Review of a case study on COVID-19 response and vaccine hesitancy in South Africa


A recent study published on the medRxiv* The preprint server proposed an approach that assesses community case studies to examine vaccine hesitancy and response to public health behaviors related to coronavirus disease 2019 (COVID-19) in South Africa.

Study: Community case studies of vaccine hesitancy and response to COVID-19 in South Africa; The VaxScenes study. Image Credit: Anishka Rozhkova/Shutterstock

COVID-19 vaccines have played a crucial role in combating the widespread impact of the ongoing pandemic; however, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine hesitancy has emerged as the biggest obstacle to global immunization programs.

About the study

This study assesses the various factors responsible for vaccine hesitancy at the community level in South Africa and determines preventive public health behaviors against COVID-19.

The study design includes mixed methods and four community case studies of adults aged 18 and older. The socio-ecological model of behavior will be used to examine barriers and factors influencing responses to COVID-19 vaccines from an individual, interpersonal, and community level to a broader context involving policies, resources, and infrastructure.

Methods developed by the Behavioral and Social Drivers of Vaccination (BeSD) Working Group will be used in this study. The BeSD framework includes four domains, namely what the public thinks and feels about COVID-19 vaccines, social factors that favor or demote vaccination, personal motivations or hesitations to get vaccinated, and practical factors affecting the process of finding and receiving COVID-19. 19 vaccines.

Convenience and purposive sampling methods, respectively, will be used to ensure inclusion of well-known sites as well as a mix of sites from different provinces of South Africa in the study. Provinces with the highest number of SARS-CoV-2 infections such as Gauteng, KwaZulu Natal and Western Cape provinces will be included as sampling sites.

Data collection and evaluation of study results at each site will be categorized into three phases. Phase 1 will use Geographic Information System (GIS) maps that will visualize housing, infrastructure, employment and private and public services as well as population centers and COVID-19 statistics. A total of 15 key informant interviews (KIIs) will then be conducted via focus group discussions (FGDs) of groups of six participants to elicit an account of the local community’s COVID-19 related experience.

Phase 2 of the study will assess acceptance of COVID-19 at the community level using a quantitative survey and group focus groups of six to eight participants. Phase 3 will include cross-case study summaries and the preparation of an integrated report for the four sampling sites.

The study will also involve a computational method to assess qualitative and quantitative data at each sampling site, including an epidemiological and demographic profile to describe vaccine response in the community. Qualitative methods of assessment will include KIIS and FGDs, including expression session FGDs and FGDs with semi-structured guides. Quantitative methods will include the BeSD COVID-19 Quantitative Vaccination Tool which is a survey tool that will capture data from face-to-face interviews that will be conducted by researchers working in each sampling site.


The proposed study has shown that adapting and validating existing tools that assess narrative-based COVID-19 vaccine hesitancy in South Africa will facilitate better assessment of factors affecting vaccine response in this region. The use of the BeSD model in African populations can help measure the social and behavioral determinants of vaccination against COVID-19.

The novel approach used in this study takes into consideration the interplay between individual, interpersonal, community, and sociopolitical factors that determine response to the COVID-19 vaccine. It also explores the factors that promote doubt or conflict against vaccines.

The researchers believe that the most effective implementation of this model at the community level is due to the fact that this approach makes it easy to identify catalysts or barriers affecting behavior change at the four aforementioned levels. This knowledge can be used to improve public engagement, for example to incorporate motivators of positive vaccine behaviors.

The success of global efforts to control the spread of SARS-CoV-2 largely depends on the uptake and acceptance of COVID-19 vaccines. Using mixed methods and a novel socio-ecological model, this approach will provide local, baseline, and timely evidence regarding factors affecting vaccine acceptance and other public health behaviors.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behaviors, or treated as established information.

Journal reference:

  • Charles Shey Wiysonge, Nancy Coulson, Nirvana Pillay, Sara Cooper, Candice Groenewald, Zaynab Essack, Saahier Parker, Gregory Houston, Jane Simmonds, Anelisa Jaca, Muyunda Mutemwa, Patrick DMC Katoto, Heidi van Rooyen. (2022). Community case studies on vaccine hesitancy and response to COVID-19 in South Africa; The VaxScenes study. medRxiv. do I:

Comments are closed.