Might first-hand experience of ill-health and economic hardship during the COVID-19 pandemic strengthen public support for vaccination and the reallocation of health sector funding towards health emergency preparedness in South Africa?
Authors: Mattes R , Dalal K , Rhoma H , Lambert S , De Wet T , Ellison GTH 
Published: December 2021

Aims

We examined whether first-hand experience of ill-health and economic hardship during the COVID-19 pandemic might strengthen public support for vaccination, and for the reallocation of health sector funding towards health emergency preparedness in South Africa – a country in which high rates of vaccine hesitancy go hand in hand with widespread discontent regarding public service delivery.

Methods

Using data from 1,600 South African respondents who were surveyed during 2021 for the Eighth Round of Afrobarometer (AB-R8), discrete measures of household- and individual-level sociodemographic and economic factors were generated to permit confounder-adjusted analyses of probabilistic causal relationships between self-reported measures of: personal/household COVID-19 illness and job/income/business loss as a result of COVID-19; and the likelihood that respondents would accept a (government-approved) COVID-19 vaccine, or support the reallocation of health sector funding towards health emergency preparedness.

Findings

There was little evidence that personal/household experience of COVID-19 illness was associated with the likelihood that respondents would (or would not) accept a (government-approved) COVID-19 vaccine (OR: 0.96; 95%CI: 0.72,1.28); or that these respondents would (or would not) support the reallocation of health sector funding towards health emergency preparedness (OR: 0.95; 95%CI: 0.71,1.26), even after adjustment for individual- or household-level sociodemographic and economic covariates considered likely confounders. There was similarly little evidence that personal/household experience of job/income/business loss as a result of the COVID-19 pandemic was associated with support for the reallocation of health sector resources for emergency preparedness (OR: 1.02; 95%CI: 0.80,1.30); again, even after adjustment for potential confounders.

However, respondents who reported that they or someone in their household had lost their job/income/or business as a result of the COVID-19 pandemic had only around half the odds of reporting that they would accept a (government-approved) COVID-19 vaccine (OR: 0.60; 95%CI: 0.47,0.77) – and this finding, like the others in these analyses, was largely unaffected by the inclusion/exclusion of covariates considered susceptible to change following the onset of the COVID-19 pandemic (i.e. those covariates potentially operating as colliders rather than genuine confounders).

Conclusions

These findings suggest that – despite the postulated ‘experiential dividend’ of COVID-19 illness (i.e. its expected impact on vaccine hesitancy and support for the reallocation of health sector resources for health emergency preparedness) – no such ‘dividend’ was observed in this broadly representative sample of South African adults. Indeed, job/income/business loss (and associated economic hardship) also had little effect on support for the reallocation of health sector resources for health emergency preparedness; yet this was somewhat paradoxically associated with a much lower odds of vaccine acceptance – paradoxically, since vaccination has been widely viewed as a pragmatic (if somewhat neoliberal) intervention to protect economic activity. However, these findings might simply reflect inadequate confounder adjustment for preceding and entrenched attitudes towards vaccination amongst those South Africans who are also most vulnerable to job/income/business loss as a result of the COVID-19 pandemic. Protecting the livelihood and health of such individuals and households is likely to remain a substantial challenge and key priority for future emergencies in which economic activity is compromised.

Aim

The aim of the present study was to examine whether first-hand experience of ill-health and economic hardship during the COVID-19 pandemic might have strengthened public support for vaccination, and for the reallocation of health sector funding towards health emergency preparedness in South Africa – a country in which high rates of vaccine hesitancy go hand in hand with widespread discontent regarding public service delivery. To this end we drew on data generated by the eighth round of household surveys undertaken by Afrobarometer (AB-R8) which interviewed 1,600 respondents across South Africa during 2021 – more than a year after the country’s first confirmed case of COVID-19 on 5 March 2020.