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International Journal of
Population Studies Drivers of COVID-19 vaccination in South Africa

and 50.26 doses in most of sub-Saharan African region however, not prominent. With respect to COVID-19, the
according to the WHO. While China, the United States, knowledge of the severity of symptoms and presentations
the United Kingdom, and France have administered in individuals who tested positive, and/or the loss of a
3 billion, 523 million, 138 million, and 140 million family member or an acquaintance to the disease may affect
vaccine doses, respectively (WHO, 2022c), South Africa an individual’s disposition to the virus, and influence their
recorded the highest number of doses administered in willingness to get vaccinated. Reading or watching the news
sub-Saharan African region, standing at 29.8 million doses about the prevalence of COVID-19, encompassing the
(Department of Health, South Africa, 2022). The doses case and death statistics, on the media may not shed light
were administered to 19.9 million people in South Africa, on the extent of its severity. The overarching hypothesis
which has an estimated population of 59 million people. of this study, therefore, is that individuals who perceived
The geographical variation in vaccination coverage could themselves as being at risk of infection, whose current
be attributed to the geography of vaccine manufacturing health status was sub-optimal, and who knew someone
technology, production capacity and availability, vaccine with COVID-19 would be more willing to get vaccinated.
nationalism prevailing in wealthy nations (Ghebreyesus, 2. Data and methods
2021), and vaccine hesitancy. While the first three
apparently put sub-Saharan African countries at a 2.1. Data source
disadvantage, vaccine hesitancy is a global phenomenon as Data for this study were sourced from Wave 5 of the National
studies have shown that COVID-19 vaccine hesitancy rate Income Dynamics Study – Coronavirus Rapid Mobile
was around 40 – 45% in Sweden, Germany, Italy, the US, Survey (NIDS-CRAM) in South Africa. The NIDS-CRAM
Russia, Poland, and France (Lindholt et al., 2021; Sallam, is a nationally representative panel survey of South
2021) and as high as 63% in Jordan (El-Elimat et al., 2021) Africans over the age of 18. In the survey, the same cohort
and 76% in Kuwait (Sallam. 2021). Factors underlying the of individuals were contacted periodically and asked a
hesitancy include perceived risks and benefits, cultural range of questions about their income, employment status,
and religious beliefs, sociodemographic characteristics, household welfare, receipt of grants, and their knowledge
and trust (Lindholt et al., 2021; Sallam, 2021; El-Elimat concerning and attitude to COVID-19 (NIDS-CRAM,
et al., 2021). 2021). The NIDS-CRAM is a special follow-up with a
In South Africa, however, the willingness to get subsample of adults from households in the National
vaccinated stood at around 76% in July 2021, despite Income Dynamics Study (NIDS) survey. NIDS is a broadly
vaccine insufficiency (National Income Dynamics Study nationally representative panel study following the lives
– Coronavirus Rapid Mobile Survey [NIDS-CRAM], of the same 28,000 South Africans, and those they live
2021). With its index case reported on March 5, 2020, 3.6 with, every 2 – 3 years since 2008 (NIDS-CRAM, 2021).
million positive cases out of 22.4 million tests, and nearly NIDS-CRAM is funded by the FEM Education Foundation
96,000 deaths in four COVID-19 waves as of February 4, and Michael and Susan Dell Foundation, implemented by
2022 (Department of Health, South Africa, 2022), South the Southern Africa Labour and Development Research
Africa has the highest prevalence of COVID-19 in Africa Unit, and the data from this survey are made accessible by
and accounts for half of the total number of cases on the DataFirst.
th
continent (WHO, 2022c). The country also ranked 17 of 2.2. Sampling
220 countries in the number of cases, a position higher
than the Netherlands, Canada, and Sweden. While a The sample for the survey was drawn using a stratified
number of studies have focused on exploring the drivers sampling technique to select households in all nine
of COVID-19 vaccine hesitancy across the world, this provinces of South Africa. Respondents who were 15 years
study investigated the factors driving the willingness to and older in the 2017 NIDS survey were included in
get vaccinated. Specifically, this study assessed the impacts the NIDS-CRAM Wave 5 survey in 2020, as they had
of individual’s beliefs about their risks of getting infected, turned 18 in 2020. Data for the survey were collected
their self-reported health status, and their familiarity with between April 6 and May 11, 2021, through Computer-
someone infected with COVID-19 on their willingness to assisted Telephone Interviewing (CATI) (NIDS-CRAM,
2021). As the sample in the panel consists of individuals
get vaccinated.
who have been followed up since Wave 1, this study
Beliefs about perceived risks of infection and health excluded respondents whose data were included in Wave
status have been shown to influence the uptake of health- 5 but without participating in the current round of data
care services (Rosenstock, 1966; Becker, 1974). Case collection. This category of individuals comprised of
familiarity as a determinant of health-care seeking is, those who were not contacted, moved out of South Africa,

Volume 10 Issue 1 (2024) 69 https://doi.org/10.36922/ijps.479