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How can we deal with COVID-19 vaccine hesitancy? Lessons learnt from the HIV pandemic

Published May 11, 2022


By Vimbai Chibango

Like any other countries in the world, South Africa’s vaccination programme has been up and

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running since February 2021. On the 19 th of January 2022, South Africa celebrated the

inauguration of a new vaccine manufacturing plant in Cape Town, the very first in Africa to

produce COVID-19 vaccines and other pharmaceuticals. This is indeed a giant step towards the

provision of locally made COVID-19 vaccines. However, the key question is, what will the

influence of COVID-19 hesitancy and anti-vaccine philosophies towards the attainment of

COVID-19 herd immunity be? Will the establishment of a vaccine manufacturing facility obtain

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the intended results?

The challenges associated with hesitancy to vaccinate or to take any newly manufactured drugs

aimed at treating an epidemic are not new. Prior to COVID-19, the world was shaken by yet

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another pandemic, HIV, which came in just over 30 years ago. The hesitancy associated with

HIV happened at two interconnected levels that are; at testing and also at the point of initiation

of antiretroviral therapy for people that receive a positive HIV test result. There are various

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reasons linked to this reluctance. For example, a study conducted in Swaziland by academics

Adams and Zambeira shows that some of the reasons associated with hesitancy to test or to take

HIV antiretroviral therapy include fear of a positive result, concerns about early initiation of

ART, stigma and discrimination, HIV conspiratorial theories and lack of trust in the commitment

and financial capacity of governments. When it comes to the uptake of the COVID-19 vaccine,

the reasons for vaccine hesitancy remain complex. However, a study conducted by academics

Machingaidze and Wiysong in low- and middle-income countries to understand COVID-19

vaccine hesitancy show lack of information as a major hindrance to vaccine acceptance. One

more worrying factor that thwarts vaccine acceptance are conspiracy theories and myths

surrounding COVID-19 vaccines which portrays negative physiological consequences emanating

from vaccination. We can therefore draw a similar pattern between the HIV and COVID-19

pandemics which explain reluctance to receive therapies designed to address each of the distinct


In the midst of all the uncertainties regarding ART, global and collaborated efforts were made to

increase HIV testing rates and that people living with HIV receive ART. For example, the

UNAIDS report of 2021 shows that globally, the number of people on ART has been rising

significantly from 2000 to 2020 (0.6 million to 30 million respectively). When it comes to

COVID-19 vaccinations, the South African Department of Health shows that the country is

making progress though we are still yet to achieve herd immunity. To date, over 31 million

people were vaccinated and 17.6 million having been fully vaccinated in South Africa since

February 2021. The ratio of the fully vaccinated is about 29% of the total population. Over 800

000 people also received Booster Dose.

According to the Centre for Disease Control and Prevention (CDC, 2022), vaccines help to lower

the risk of getting and spreading the virus that causes COVID-19 as well as prevent serious

illness and death. Also, the National Institute for Communicable Diseases (NICD) considers

vaccination not only as an individual asset but as an important measure against COVID-19 which

benefits the whole country, which they refer to as ‘population immunity’. Similarly, we have

also learnt from the HIV pandemic that for persons infected with HIV, the ART helps to stop the

virus from multiplying, thereby increasing onesCD4 count. It also prevents progression to AIDS.

Thus, the idea of weakening the viral load as a result of ART is central in fighting HIV.

However, delays in acceptance or refusal to vaccinate has proved to be detrimental to progress

towards preventing the spread of COVID-19. News from the South African Medal Research

Council (SAMRC) state the following reflections and facts about vaccine hesitancy:

 Reports from South Africa’s biggest hospitals, show that almost 99% of hospital

admissions, resulting in serious illness or death due to COVID-19 affected unvaccinated


  [Vaccine hesitancy] can result in communities being unable to reach thresholds of

coverage necessary for herd immunity, thus unnecessarily perpetuating the pandemic and

resulting in untold suffering and deaths.

  Failure to improve vaccination coverage will mean further infections that carry with

them the threat of driving the development of mutations and new COVID-19 variants that

can create large-scale outbreaks and be even more deadly.

The launch of the vaccine production plant in South Africa is indeed a milestone as it is intended

to address many gaps specifically in the roll-out of COVID-19 vaccine, cancer vaccines cancer

vaccines and other pharmaceuticals. However, there is an urgent need to address the challenge of

vaccine hesitance and anti-vaccination philosophies that might be counterproductive to the

success towards the fight against COVID-19. A study by academics Cooper, Rooyen and

Wiysonge investigated the extent and determinants of COVID-19 hesitancy in South Africa and

it demonstrates that vaccine hesitancy is likely to be influenced by age, race, education, politics,

geographical location, and employment.

There are a number of lessons that can be learnt from HIV which can also be relevant in the fight

against COVID-19. In the context of HIV, it was necessary to understand the problems,

challenges and setbacks towards the prevention and treatment of HIV. This provided an

opportunity to reach the real issues and address them accordingly. In the same vein, South Africa

and other countries that are faced with vaccine hesitancy may need to look into the real causes of

vaccine hesitancy and pave the way for dialogue with communities in fighting the pandemic.

Such an approach is likely to facilitate progress towards the fight against COVID-19 which is

expected to be aided by the production of home-grown vaccines.


South Africa’s initiative to have a COVID-19 vaccine manufacturing plant reminds us of the

significant developments it made in the early years of the HIV pandemic. The country began to

develop home-grown antiretroviral drugs which helped to circumvent the costs of importing

drugs and other challenges associated with foreign-based pharmaceuticals for HIV treatment. To

date, South Africa prides itself as one of the leading countries in the world with a high ART roll-

out. It is also our hope that the objectives of the COVID-19 vaccine production initiatives be

soon realised.

Dr Vimbai Chibango is attached to Gender Justice, Health and Human Development. This piece

emerges from a RADLA (Research and Doctoral Leadership Academy) workshop. Vimbai writes

in her personal capacity.

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