Infecting Minds: Perceptions and attitudes towards vaccines among rural and urban dwellers in the context of the COVID-19 pandemic in KwaZulu-Natal, South Africa

Abstract

Abstract Background We investigated how social and contextual factors shape perceptions and attitudes of rural and urban dwellers towards vaccines in South Africa. We assessed the views, acceptance, and uptake of vaccines for a range of infectious diseases, in the light of the experiences of the COVID-19 pandemic. Methods We conducted 30 in-depth face-to-face and virtual interviews in the uMkhanyakude district municipality and Durban, KwaZulu-Natal South Africa. Participants were adults (≥ 18 years) consisting of ordinary citizens, traditional leaders and healers, and nurses. Data collection was conducted in IsiZulu. Thematic analysis was used to identify key themes. Findings We found broad vaccine acceptance among most study participants. The main reasons given for vaccine uptake included fear of death, government campaigns, vaccine mandates and penalties, understanding the importance of vaccines for disease prevention and survival, and securing the health of family members. Older participants (≥ 40 years) demonstrated more positive attitudes towards vaccines. Most participants downplayed the role of culture and religion in attitudes towards vaccines. Some of the drivers of vaccine hesitancy were having an ancestral calling, medical pluralism, or local myths around the treatment of infections such as influenza and mumps, insufficient information, a perceived depopulation agenda couched in mistrust and the use of incentives and threats to force people to accept COVID-19 vaccines. Conclusion Participants’ views shape the understanding of vaccine confidence in South Africa. Exploring the roots of vaccine hesitancy over time in communities occupying different geographical and cultural spaces provides opportunities to understand the complex reasons why vaccines are accepted or rejected. The exploration of contexts, exposures and circumstances provide insights into perceptions, outlook, and behaviour. Deeper engagement with local communities is therefore crucial to develop evidence that can inform vaccine interventions. Assumptions about how culture and religion affect vaccine hesitancy or acceptance should be avoided in the process of developing such evidence.