availability of vaccination services, and more recently defined as a motivational state of being conflicted about, or opposed to, getting vaccinated, including intentions and willingness; has been a growing challenge to vaccination uptake and coverage over the years. Its negative effects on vaccination, an acclaimed successful public health measure that saves millions of lives annually, reached such high levels of concern that the World Health Organization (WHO) declared it as one of the ten top threats to global health in 2019. This made the earlier recommendation of the WHO that countries should incorporate plans to measure and address vaccine hesitancy into their immunization programs more exigent. To comply with this recommendation, governments and health institutions need to be able to detect early concerns about vaccination in the population, track vaccination attitudes, and monitor changes in vaccination behaviors. To do this effectively, context-specific knowledge of vaccine hesitancy is required. The paucity of such data in South Africa is a major challenge, making investigating vaccine hesitancy in its context an important necessity. Moreover, the advent of the coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which started in late 2019 further aggravated matters. The accelerated rate of development and approval for emergency use of some of the COVID-19 vaccines among other factors heightened public skepticism and contributed to further erosion of confidence in vaccines and vaccination in general; and of COVID-19 vaccines in particular. The devastating effects of the disease on lives, livelihoods, and economies of many countries and the strain exerted on healthcare workers and systems particularly in low and middle income countries (LMICs) turned an important necessity into a critical need. This study, conceptualized, developed and commenced before the outbreak of the pandemic and amended during its first year, aimed to investigate vaccine hesitancy in the City of Cape Town Metropolitan District. This was done by conducting a scoping review of existing vaccine hesitancy measurement tools, a qualitative enquiry into vaccine hesitancy in the City of Cape Town Metropolitan District, and a quantitative assessment of vaccine hesitancy in the district using an adaptation of one of the measurement tools identified in the scoping review. This study is a two-part, three-phase study. The first part consists of the evidence synthesis part (phase 1) while the second part is the primary study part consisting of phase 2 (qualitative) and phase 3 (quantitative) sub-studies. Listed below are the sub studies in the order of appearance. 1. Phase 1: Scoping review of current tools available to measure vaccine hesitancy in a period spanning 2010 to 2019. This included the first 9 years of the decade of vaccines endorsed by the 65th World Health Assembly in May 2012 to be 2011 to 2020. Conceptualized and developed with the protocol published before the outbreak of the COVID-19 pandemic, this review scopes the literature for published tools for measuring vaccine hesitancy in various contexts. Evidence from the review suggests that relatively few tools for measuring vaccine hesitancy existed prior to the pandemic. However, a significant amount of quantitative studies that explored various aspects of vaccine hesitancy were published in the said period. 2. Phase 2: Investigating the major drivers of vaccine hesitancy from the perception of vaccinators in the Cape Metropolitan District. Key informant interviews were conducted with 19 point-of-care vaccinators from 16 selected facilities drawn from the 8 health sub-districts of the Metro. Two qualitative enquiries were conducted simultaneously, the first explored and established the presence of vaccine hesitancy in the Metro; while the second documented other challenges apart from vaccine hesitancy encountered by the vaccinators in the course of their duties. It also documented the creative ways of mitigating them currently employed and recommended by the vaccinators. Findings from both enquiries have been published in international, peer-reviewed journals. 3. Phase 3: Measuring vaccine hesitancy among current staff and students at the Faculty of Medicine and Health Sciences (FMHS), Stellenbosch University (SU). The outbreak of the COVID-19 pandemic and the initial strict containment measures necessitated changes in some aspects of the study. The initially-planned door-to-door survey of mothers and primary caregivers had to be set aside, and a pandemic regulation-compliant, relevant sub-study developed in its place. This sub-study estimated the levels of vaccine confidence among current staff and students of the FMHS. High levels of vaccine confidence were recorded among the study population. The protocol detailing the methodology, and the full results of the sub-study have been published in an international, peer-reviewed journal. Vaccine hesitancy is a threat not only to the success of previous vaccination endeavors, but also to the health and economic wellbeing of millions across the globe as the control and containment of the COVID-19 pandemic largely depends on high vaccination uptake and coverage. Findings from the scoping review indicate that of the limited number of validated tools available to measure vaccine hesitancy in the decade of vaccines (2010-2019), few were developed and validated for use in LMIC contexts. The predominantly positive attitude of the public to vaccination as alluded to by the interviewed point-of-care vaccinators in the Cape Metro, and high levels of vaccine confidence among future healthcare workers and their trainers indicates that the challenge of vaccine hesitancy is still minimal in the Metro. The creative ways employed by the vaccinators and the insightful recommendations proffered by them to mitigate against the challenges of vaccination in the Metro will be invaluable interventions that will further enhance vaccination uptake and coverage not only in the Metro, but wherever they are adapted and/or adopted.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Thesis (PhD)--Stellenbosch University, 2022.
COVID-19 (Disease) -- Vaccination -- Cape Town (South Africa), Vaccine hesitancy -- Cape Town (South Africa), Coronavirus infections -- Vaccination -- Cape Town (South Africa), UCTD