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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

Prof. Letticia Moja a winner in her category

2004-08-17

Prof. Moja a finalist in award
'Every member of staff is important to me'

Michelle Cahill - Bloemnuus

IF you are in need of a dose of inspiration, try and get an appointment with Prof. Letticia Moja, the Dean of the Faculty of Health Science at the University of the Free State. It will not be easy as she has an extremely tight schedule, over and above being a finalist in the 2004 Shoprite/Checkers Woman of the Year competition.

Although not a born and bred Free Stater, this dynamic woman has come to love the Free State. "Once you get past the mindset of a small town and all the negatives surrounding it, it is an absolutely wonderful experience," Moja said.

Moja was born in Pretoria and grew up in Garankuwa as the second eldest of five children. "That was nothing special. I was not the eldest and I wasn't the youngest," she quipped. She had two younger brothers, one of whom died in a car accident and then two sisters.

She went to school in Pretoria and her first contact with the Free State was when she wrote her matric at Moroka High School in Thaba Nchu. "That was one of the best schools for us at that time," she says. After completing matric, she went on to study medicine in KwaZulu-Natal.

In 1982 she returned "home" and completed her internship at the Garankuwa Hospital. Hereafter she specialised in gynaecological obstetrics at Medunsa.

She became the head of the gynaecological obstetrics unit and later opened a branch in Pietersburg.

"This was just about the most heart-rending time of my life. You saw people travelling for up to three days just to see a doctor," she says. "Here we really interacted with the community."

In 2001 she was invited by the University of the Free State to apply for the job of vice-dean of the Faculty of Health Science. "I wasn't too keen," she says, "but they kept on calling to find out if I had applied or not," she says with a smile. "Eventually I gave in and was appointed."

She thought she would work a couple of years under Prof. Kerneels Nel, then the dean of the faculty. "Unfortunately that was not to be. I had hoped that I could learn from him," Moja says.

Prof. Nel died of a heart attack in 2003 after which Moja deputised for him before being appointed as dean.

"This brought along a whole newset of challenges," she says, "Now I have to work out budgets and I need to know what human resources are," she jokes. This has prompted her to take up her studies again and she is currently doing her MBA.

"It has certainly been a challenge to go into management and without my support structure I most certainly wouldn't have been able to do it," Moja says.

Moja is actively involved in her church and serves on various committees including the Health Professional Council where she is acting president of the Medical and Dental Board and the Provincial Aids Council.

To her no job is menial. She recalls when she used to have "high tea" with her staff in Gauteng and Limpopo. "One of the cleaning ladies used to think her job was menial. That is just not so. No hospital can do without even the lowest position. Imagine stepping over rubbish while you're trying to catch a baby. To me everybody is important no matter what you do. "

Moja's eldest daughter is studying for her B.Accounting degree at Wits . Her youngest daughter is in Gr. 9 at Eunice and she has also brought along her niece, who is in Gr. 8 at Eunice. "You see, we need to be three girls in the house."
She feels honoured to have been nominated by the institution especially as it is traditionally male-dominated. "It is not about me, but about the support structure. Nobody can do it on their own. It is a team effort."
BLOEMNUUS - VRYDAG 9 JULIE 2004

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