South African university staff and students' perspectives, preferences, and drivers of hesitancy regarding COVID-19 vaccines: A multi-methods study

Gavin George, University of KwaZulu-Natal
Michael Strauss, University of KwaZulu-Natal
Emma Lansdell, University of KwaZulu-Natal
Nisha Nadesan-Reddy, University of KwaZulu-Natal
Nomfundo Moroe, University of the Witwatersrand, Johannesburg
Tarylee Reddy, South African Medical Research Council (SAMRC)
Ingrid Eshun-Wilsonova, Washington University School of Medicine in St. Louis
Mosa Moshabela, University of KwaZulu-Natal


COVID-19 vaccine hesitancy poses a threat to the success of vaccination programmes currently being implemented. Concerns regarding vaccine effectiveness and vaccine-related adverse events are potential barriers to vaccination; however, it remains unclear whether tailored messaging and vaccination programmes can influence uptake. Understanding the preferences of key groups, including students, could guide the implementation of youth-targeted COVID-19 vaccination programmes, ensuring optimal uptake. This study examined university staff and students' perspectives, preferences, and drivers of hesitancy regarding COVID-19 vaccines. A multi-methods approach was used-an online convenience sample survey and discrete choice experiment (DCE)-targeting staff and students at the University of KwaZulu-Natal, South Africa. The survey and DCE were available for staff and students, and data were collected from 18 November to 24 December 2021. The survey captured demographic characteristics as well as attitudes and perspectives of COVID-19 and available vaccines using modified Likert rating questions adapted from previously used tools. The DCE was embedded within the survey tool and varied critical COVID-19 vaccine programme characteristics to calculate relative utilities (preferences) and determine trade-offs. A total of 1836 staff and students participated in the study (541 staff, 1262 students, 33 undisclosed). A total of 1145 (62%) respondents reported that they had been vaccinated against COVID-19. Vaccination against COVID-19 was less prevalent among students compared with staff (79% of staff vs. 57% of students). The vaccine's effectiveness (22%), and its safety (21%), ranked as the two dominant reasons for not getting vaccinated. These concerns were also evident from the DCE, with staff and students being significantly influenced by vaccine effectiveness, with participants preferring highly effective vaccines (90% effective) as compared with those listed as being 70% or 50% effective (β = -3.72, 95% CI = -4.39 to -3.04); this characteristic had the strongest effect on preferences of any attribute. The frequency of vaccination doses was also found to have a significant effect on preferences with participants deriving less utility from choice alternatives requiring two initial vaccine doses compared with one dose (β = -1.00, 95% CI = -1.42 to -0.58) or annual boosters compared with none (β = -2.35, 95% CI = -2.85 to -1.86). Notably, an incentive of ZAR 350 (USD 23.28) did have a positive utility (β = 1.14, 95% CI = 0.76 to 1.53) as compared with no incentive. Given the slow take-up of vaccination among youth in South Africa, this study offers valuable insights into the factors that drive hesitancy among this population. Concerns have been raised around the safety and effectiveness of vaccines, although there remains a predilection for efficient services. Respondents were not enthusiastic about the prospect of having to take boosters, and this has played out in the roll-out data. Financial incentives may increase both the uptake of the initial dose of vaccines and see a more favourable response to subsequent boosters. Universities should consider tailored messaging regarding vaccine effectiveness and facilitate access to vaccines, to align services with the stated preferences of staff and students.