APRIL 2021 - It’s vital to understand how people think, feel, and act in relation to COVID-19 vaccines to develop strategies to improve acceptance and uptake, and reduce illness and death. [1] South Africa Country Office, in partnership with government, deployed the Behavioural and Social Drivers (BeSD) tools for a Health Worker COVID 19 Vaccine Perceptions Survey to inform interventions to improve acceptance and uptake of COVID-19 vaccines in health workers.

The BeSD tools allow​​​​​​​ for large scale data collection, and measure four domains that play a major role in shaping vaccine uptake: what people think and feel about vaccines; social processes that drive or inhibit vaccination; individual motivations (or hesitancy) to seek vaccination; and practical factors that shape the experience of seeking and receiving vaccination. ​​​​​​​

Adapted for COVID-19 vaccines and to specifically target health workers, such data can offer insights in how to continually tailor communication strategies and approaches, and ultimately greater impact with more efficiency. ​​​​​​​

South Africa and other ESAR countries used the Internet of Good Things (IoGT) to administer the survey, which enables rollout at virtually no cost. A short WhatsApp message with a link to the IoGT site was shared to the Health Stakeholder Forum, a grouping of all professional bodies of health workers in South Africa. The same link was also shared with the provincial COVID-19 communication teams, trade unions, professional associations and civil society.

​​​​​​Launching at the end of January and open for one week, the survey received nearly 23,000 responses in nine provinces from community health workers, doctors, nurses, paramedics, traditional healers, and other related groups. The data were analyzed and displayed through a user-friendly dashboard with support from the IoGT and ESAR C4D teams.

Key findings were that:

• There was a gap between perceived importance of the vaccine vs. trust in the vaccine linked to concerns on safety, efficacy and adverse effects following immunization (AEFI).

• Vaccination as a work norm/social descriptive norm was not well established. Over one-third of HWs say that they were not sure if most of the people they work with will get a COVID-19 vaccine.

• Majority of health workers in South Africa were willing to get the vaccine. Main reason driving hesitancy was concerns of vaccine safety and efficacy.

• HW thought it would not be easy for them to get vaccinated. Even though the respondents were working in health facilities, nearly a quarter of respondents said it would be “not easy at all” to get vaccinated when the vaccine becomes available. ​​​​​​​

​​​​​​​While hesitancy will need to be monitored and addressed with tailored interventions, the data showed that the focus should be on removing barriers and activating intentions of those who want to get vaccinated, while continuing to monitor those who are hesitant. UNICEF South Africa with government and partners have already taken action on these issues with low-cost high impact interventions.

South Africa Country office notes that government and health stakeholder buy-in were critical to extend the reach of the survey. However, with such extensive reach resulting in a large sample size, data analysis of the high volumes of qualitative information became a challenge.

Looking forward, South Africa Country Office plans to continue to liaise with Department of Health focal points to discuss data dissemination mechanisms and expect provincial disaggregation to further support tailored interventions as vaccine rollout continues. The potential for using BeSD tools for an adult vaccine perception survey is being discussed ahead of Phase Two of the vaccine roll out, which is due to start on May 17.

_______________________________________

[1] WHO. (2019). BeSD Data for Action Guidebook.