Examining a case study of COVID-19 response and vaccine hesitancy in South Africa

Clinical Trials & Research

A recent study posted to the medRxiv* pre-print server proposed an approach that assesses community-based case studies to examine vaccine hesitancy and the response to coronavirus disease 2019 (COVID-19)-related public health behaviors in South Africa.

Study: Community-based Case Studies of Vaccine Hesitancy and the COVID-19 Response in South Africa; The VaxScenes Study. Image Credit: Anishka Rozhkova/Shutterstock

COVID-19 vaccines have played a crucial role in combating the widespread impact of the ongoing pandemic; however, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine hesitancy has become the prime obstacle in global vaccination programs.

About the study

The present study evaluates the various factors responsible for vaccine hesitancy on a community level in South Africa and determines COVID-19 preventative public health behaviors.

The study design includes mixed methods and four community-based case studies of adults of ages 18 years and older. The socio-ecological model for behavior will be employed to examine barriers and factors influencing the responses towards COVID-19 vaccines from an individual, interpersonal, and community level to a wider context involving policies, resources, and infrastructure.

Methods developed by the behavioral and social drivers of vaccination (BeSD) working group will be used in this study. The BeSD framework involves four domains, namely, what the public thinks and feels about COVID-19 vaccines, social factors that promote or demote vaccination, personal motivations or hesitancies towards receiving a vaccination, and practical factors affecting the process of seeking and receiving COVID-19 vaccines.

Convenience and purposive sampling methods, respectively, will be used to ensure the inclusion of well-known sites as well as a mix of sites from different provinces of South Africa in the study. Provinces with the highest number of SARS-CoV-2 infections like Gauteng, KwaZulu Natal, and Western Cape provinces will be included as sampling sites.

Collection of data and evaluation of study findings at each site will be classified into three phases. Phase 1 will employ geographic information system (GIS) maps that will visualize housing, infrastructure, employment, and private and public services along with centers of populations and COVID-19 statistics. A total of 15 key informant interviews (KIIs) will be then conducted via focus group discussions (FGDs) of groups of six participants to obtain a narrative of the COVID-19-related experience of the local community.

Phase 2 of the study will evaluate the COVID-19 acceptance on a community level using a quantitative survey and FGDs of groups of six to eight participants. Phase 3 will involve syntheses of cross-case studies and the preparation of an integrated report for the four sampling sites.

The study will also involve a desktop-based method to evaluate qualitative and quantitative data at each sample site, including an epidemiological and demographic profile to describe the response towards vaccines in the community. Qualitative methods of evaluation will comprise KIIS and FGDs including expression session FGDs and FGDs with semi-structured guides. Quantitative methods will include the BeSD quantitative COVID-19 vaccination tool which is a survey tool that will capture data from face-to-face interviews that will be conducted by researchers working in each sample site.


The proposed study showed that the adaptation and validation of the existing tools that evaluate COVID-19 vaccine hesitancy as per the narrative in South Africa will facilitate a better evaluation of factors affecting vaccine response in this region. The usage of the BeSD model in the African populations can help measure both social and behavior-related determinants of COVID-19 vaccination.

The novel approach used in this study takes into consideration the interplay between individual, interpersonal, community, and sociopolitical factors that determine response towards the COVID-19 vaccine. It also explores the factors that foster doubt or a conflict against the vaccines.

The researchers believe that the most effective implementation of this model at the community level is because this approach allows easy identification of enablers or barriers affecting behavioral changes at the four aforementioned levels. This knowledge can be utilized to improve public engagement such as to incorporate motivators of vaccine-positive behaviors.

The success of global efforts to fight the spread of SARS-CoV-2 largely depends on the uptake and acceptance of COVID-19 vaccines. Using mixed methods and a novel socio-ecological model, this approach will provide locally responsive, base-level, and timely evidence regarding the factors impacting vaccine acceptance and other public health behaviors.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

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