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