This is a weekly report of Covid-19 & vaccine sentiment, rumours & misinformation in SA. Further information  that provides the background to this report, especially input from many health districts, is available here.

Click here to download this report as a pdf

 

KEY TRENDS

Fear of fifth wave of Covid. The number of Covid infections in South Africa is increasing, especially due to the Omicron subvariants BA.4 and BA.5. The positivity rates (the percentage of all tests that are show positive for Covid infection) is rising fast. While the fifth wave has not officially been declared, there is fear that it has already started (Here and Here). Many suspect that the surge in infections was because of the Easter weekend. There is debate whether we need to impose new restrictive regulations (Here). Sentiments express anxiety about the resurgence: ”Oh please people, wake up!! Everyone’s lives are at stake here. Do the right thing and get your vaccinations and booster shots. Plus, get your flu shots too” (Here). “As anticipated the 5th wave is with us, stay focus and protect yourself and those around you” (Here). “Mzansi, pls stop taking it lightly. This Covid thing is coming back, and with full force these days” (Here).

Covid fatigue & the fifth wave. As many people lose interest in Covid, health communication experts are at pains to revive interest in the face of the looming fifth wave (Here). Covid fatigue has become a global phenomenon after interest in vaccines in many countries “halved since the start of the year” (Here). Avoidance of news about Covid is common among youth and people who had bad experiences of vaccines (Here) and “many South Africans can’t be bothered with the coronavirus anymore.” (Here). Health communication experts have identified reasons for the declining interest as “dis/misinformation on social media with increased political polarization of Covid-19, distrust in scientists with the current media landscape likely to influence the spread of false information” (Here) as well as the “multifactorial, context-specific and largely influenced by confidence, complacency and convenience” with many challenges coming with the end of the state of disaster (Here).

Social media. Google searches on “disadvantages of Covid vaccines” increased by 400% compared to the previous week, “which Covid vaccine is safest?” (+350%), “Weekend vaccination sites Gauteng” (+200%), “How long after Covid I can vaccinate?” (+200%). Most shared links on Twitter included SA Covid perception survey (here), disinformation on people going blind after Covid vaccination (here), petition against SA Health regulation amendment (here). Top articles on digital news media by engagement include:
SA losing interest in Covid – just in time for a fresh wave , ZCC to resume services on Sunday , ‘Get your child immunised’ – Gauteng health dept urges parents, Modise: Defence Dept made mistake buying heberon vaccine from Cuba, and Expert sounds alarm bells on fifth wave

Growth in vaccinations – but not enough. Vaccinations continue, and now just under half of all adults (49.3%) have received at least one Covid vaccination. There is growing scepticism about the efficacy of the vaccines. “Covid-19 restrictions and vaccines are completely useless, they solved absolutely nothing in the past two years” and “millions of people vaccinated but still the cases are rising. I mean this is half of our population, so that proves your vaccine is not working” (Here). However, scientists argue that it is even more important to vaccinate with the presence of Omicron as there are more risks of severe illness and death for the unvaccinated. ”The risk of dying from Covid-19 in February 2022 was 10 times higher for unvaccinated people compared to those vaccinated … and 20 times higher than those fully vaccinated and with a booster” (Here).

Growing public distrust of Covid messages. Scepticism about the Covid vaccine is rising. Almost all responses to the posters on HealthZA Facebook were dismissive views about Covid vaccine that the government was “spending too much attention and resources on one disease” (Here). Others question why they should continue to vaccinate when the “rest of the world has forgotten about Covid” (Here). One person questioned why “cases were still rising when almost half the population had vaccinated – does it mean the vaccines are not working?”. People were also suspicious of statistics which they described as “jumping around like the petrol price” causing “so much confusion” that “we end up not knowing what to believe anymore” (Here). However, others were hopeful that “there is still an opportunity to persuade vaccine-hesitant individuals, and it is important to identify them early before they become vaccine refusers” (Here).

Vaccine mandates at universities. The organisation Free State for Choice (FS4C) withdrew the court application against the mandatory vaccine policy of the University of the Free State (here and here).

Natural immunity discussion. Natural immunity from previous infections is being discussed. Some say natural immunity is better than vaccination (Here), while medical science suggests that “Even people who have had Covid-19 receive long-lasting benefits from a full course of vaccination” (Here) and that “as immunity wanes the risk of infection increases and vaccines continue to protect against severe disease and death” ((Here).

Regulations for stadiums. Social media has questioned whether vaccination at the stadium for unvaccinated people wanting to watch matches allowed adequate protection and that additionally a negative test result should also be presented. “Does it now give immediate immunity? (Here). Others were totally against any form of vaccine mandates, saying South Africa should adapt to the recent changes. “UK is welcoming Novac to Wimbledon. No more vaccine mandates for players to partake. SA What about you?” (Here) and referred to the “US Supreme Court has blocked the workplace vaccine mandates” news (Here).

Routine immunisation damaged. In the race to vaccinate the world against Covid, the global campaign for routine vaccination against measles, tetanus, diphtheria, polio and other diseases has suffered. “More than 30 million children have missed out on other basic vaccinations during the pandemic, with south-east Asia and the eastern Mediterranean region being the worst hit” (Here). Through integration of Covid vaccination with routine immunization services and campaigns, South Africa hopes to address the problem. There is policy recommending this to ensure a more sustained system for future pandemics, but it has not happened in many health facilities. Many are very critical of over-focus on Covid at the expense of treatment for other diseases.

Community engagements in KwaZulu-Natal. KZN has recently suffered a devastating flood and now is one of three provinces worst hit by the resurgence of Covid infections. Stakeholders in the province have restarted community engagements. As the science keeps changing with the evolving pandemic, “it has become more challenging to keep the health workers informed with the latest changes to gain their confidence and buy-in. Without adequate access to updated and official information, they rely on social media and unofficial media messages”, according to the KZN health communication and social mobilization experts.

Healthcare workers Covid knowledge. In focus groups in KZN it emerged that in many communities, healthcare workers are highly trusted. However, many of them are not able to confidently respond to questions around Covid and vaccines, also due to changing science and guidelines. It was also confirmed that healthcare workers sometimes rely on unofficial radio and social media for information. There is an information gap with healthcare workers themselves.

Vaccination certificate issues. Hassles with certificates were the main reasons for calls to the National Covid Contact Centre, especially assistance in downloading and obtaining vaccination certificates. There was a report of attempted bribery to obtain a vaccination certificates without actually vaccinating. This incident was reported to the police.

Clinical practice differs from policy. There have been many reports of differences between the policy of the National Department of Health and what actually happens in some health facilities. People who want to vaccinate have been turned away because they didn’t have the certificate of a previous vaccination, didn’t have an official ID document or for other reasons.

DISTRICT REPORTS

  • Ekurhuleni (Gauteng). Vaccine acceptance is increasing now, with growing fear that Covid could increase as Winter approaches and people see vaccination as a preventative measure. There is concern whether a someone who is not immunocompromised should take booster doses. Some want the KeReady campaign to be continued. There are less pop-up sites even though we still have people who have not taken their first vaccination who cannot easily access vaccination sites. We need to establish more pop-up sites in larger communities without a local clinic to allow people with transport difficulties to vaccinate. Solidarity Fund mobilisers are helping the Malaria Awareness campaign, which also covered TB & HIV and was a success. Some youth are vaccinating so they can attend social gatherings and job opportunities that require vaccine certificates.
  • Johannesburg (Gauteng). Vaccine acceptance is increasing with youth, and vaccination in schools makes it easy for many of them to access vaccination. However, many people still believe that vaccination will make no difference. Many people came to the FNB football games in the days of mobilisation. There still is a widespread fear of needles.
  • Harry Gwala (KZN). Vaccination has been very low due to the bad weather and flooding. People couldn’t get to the vaccination sites and the vaccination teams could not easily travel as planned. People are worried that the government won’t be able to control the spread of the virus now that the Disaster Management Act has been lifted; others say there is no more Covid and everyone should return to normal life. Some youth only get vaccinated as business and learning institutions have mandatory vaccination policies. Youth are still listening to wrong information on social media.
  • Ilembe (KZN). Some people don’t understand why they need boosters after being told they were fully vaccinated. Most young people are only willing to get vaccinated when informed that most employers prefer to hire vaccinated people. Some people believe that should they get infected with Covid, they will have minor symptoms, some even claim to have been infected in the past and recovered without any severe illness. Many people agree to vaccinate when health care professionals visit them where they live.
  • Ethekwini (KZN). The demand creation team is now working with school nurses, running community dialogues and mobilizing community structures which gets the buy-in of local leaders. We are working with local radio stations well as we reach many people and listeners are able to ask questions. Pop-up sites are successful. Working people find it difficult to get to vaccination sites during the week – weekend opening would be very helpful or local pop-up sites. Transport is still a problem, especially as Ethekwini is very big. People are still coming to vaccinate, though others are reluctant sue to peer pressure from friends not to. Vaccination Friday in local facilities has increased the number of people walking in. The employment of new community mobilisers in Umlazi is very helpful and the support of local NGOs is very useful. We are working well with schools, tertiary education institutions, local leaders and community organisations. Young people are now coming to vaccinate in pop-up sites, and loud hailing of health information works well.
  • Umkhanyakude (KZN). Most people who vaccinate are coming for boosters, not first doses. There is uncertainty whether boosters are the same vaccine as the ones taken previously. Many people feel Covid-19 is no longer a threat – this is a widespread and strong belief. Going out to people and not waiting for people to come to the vaccination site (our roving strategy) is 5 times more successful than waiting.
  • Bojanala (North West). Vaccine uptake among undocumented foreigners is very slow as they fear being deported. Many say that government official benefit through corruption from the vaccines, hence the push for boosters. There is widespread sentiment that Covid-19 is over so there is no need to vaccinate now as the national State of Disaster has ended. Many people cannot reach vaccination sites even if they want to – sites should be set up after consulting with the community where there is good transport, and also local pop-up sites should be used. Vaccination targets are not being met. Myths and misinformation on Covid vaccines are still circulating. Vaccination should be taken to the people. KeReady Flex challenge is increasing youth vaccination. Other youth don’t care when happens to them and believe nothing good can come out of vaccinating.
  • Dr Ruth Segomotsi Mompati (North West). Youth are more exposed to misinformation as they use the internet and social media, where they are exposed to myths, e.g. people become zombies after vaccination; the vaccine will kill you; side effects are severe; it places a micro-chip; the vaccine is just for older people as they are the only ones who get sick with Covid-19. Demand creation is hampered by a lack of transport, rain and weak cooperation with various local partners. Some youth don’t have smart phones. More vaccination sites have been set up in more convenient locations which reduces logistical barriers, though transport to sites remains a problem for many. KeReady has helped to motivate youth to vaccinate – but there is still a huge problem with most youth not wanting to vaccinate. More women get vaccinated than men. Many youths don’t believe in vaccines and think that there are very few people sick with Covid any more. More youth would vaccinate if they see their peers and role models getting vaccinated.
  • Namakwa (Northern Cape). Vaccine acceptance now is stagnant. Many feel that the vaccine (including boosters) is not as effective as they’re supposed to be so we are now trapped in an endless cycle of continuous injections. People older than 50 tend to come for boosters, while youth are noticeable in their absence. One myth is that the more vaccinations (e.g. boosters), the more immunocompromised the body becomes. Many less educated people aren’t getting the message of the importance of vaccination – we should use other means like photo stories and stories on radio. There is little or no control at sport stadiums, even though they are meant to check for vaccination certificates. We still need transport to get people to the vaccination sites, especially from remote rural areas. There should be better cooperation between the Dept of Health teams and Re-Action. The Northern Cape Department of Education has now given permission for in-school vaccination – this is great news. Developing children’s literature with picture stories and cartoons would help to convey a stronger message of the importance of vaccination.
  • Cape Winelands (Western Cape). Vaccine uptake is increasing as many vaccinated people have been able to convince unvaccinated people to come. There are not many incidents of misinformation circulating. Some vaccinate when they need to do an interview to get a job. Our success lies in door-to-door mobilisation and vaccination where there is no form of stigmatisation.
  • Central Karoo (Western Cape). As the country is moving away from Covid priority, many people are saying they don’t care about Covid anymore. Door-to-door campaigns are doing very well in getting large numbers of people to vaccinate every week. Pop-up sites really help as people don’t have to go to far-away vaccination sites. We are going street by street and door-to-door to vaccinate people.
  • Garden Route (Western Cape). People are concerned about increasing Covid deaths and want to know if the 5th wave has started. Misinformation is circulating that vaccines are killing people with symptoms like heart problems, blood clots, heart attacks and neurological damage. Some people do not heal from Covid, symptoms stay longer and others are left damaged, others can’t go back for their second shots because they don’t recover and others don’t trust us and the vaccine anymore. Elderly people are unsure whether Covid or vaccine symptoms live longer and can leave them damaged. Our youth is influenced by a US doctor who speaks about the Killing of Vaccination, and they want to know if it’s true.
  • Swartland (Western Cape). Vaccine acceptance is slowly increasing for young people. The Riebeeck Kasteel area is a big challenge – they simply refuse to vaccinate. Others thank us for informing them about vaccine, boosters and where the vaccination sites are. Community workers are helping greatly in spreading the message throughout the Swartland. Vaccines are accepted by elderly people, but most of the young people totally refuse. A few youths did register when I did site visits. Many are scared of injections and the vaccine’s side effects. Some youth are not getting second doses as they fell sick after the first dose. The collaboration with community health workers is going well for local mobilisation. Many people are very appreciative when we go and inform them about Covid-19 and the vaccine. Some youth take dagga and say that this drug protects them from Covid.

 

MISINFORMATION

  • MISINFO: The prediction of a 5th wave shows that the pandemic is carefully planned to control people. TRUTH: There’s no evidence to support this. Prediction of the waves of the pandemic are based on carefully considered epidemiological models, based on previous experience to support planning and preparation. See here and here.
  • MISINFO: I have survived four waves of COVID so I don’t need vaccine to survive a fifth. TRUTH: Getting vaccinated helps to prevent spread to others, and in addition being vaccinated increases your chances of not getting COVID, and helps to limit variants. See here and here.
  • MISINFO: Covid isn’t that bad so we don’t need to be vaccinated. TRUTH: While some people who get Covid-19 can show no or mild symptoms, vaccines are highly effective in preventing serious illness and hospitalisation. See here and here.
  • MISINFO: Only old people need to get vaccinated as they’re the only ones at risk from Covid. TRUTH: While older people do have higher risk, it’s important for young healthy people to also be vaccinated, to help reach herd immunity and also limit variants.  See here and here.
  • MISINFO: Natural immunity is better than vaccine immunity and shows we don’t need to be vaccinated. TRUTH: Natural immunity can help protect you but it depends on when you had Covid-19, which variant and your own immunity strength and health. With new variants prevalent in SA, natural immunity will be less of a protection. Vaccines are essential to giving sufficient anti-bodies to protect you, which is why boosters are essential too.  See here and here.
  • MISINFO: Vaccines side effects are being under reported and can kill you. TRUTH: There’s no evidence to support this claim, most side effect are mild and self-resolving. See here, here and here.
  • MISINFO: Vaccines cause infertility and erectile dysfunction. TRUTH: There is no evidence supporting this claim.  Covid-19 however can impair sexual performance. See here, here and here.
  • MISINFO: Covid booster vaccines are dangerous. TRUTH: There also is no evidence to support this claim. The vaccine used for boosters is the same as the vaccine used in initial vaccinations. Boosters shots are normal practice for many vaccines. See here and here.
  • MISINFO: Vaccines are dangerous and cause “vaccine-acquired immunodeficiency syndrome” or “VAIDS”. TRUTH: There is no evidence at all to support the claim of immunodeficiency being related to Covid-19 vaccines.  See here and here.
  • MISINFO: Pfizer’s own data shows over 1,291 side effects of Covid vaccine. TRUTH: It is true that a report from Pfizer released in 2021 does list 1,291 potential side effects of any new drug. However, this is NOT a list of side effects of their Covid vaccine; instead it is a list of the possible side effects that their study was watching out for. The vaccine is safe, being authorised by the SA Health Products Regulatory Authority and similar bodies around the world. See here and here.
  • MISINFO: Covid vaccines require use of long painful needles. TRUTH: Covid vaccines may cause slight pain, like a poke or pinch, for only for a few seconds. It’s really not that bad.  See here and here for tips and advice to manage fear and pain.
  • MISINFO: COVID cases are low so now we don’t need to vaccinate. TRUTH: Confirmed cases of Covid infection are increasing now in SA – we could be starting the fifth wave. It is very important now to vaccinate to reduce the severity of future infections. See here.

 

WHO Africa Infodemic Response Alliance (AIRA) & Viral Facts

 AIRA is the Africa-wide initiative of the World Health Organisation, managaing the infodemic of misinformation and communications overload related to Covid-19 and vaccination. Their Viral Facts content responds to misinformation and can be used freely.

Belief that Covid-19 vaccine are weakening the immune system. Anti-vaccine narratives are spreading at a much faster rate than pro-vaccine messages as many prominent voices in public health have reduced their dissemination of evidence-based messaging. This has allowed for speculation and misinformation to go unchecked and accurate content is not keeping pace. The distrust in all vaccinations is concerning, and the belief that mRNA vaccines causes severe immune system side effects has resurfaced.

 

Recommendations:

  • Continue promoting accurate statistics for Covid-19 cases, hospitalizations and deaths for non-vaccinated in comparison to vaccinated people to debunk these claims and reiterate the positive impacts of vaccinations for strengthening immuno-responses.
  • Address mRNA vaccines in public health messages. The key components to be addressed are:
    • What is mRNA, and why is it a part of the Covid-19 vaccine?
    • Does the mRNA component of the Covid-19 weaken the immune system?

More Viral Facts:

  • The importance of getting vaccinated [LINK]
  • The pandemic is not over! [LINK]
  • Covid-19 effects on sexual performance [LINK]

 

RECOMMENDATIONS FOR RISK COMMUNICATIONS & COMMUNITY ENGAGEMENT

Information for healthcare workers: Clear informative guides should be prepared and disseminated to healthcare workers, explaining up-to-date science on Covid and the vaccine rollout strategy. Health workers should be encouraged to call the national Covid contact centre when desired, and should encourage hospitals and clinics to post the Covid hotline number 0800 029 999 prominently on their notice boards.

How to increase vaccination: Experience from around the country backed up by surveys strongly suggests that the way to increase vaccination is through having strong local mobilisation with trusted local leaders, a door-to-door and face-to-face approach with mobilisers speaking directly to people, and organising pop-up sites or arranging ‘vaxi taxi’ transport to sites. This approach, especially in informal settlements and rural areas, significantly increases vaccination rates. Vaccination data and demographic data can be used to ‘micro-target’ the areas where this social mobilisation approach will be most effective.

Prepare to be the majority: In May or early June, SA will have vaccinated over 50% of adults. This is an achievement which needs to be celebrated widely. This can be used as a hook for a new wave of vaccination promotion. We have to make this majority ‘visible’ so that people throughout SA are aware that most adults have vaccinated. We need to reset the social norm.

 

METHODOLOGY AND COLLABORATION

The Social Listening & Infodemiology team that produces this report is part of the Risk Communications & Community Engagement Working Group of the Department of Health. This report is compiled following the methodology of the WHO Africa Infodemic Response Alliance (AIRA, see here), the “Identify” stage.  We pool information from the following:

  • SA National Department of Health
  • Covid-19 Hotline: Reports from the national Covid-19 call centre
  • Org: NDOH Covid-19 WhatsApp system
  • WHO Africa Infodemic Response Alliance (AIRA)
  • UNICEF: digital analysis of content on Google, Twitter, YouTube and Facebook, and digital news
  • Red Cross: Network of over 2,000 community volunteers reporting misinformation and concerns
  • Real 411 Media Monitoring Africa: a mis- and disinformation reporting and debunking initiative
  • Covid-19 Comms: a network of communications specialists that produces information on the pandemic
  • DOH Free State & KZN: Provincial Departments of Health
  • Community Constituency Front (CCF), Covid-19 Hotline, Health Systems Trust
  • Centre for Communication Impact, Centre for Analytics & Behavioural Change, Section 27
  • Medical Research Council, National Institute for Communicable Diseases,
  • SA Vaccination and Immunisation Centre, HSRC, DG Murray Trust, Right To Care
  • Universities of Johannesburg, Cape Town, Free State, Wits, Stellenbosch, Sefako Makgatho

Other organisations involved Government Communications & Information Service, SA Council of Churches, Clinton Health Access Initiative, Heartlines, Children’s Radio Foundation, IPSOS, People’s Health Movement, and Business for SA, SA Minerals Council, Wits Reproductive Health & HIV Institute, UN Verified, HealthEnabled, Deaf SA, SA National Council for the Blind, Treatment Action Campaign and Disability SA.

This edition was prepared by Charity Bhengu, Herkulaas Combrink, William Bird and Peter Benjamin.

Contact:

Nombulelo Leburu, National Department of Health          nombulelo.leburu@health.gov.za            082 444 9503
Peter Benjamin, HealthEnabled                                      peter@healthenabled.org                       082 829 3353
Charity Bhengu, National Department of Health               charity.bhengu@health.gov.za               083 679 7424