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They who hesitate are lost – the psychology of vaccine hesitancy and refusal

08 October 2021 | Story Angie Vorster | Photo Supplied

AngieVorster copy — Angie Vorster is a Clinical Psychologist in the School of Clinical Medicine, University of the Free State (UFS), and believes that the only way to get rid of COVID-19, or at least to continue our lives alongside it, is for all of us to be vaccinated against this deadly virus

Opinion article by Angie Vorster, Clinical Psychologist in the School of Clinical Medicine, University of the Free State.

The World Mental Health Day campaign has chosen ‘Mental Health in an Unequal World’ as the theme for 2021. This is partly to raise awareness of the distinct polarisation between countries and individuals that has been highlighted by the COVID-19 pandemic over the past two years. Access to health-care resources is significantly impinging the ability of countries across the world to address the effects of the pandemic, and stark inequality regarding pivotal elements such as access to vaccines has become visible. Obtaining, storing, and distributing vaccines has proven to add another burden to countries that are already financially and resource-impeded. Yet, once South Africa was lucky enough to secure adequate amounts of vaccines, we were faced with a baffling dilemma. How to get our residents to actually take it? In trying to understand the psychology behind vaccine hesitancy, it is interesting to note that the World Health Organisation listed vaccine hesitancy (delaying or refusing vaccination) as one of the top ten threats to global health – well before the outbreak of the COVID-19 virus.

Understanding why people refuse or resist vaccination

To understand why people – who are otherwise reasonable, conscientious, and informed individuals – would refuse or resist vaccination, it is helpful to look at the 5C model. The first aspect is confidence – the extent to which the person trusts that the vaccine is safe and will in fact do what it is said to do. Confidence is also affected by the level of trust that the individual has in the system that dispatches the vaccine – consequently, individuals who are hesitant to vaccinate are likely to be suspicious of authority figures and structures. Another factor is the number of constraints that individuals face in accessing the vaccine. If there are many barriers (e.g., unable to afford transport to the vaccination site, unable to take time off work, etc.) in terms of the calculation of costs versus benefits, obviously it would be easier to delay or refuse vaccination. Interestingly, perceived scarcity makes items/events more desirable. Perhaps it is the very fact that the vaccine is free and available that makes people not interested in receiving it.

Having a sense of collective responsibility and altruism are important characteristics in those who submit to vaccination. People who refuse vaccination tend to be more individualistically orientated and less motivated by the greater good of all, than by their own personal preferences. And this brings us to the final C, which is complacency. People who perceive the risk of COVID-19 as low tend to feel less urgency to vaccinate. Unfortunately, these are the patients who admit to COVID ward front-line workers that they now regret not getting vaccinated when they had the chance; instead, they frequently come to this realisation once their prognosis is terminal and they are facing the harrowing reality of dying, separated from their loved ones.

And then we all know someone who believes in an ‘alternative’ explanation for the COVID-19 virus and its vaccine. There are many hypotheses as to why people prefer conspiracy theories over scientific truth – some of which include the fact that the science behind understanding viruses and their prevention is quite abstract and too complicated for lay people to understand. Unless they witness the devastating impact of the virus first-hand – it may be difficult to comprehend that an invisible entity can do so much damage. Another explanation is that the truth of a natural disaster such as a pandemic, which can occur at any time, randomly, and without warning, catching humanity off guard, is just too frightening to accept. So, it makes us feel safer to believe that humans ARE in fact in control and actually created COVID-19 for some larger sinister goal. Otherwise, we are left to contemplate how utterly vulnerable we all really are. Instead, we deny reality and substitute it with something that makes us feel a bit better.

How to encourage all citizens to get vaccinated

So, how do we encourage all citizens to get vaccinated in order for our society to regain some pre-pandemic normality? Force, anger, and frustration (which are undoubtedly justified, particularly by those who work on the front line, and by those who have lost loved ones due to this virus) are not going to get us there. Instead, we need religious and other leaders to set the example and publicly advocate for vaccination. We need to tailor the information to the vast majority of South Africans who are not science-literate, making it accessible and understandable in their home language. Unfortunately, there is a significant percentage who will not be swayed by these actions, and for these fellow South Africans I have the following message:

It does not matter anymore whether or not COVID-19 is in fact the product of a global conspiracy and whether or not the companies that create vaccines do so only for financial gain. It does not matter that this all happened very fast and that we all realised how terribly weak and vulnerable the human body is. What does matter is that this virus is here. In our homes, our schools, cities, and country. And the only way to get rid of it, or at least to continue our lives alongside it, is for all of us to be vaccinated. We have science – facts, not opinions or feelings or theories or beliefs – to tell us that vaccines are safe and effective. In ten years from now, this will be the plague of 2020. I hope that you will be able to say that you were brave, even though you were scared, even though you were unsure, even though you might have been fine without the vaccine, but that you were strong enough and kind enough and human enough to do this small thing for the greater good of humanity. And our children will thank you for restoring connection and hugs, concerts, and playtime at school without distancing and sanitiser and masks. You will have done something important. For your community and your country and in fact, the world. This is your chance to be part of a great victory of humanity over a seemingly insurmountable tide of death and suffering. Our hope lies in you. Take this great responsibility, wear it with pride and importance, and meet us at the other side of COVID-19.

News Archive

Multidisciplinary conference on TB control

2003-09-22

Theme: Tuberculosis control: a multidisciplinary approach to research, policy and practice Venue: CR Swart Auditorium, University of the Free State Campus, Bloemfontein Date: 11 and 12 November 2003 Time: 11 November, 19:00-20:30 AND 12 November 08:30-17:00

Tuesday, 11 November - 19:00-20:30 (registration from 18:30) and Wednesday, 12 November - 08:30-17:00 (registration from 07:30)

The Honourable MEC for Health in the Free State will officially open the Conference on the evening of 11 November, while Prof Frederick Fourie (Vice-Chancellor and Rector of the University of the Free State) will attend to the welcoming. In addition, Prof Françoise Portaels (Institute of Tropical Medicine, Belgium) and Dr Refiloe Matji (National Department of Health, South Africa) will respectively present a global and a South African perspective on TB. The majority of the presentations will follow on 12 November.

Main thrust of Conference

The main thrust of the Conference is to disseminate both research results and policy/managerial matters relevant to TB and TB control, and to facilitate discourse among researchers and health policy makers/managers/practitioners in the field of TB control. Presenters of papers, as well as delegates are, therefore, drawn from both academic/research institutions, and from health service sectors involved in TB control in all provinces and in neighbouring countries.

Topics of presentations

A variety of topics will be dealt with during presentations, such as: New challenges in the global control of MDR-TB New strategies and policies on MDR-TB in South Africa A South African perspective on TB control A provincial perspective on implementing the national TB control policy

The role of the public district hospital in TB control Tuberculosis control through DOTS Case detection strategies

TB in children Hospital to clinic: is this the missing link? Patient compliance with DOT for TB Challenges for effective health communications in a multicultural context

The economics of TB Frequency of multiple infections with M. tuberculosis in pulmonary TB patients HIV/AIDS and TB, etc.

Speakers

Among the speakers will be Dr Victor Litlhakanyane (Head of Health: Free State); Prof Françoise Portaels and Dr Leen Rigouts (Institute of Tropical Medicine, Belgium); Dr Reliloe Matji (Director: NTBC Programme); Ntsiki Jolingana (Director: HIV, AIDS, TB and Communicable Diseases, Free State) and Annatjie Peters (Free State TB Coordinator); Dr Karin Weyer (Medical Research Council); Profs Herman Meulemans, Diana De Graeve, Luc Pauwels and Christiane Timmerman (University of Anwerp, Belgium); Dr Lara Fairall (UCT Lung Institute, University of Cape Town); Prof Frikkie Booysen (Department of Economics, University of the Free State); Christo Heunis, Ega Janse van Rensburg-Bonthuyzen, Zacheus Matebesi and Kobus Meyer (CHSR&D); Dr Mary Ednington (School of Public Health, Wits); Dr Carmen Báez and Sabine Verkuijl (ISDS); Anneke Van der Spoel-Van Dijk (Medical Microbiology, University of the Free State).

Costs

There will be no registration fees. However, delegates are expected to arrange their own transport and accommodation, or arrange for sponsorships themselves.

Contact details in case of inquiries and confirmation:

Postal Address: The Director, CHSR&D, PO Box 339, University of the Free State, Bloemfontein, 9300 Fax: 051 448 0370 Tel: 051 401 2181 OR 051 401 3256 E-mail: vrensh@mail.ufs.ac.za (Dingie van Rensburg) OR neljc@mail.ufs.ac.za (Ohna Nel)

PLEASE, CONFIRM YOUR ATTENDANCE AS SOON AS POSSIBLE, BUT AT THE LATEST BEFORE 25 OCTOBER 2003 ? BY TELEPHONE, FAX OR E-MAIL.

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