Following the rollout of several effective vaccines against coronavirus disease 2019 (COVID-19), many countries have introduced vaccination passports or certificates as a means of certifying that an individual has been vaccinated against, is immune to, or is presently uninfected with COVID-19. An extensive ethical debate has ensued.
To determine the perspectives of South African healthcare workers (HCWs) on the implementation of COVID-19 vaccination passports (C19VPs) in South Africa (SA).
Healthcare workers working in various fields and practice settings throughout SA were invited to complete an online questionnaire.
An online questionnaire was distributed using convenience sampling via social media platforms to HCWs over a 1-month period, collecting demographic details and responses to 8 Likert-type items regarding agreement with C19VPs, ethical issues and feasibility. Each item was graded from 1 (strongly disagree) to 5 (strongly agree), with grouping of 4 of the 8 items exploring a common theme of C19VPs being a good idea, constituting a score out of 20. Non-parametric tests were performed to determine differences in responses between groups.
One thousand HCWs responded to the survey and fulfilled inclusion criteria. The majority (83.2%) of respondents were medical practitioners (MPs). Overall, most (73.5%) respondents agreed that C19VPs are a good idea. Older respondents agreed more strongly than younger respondents (medians 18 and 17, respectively,
The perspectives of HCWs, mainly MPs, about C19VPs in SA were obtained. Further research should focus on vaccine hesitancy and its factors in HCWs and the effect of C19VPs on restrictions, reduction in transmission and benefits on economies and mental health.
To the authors’ knowledge, this is the first survey data published on the perspectives of South African HCWs on C19VPs in the country. Healthcare workers are trusted influencers of vaccination decisions, and their opinion on vaccination certificates may also influence the South African public’s perception and acceptance thereof.
Following the global rollout of coronavirus disease 2019 (COVID-19) vaccines, many countries began to introduce so-called ‘vaccination passports’, or immunity licences, as a means of certifying that an individual has been vaccinated against, is immune to, or is presently uninfected with COVID-19 (Phelan
Practical implications of implementing immunity-based certificates have been raised, for example, where an individual may falsely be declared immune due to inaccurate serological tests (Persad & Emanuel
Conversely, ethicists have highlighted the problems with unnecessarily restricting movement in individuals considered to be immune, as well as highlighting benefits such as a resumption of pre-pandemic normality, lifting of restrictions on free movement (i.e. an end to lockdowns), reducing social harms caused by unemployment and isolation, allowing the reopening of small businesses and restaurants and enabling people to attend cultural, worship and sporting events in person (Brown et al.
Despite this ongoing debate, several countries have introduced COVID-19 vaccination passports (C19VPs) due to the public health benefits ascribed. Most of these are stored digitally, can be retrieved using unique QR codes and have allowed for the easing of some restrictions (European Commission
In SA, there is a legal framework for the introduction of a mandatory vaccination policy in the workplace, with the
With these factors in mind, the researchers sought to obtain the perspectives of HCWs in SA on the concept and implementation of C19VPs in SA, as one of the groups of workers most exposed to COVID-19 and who may face vaccine mandates in the workplace.
A cross-sectional, quantitative study design was followed, inviting HCWs to complete a single survey to determine their knowledge, attitudes, practices and beliefs (KAPB) on C19VPs.
Healthcare workers working in various fields and practice settings throughout SA were invited to complete an online questionnaire.
Non-probabilistic, convenience sampling was used. With an estimated population of South African HCWs of 650 000 (Kerr & Thornton
The following variables were recorded: age group, SA residency status (citizen, permanent resident or visa holder), professional or regulatory authority (Health Professions Council of South Africa [HPCSA], South African Nursing Council [SANC], among others), employment status (employed, retired or studying), healthcare sector (private, state/public, or both), province, professional group (per HPCSA or SANC categories), profession, and level of medical practice in the case of medical practitioners (MPs).
Following these demographic details, respondents were asked for their degree of agreement with 8 Likert-type statements, with 5 possible responses graded from 1 (‘Strongly Disagree’) to 5 (‘Strongly Agree’), which are shown in
Responses to Likert-type items.
Likert items 1 through 4 represented similar statements and were grouped into a Likert scale (Cronbach’s alpha = 0.94), with responses to the 4 statements thus contributing to a maximum of 20 points (4–7 = strongly disagree; 8–11 = disagree; 12 = neutral; 13–16 = agree; 17–20 = strongly agree), representing the statement ‘C19VPs are a good idea’. Statements 5 to 7 related to ethical issues surrounding C19VPs but were not grouped as they explored dissimilar concepts.
Simple descriptive statistics were calculated on the Likert-type items, with the median and interquartile range (IQR) being the most appropriate measures of central tendency and spread in this type of data (El Omda & Sergent
The data did not follow a normal distribution; thus non-parametric tests were performed to find differences in responses between groups. The Kruskal-Wallis test was performed to determine whether there were differences in the mean ranks of responses between at least one pair of groups when there were three or more groups being compared; with the null hypothesis being that the mean ranks of all groups are the same, degrees of freedom (
The Mann-Whitney
Grouping was performed for certain demographic details, such as age and profession, in addition to the grouping of provinces according to their proportion of the population vaccinated at the time of the survey, with data sourced from Covid19SA.org, a collaboration between the University of the Witwatersrand and the National Research Foundation’s iThemba LABS (COVID-19 SA
Ordinal logistic regression analyses were performed between responses to different Likert items to generate response outcome probability prediction. A McFadden’s pseudo R-square of 0.2–0.4 was considered an excellent fit. Goodness of fit indicators (Pearson residuals chi-square and deviance residuals chi-square)
The protocol for this study was reviewed and approved by the uMgungundlovu Health Ethics Review Board on 06 May 2021 (UHERB 003/2021) and was approved by all nine provincial Departments of Health following review via the National Health Research Database. An information sheet was made available to participants and informed consent was required before continuing with the survey.
There were 1053 responses to the survey, of which 1000 met the inclusion criteria (see ‘Sampling’ above). Of the 53 sets of responses excluded from analysis, 36 reported not to be HCWs, and 17 reported they were not currently employed or studying in SA. The demographic details of the respondents are shown in
Demographics.
Characteristics | % | |
---|---|---|
18 to 24 | 37 | 3.70 |
25 to 34 | 389 | 38.90 |
35 to 44 | 163 | 16.30 |
45 to 54 | 161 | 16.10 |
55 to 64 | 127 | 12.70 |
Over 65 | 123 | 12.30 |
Employed | 902 | 90.20 |
Retired | 56 | 5.60 |
Studying | 42 | 4.20 |
SA citizen | 964 | 96.40 |
Permanent resident or visa | 36 | 3.60 |
Private sector only | 400 | 44.35 |
State/public sector only | 398 | 44.12 |
Both public and private sectors | 104 | 11.53 |
Gauteng (GP) | 330 | 36.59 |
KwaZulu-Natal (KZN) | 249 | 27.61 |
Western Cape (WC) | 180 | 19.96 |
Eastern Cape (EC) | 52 | 5.76 |
Free State (FS) | 26 | 2.88 |
Mpumalanga (MP) | 23 | 2.55 |
North West (NW) | 22 | 2.44 |
Limpopo (LP) | 11 | 1.22 |
Northern Cape (NC) | 9 | 1.00 |
, recorded only for employed healthcare workers.
Respondents’ professions.
Professions | % | |
---|---|---|
Dietician | 1 | 0.1 |
Emergency Care Assistant | 1 | 0.1 |
Emergency Care Practitioner | 12 | 1.2 |
Emergency Care Technician | 1 | 0.1 |
Clinical Associate | 1 | 0.1 |
Dentist | 4 | 0.4 |
Health Assistant | 1 | 0.1 |
Medical Practitioner | 832 | 83.2 |
Medical Technologist | 1 | 0.1 |
Supplementary Laboratory Assistant | 1 | 0.1 |
Enrolled Nurse | 6 | 0.6 |
Enrolled Nursing Assistant | 2 | 0.2 |
Registered Midwife | 4 | 0.4 |
Registered Nurse | 57 | 5.7 |
Occupational Therapist | 7 | 0.7 |
Optometrist | 1 | 0.1 |
Pharmacist | 9 | 0.9 |
Pharmacist’s Assistant | 1 | 0.1 |
Biokineticist | 1 | 0.1 |
Physiotherapist | 27 | 2.7 |
Psychologist | 10 | 1.0 |
Clinical Technologist | 6 | 0.6 |
Radiographer | 4 | 0.4 |
Audiologist | 9 | 0.9 |
Speech Therapist and Audiologist | 1 | 0.1 |
Medical practitioner level of practice.
Levels of MP | % | |
---|---|---|
MO | 243 | 29.21 |
Consultant | 214 | 25.72 |
Registrar | 65 | 7.81 |
Intern | 65 | 7.81 |
GP | 55 | 6.61 |
Retired | 49 | 5.89 |
Other | 42 | 5.05 |
Student | 39 | 4.69 |
CSMO | 33 | 3.97 |
HOD | 27 | 3.25 |
MP, medical practitioner; MO, medical officer; GP, General Practitioner/Family Physician; CSMO, Community Service Medical Officer; HOD, Head of Department.
Median and quartiles responses for each statement.
Statement | Median | First quartile (Q1) | First quartile (Q3) |
---|---|---|---|
1 | 5 | 4 | 5 |
2 | 4 | 3 | 5 |
3 | 4 | 2 | 5 |
4 | 4 | 3 | 5 |
1–4 | 17 | 12 | 20 |
5 | 3 | 2 | 5 |
6 | 2 | 1 | 4 |
7 | 2.5 | 1 | 4 |
8 | 3 | 2 | 4 |
Most respondents agreed that C19VPs are a good idea, with 73.5% of responses yielding a score of 13 or more for the grouped statements 1–4.
There was a difference (
Differences in responses to statements among groups.
Variable | Group | Statements 1–4 |
Statement 5 |
Statement 6 |
Statement 7 |
Statement 8 |
|||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Median | IQR | H | Median | IQR | H | Median | IQR | H | Median | IQR | H | Median | IQR | H | |||||||||
18 to 24 | 37 | 5 | 16 | 12–18 | 14.55 | 0.012 | 4 | 3–5 | 17.489 | 0.004 | 3 | 2–4 | 19.59 | 0.001 | 4 | 2–5 | 22.368 | < 0.001 | 3 | 2–4 | 14.525 | 0.013 | |
25 to 34 | 389 | 16 | 12–19 | 3 | 2–5 | 2 | 1–4 | 3 | 2–4 | 3 | 2–4 | ||||||||||||
35 to 44 | 163 | 17 | 10.5–20 | 3 | 2–5 | 2 | 1–4 | 3 | 1.5–5 | 3 | 2–4.5 | ||||||||||||
45 to 54 | 161 | 18 | 12–20 | 3 | 2–4 | 2 | 1–4 | 2 | 1–4 | 3 | 2–5 | ||||||||||||
55 to 64 | 127 | 19 | 14–20 | 3 | 2–4 | 2 | 1–3 | 2 | 1–3 | 4 | 3–5 | ||||||||||||
Over 65 | 123 | 18 | 12.5–20 | 3 | 2–4 | 2 | 1–3 | 2 | 1–4 | 4 | 2–5 | ||||||||||||
Public | 398 | 2 | 16 | 12–19 | 13.151 | 0.001 | 3 | 2–4 | 3.864 | 0.145 | 2 | 1–4 | 5.715 | 0.057 | 3 | 2–4 | 4.083 | 0.13 | 2 | 2–4 | 5.215 | 0.074 | |
Private | 400 | 18 | 13–20 | 3 | 2–4 | 2 | 1–4 | 2 | 1–4 | 3 | 2–5 | ||||||||||||
Both | 104 | 17 | 8–19.25 | 3 | 2–5 | 2.5 | 1–5 | 3 | 1–4 | 3 | 2–5 | ||||||||||||
HOD | 27 | 9 | 17 | 13–20 | 21.089 | 0.012 | 3 | 2–4.5 | 28.947 | < 0.001 | 1 | 1–3 | 34.795 | < 0.001 | 3 | 1.5–4 | 28.411 | < 0.001 | 3 | 1.5–4 | 25.402 | 0.003 | |
Consultant | 214 | 19 | 15–20 | 2 | 1–4 | 2 | 1–3 | 2 | 1–3 | 4 | 2.5–5 | ||||||||||||
Registrar | 65 | 17 | 11–20 | 4 | 2–5 | 2 | 1–4 | 3 | 2–5 | 4 | 3–5 | ||||||||||||
MO | 243 | 17 | 10–20 | 3 | 2–4 | 3 | 1–4 | 2 | 1–4 | 3 | 2–4 | ||||||||||||
CSMO | 33 | 18 | 13–20 | 3 | 2–4 | 2 | 2–4 | 2 | 2–4 | 3 | 2–4 | ||||||||||||
Intern | 65 | 16 | 13–18 | 3 | 2–4 | 2 | 1–4 | 3 | 2–4 | 3 | 2–4 | ||||||||||||
Student | 39 | 16 | 8–19 | 4 | 3–5 | 3 | 2–5 | 4 | 2–5 | 3 | 2–4 | ||||||||||||
Retired | 49 | 18 | 12–20 | 3 | 2–4 | 2 | 1–3 | 3 | 2–4 | 3 | 2–4 | ||||||||||||
GP | 55 | 17 | 11–20 | 3 | 2–5 | 2 | 1–3.5 | 2 | 1–4 | 3 | 2–4 | ||||||||||||
Other | 42 | 18 | 14–20 | 3 | 2–5 | 2 | 1–4.75 | 2.5 | 1–5 | 3 | 2–5 | ||||||||||||
EC | 52 | 8 | 18 | 11–20 | 18.149 | 0.02 | 3.5 | 2–5 | 1.938 | 0.983 | 2 | 1–4 | 19.049 | 0.015 | 2 | 1–4 | 6.009 | 0.646 | 3 | 2–5 | 14.005 | 0.082 | |
FS | 26 | 17 | 11.25–19 | 3 | 2–5 | 2 | 2–3 | 3 | 1.25–4 | 3 | 2–4 | ||||||||||||
GP | 330 | 18 | 13–20 | 3 | 2–4.75 | 2 | 1–4 | 2 | 1–4 | 3 | 2–5 | ||||||||||||
KZN | 249 | 16 | 13–19 | 3 | 2–4 | 3 | 2–4 | 3 | 2–4 | 3 | 2–4 | ||||||||||||
LP | 11 | 9 | 5–12.5 | 3 | 1–5 | 3 | 1–5 | 3 | 1.5–3.5 | 3 | 1–3 | ||||||||||||
MP | 23 | 16 | 8–19 | 3 | 2–5 | 3 | 1.5–5 | 2 | 1–3.5 | 4 | 1.5–5 | ||||||||||||
NW | 22 | 20 | 12.25–20 | 3 | 2–4.75 | 3 | 1.25–4.75 | 2 | 1–3 | 4 | 2.25–5 | ||||||||||||
NC | 9 | 16 | 8–19 | 2 | 2–5 | 2 | 2–5 | 2 | 2–3 | 2 | 1–4 | ||||||||||||
WC | 180 | 18 | 13–20 | 3 | 2–4 | 2 | 1–3.25 | 2 | 1–4 | 4 | 2–5 |
Statistical tests: Kruskal Wallis.
, Students and retired healthcare workers not included.
IQR, interquartile range; CSMO, community service medical officer;
Age brackets were subsequently grouped into a younger (< 45 years) and older (≥ 45 years) group, and responses between the two groups were compared (see
Differences in responses between groups.
Variable | Group | Statements 1–4 |
Statement 5 |
Statement 6 |
Statement 7 |
Statement 8 |
||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Median | IQR | Median | IQR | Median | IQR | Median | IQR | Median | IQR | |||||||||||||
Age | < 45 years | 589 | 17 | 12–20 | 135 396 | 0.001 | 3 | 2–5 | 106 820 | 0.001 | 2 | 1–4 | 107 183 | 0.002 | 3 | 2–4 | 103 427 | < 0.001 | 3 | 2–4 | 135 579 | < 0.001 |
≥ 45 years | 411 | 18 | 13–20 | 3 | 2–4 | 2 | 1–3 | 2 | 1–4 | 4 | 2–5 | |||||||||||
Residency | SA citizen | 964 | 17 | 12–20 | 18 435 | 0.518 | 3 | 2–4.25 | 20 568 | 0.053 | 2 | 1–4 | 18 564 | 0.464 | 2.5 | 1–4 | 17 593 | 0.885 | 3 | 2–4 | 17 816 | 0.781 |
Non-SA citizen | 36 | 19 | 10–20 | 4 | 2–5 | 2.5 | 1–4.25 | 2.5 | 1.75–4.25 | 3 | 2–5 | |||||||||||
Practitioner type | MP | 832 | 17 | 12–20 | 74 810 | 0.143 | 3 | 2–4 | 61 241 | 0.01 | 3 | 1–4 | 59 445 | 0.002 | 2 | 1–4 | 59 614 | 0.002 | 3 | 2–5 | 71 535 | 0.622 |
Non-MP | 168 | 17 | 12–19 | 3 | 2–5 | 3 | 2–4 | 3 | 2–5 | 3 | 2–4 | |||||||||||
Studying | Students | 42 | 15.5 | 8.5–19 | 23 201 | 0.087 | 3.5 | 3–5 | 16 201 | 0.029 | 3 | 2–4.75 | 15 070 | 0.005 | 4 | 2–5 | 15 824 | 0.016 | 3 | 2–4 | 22 622 | 0.162 |
Non-students | 958 | 17 | 12–20 | 3 | 2–5 | 2 | 1–4 | 2 | 1–4 | 3 | 2–4.75 | |||||||||||
Proportion of provincial population vaccinated |
Highest | 599 | 18 | 12–20 | 97 451 | 0.065 | 3 | 2–5 | 87 898 | 0.43 | 2 | 1–4 | 76 066 | < 0.001 | 2 | 1–4 | 86 520 | 0.241 | 3 | 2–5 | 94 177 | 0.342 |
Lowest | 303 | 17 | 12–20 | 3 | 2–4 | 3 | 2–4 | 3 | 2–4 | 3 | 2–4 |
, Statistical tests: Mann-Whitney
, Students and retired healthcare workers not included. Highest proportion at the time of survey = WC, EC, LP, FS & GP; lowest = KZN, MP, NW & NC (COVID-19 SA
EC, Eastern Cape; FS, Free State; GP, Gauteng; IQR, interquartile range; KZN, KwaZulu-Natal; LP, Limpopo; MP, Mpumalanga (in context of province) or medical practitioner (in context of HCW type); NW, North West; NC, Northern Cape; SA, South Africa; WC, Western Cape.
There was a statistically significant difference (
Medical practitioners at different levels of practice responded differently to grouped questions 1–4 (
When analysing the results from different provinces for responses regarding whether C19VPs are a good idea, there was a difference found (
There were, however, no differences found in responses to grouped statements 1–4 using the Mann-Whitney U test to compare groups of provinces with the most versus fewest confirmed cases of COVID-19 (
When comparing responses to grouped statements 1–4 by respondents’ residency status, there was no difference in responses between non-SA and SA citizens (
Responses for statement number 5 were widely spread as seen in
There was a significant difference (
When age groups were dichotomised into a younger and older group of HCWs, there was a significant difference (
Responses to statement 5 in younger and older healthcare workers.
There was a statistically significant difference in the responses to statement 5 between MP (median = 3) and non-MP HCWs (median = 3, see
Responses to this statement were different when comparing MPs practising at different levels (
When comparing responses to statement 5 by respondents’ residency status, there was no difference in responses between non-SA- and SA citizens (
Respondents tended to disagree that these factors make C19VPs unethical, with 54.7% of HCWs, the majority being MPs, disagreeing overall.
There was again a significant difference in responses to this statement across age groups using the Kruskal-Wallis test (
When grouped into a younger and older group of HCWs (see
A difference was also found when comparing responses from respondents in different provinces, as shown in
Notably, as shown in
A difference was noted in the distribution of responses from MPs (median = 3) compared to non-MPs (median = 3, see
There was again a difference noted in responses when comparing MPs at different levels of practice (
No difference was found when comparing SA- to non-SA citizens (
Respondents were more likely to disagree that C19VPs will disadvantage the poor, as shown in
Responses differed between age brackets (
A statistically significant difference was noted when comparing responses to this statement between MP (median = 2) and non-MP HCWs (median = 3,
A difference in responses was also observed between students (median = 4) and non-students (median = 2), where students were more likely to agree with the statement, while non-students disagreed (
Different levels of MPs responded differently to this statement (
No differences were observed in responses to this statement between SA- and non-SA citizens (
There was wide variation in the responses to this statement (see
A difference in responses to the statement was noted between age brackets (
There was a difference (
There was no difference in opinion on feasibility of C19VPs in SA when comparing SA- to non-SA citizens (
Ordinal logistic regression analyses showed that HCWs’ opinion on feasibility could be somewhat predicted according to whether they thought C19VPs are a good idea. If respondents thought C19VPs were a good idea, there was a 59.7% chance they would respond that they are feasible; whereas disagreeing that C19VPs are a good idea yielded an 82.3% chance of respondents saying they are not feasible, with a McFadden’s pseudo R-square value of 0.188. Ordinal logistic regression analyses between other responses yielded models with lack-of-fit (goodness of fit indicators
The perspectives of HCWs in SA on C19VPs varied. A wide range of HCWs responded to the survey, with equal numbers from the private and public sectors, but with the majority being younger HCWs under the age of 45, three-quarters coming from only three provinces, GP, KZN and WC and with a significant majority being MPs. This was most likely a result of the convenience sampling used, with dissemination of the survey via social media and presents a limitation in the generalisability of the findings of this study.
Almost three-quarters of respondents in SA responded that C19VPs are a good idea – significantly more than previous studies have found when assessing support for immunity passports among the general public (Hall & Studdert
The older demographic of HCWs tended to agree more strongly that C19VPs were a good idea compared to the younger demographic and was more likely to think that implementation of C19VPs in SA is feasible; responses which may be influenced by many factors, including their increased risk of morbidity and mortality associated with COVID-19 infection.
Healthcare workers in private practice were more likely to agree that C19VPs are a good idea compared to their state practice counterparts, perhaps because they have experienced the economic impact of the pandemic first-hand on their practices’ reduced patient loads and finances (Van den Heever & Dasoo
In SA, HCWs were some of the first to be vaccinated through the Sisonke Programme, a collaboration between the National Department of Health, South African Medical Research Council, CAPRISA, Desmond Tutu Health Foundation, Janssen and Johnson and Johnson (South African Medical Research Council
The national vaccine rollout has entered phase 3, with all adults now being eligible to receive the vaccination (South African Government
The vaccine rollout in SA is accessible free of charge to everyone, but questions have been raised about the fairness of the English-only, digital EVDS, which initially required internet access and an appropriate device to register for vaccination (South African Government
The majority of respondents across all groups disagreed that individuals’ personal, religious, or philosophical objection to vaccination make vaccine certification unethical. The younger demographic, students and non-MP HCWs disagreed to a lesser degree than their comparator groups. This is in keeping with findings from the HSRC, which showed increasing levels of vaccine hesitancy with decreasing age (Runciman et al.
The WHO named vaccine hesitancy as one of the top 10 threats to global health in 2019 due to its contribution to the resurgence of vaccine-preventable diseases such as measles and said that ‘health workers, especially those in communities, remain the most trusted advisor and influencer of vaccination decisions’ (World Health Organization
The authors did not specifically enquire after HCW vaccination status in their survey; however, respondents from provinces with the highest vaccination proportion were more likely to disagree that C19VPs are unethical due to individual objections to vaccination, compared to their counterparts in provinces with a lower proportion of the population vaccinated.
The question of the feasibility of C19VPs in SA elicited varying responses from HCWs, with those who thought it was a good idea believing it to be feasible. Despite doubts, the South African COVID-19 Vaccine Certificate has been launched and is set to be used for a variety of purposes (Daniel
This study explored the perspectives of HCWs in SA around C19VPs but had certain limitations. The convenience sampling technique used in this study did not obtain a sample representative of the different subsets of HCWs, with the proportion of MPs in the sample far exceeding that expected in the South African HCW population. It is expected that those who feel strongly about COVID-19 vaccinations (either positively or negatively) would have been more likely to take interest and respond to the survey. The rapidly evolving nature of the pandemic means that HCW responses may also evolve over time – the authors captured their perspectives during the third wave of infections, before vaccination was available to all adults and before implementation of the South African COVID-19 Vaccine Certificate. Additionally, Likert-type responses are known to be subject to distortion through several mechanisms. Central tendency bias arises where individuals are more likely to avoid extreme answers – this was mitigated by dichotomisation of results for statistical analysis. Acquiescence bias is a tendency to agree with statements as presented, which the authors attempted to avoid by presenting specific statements and then grouping the results, rather than broad opinions on whether it is a good or bad idea.
In conclusion, most HCWs sampled (the majority being MPs) thought that C19VPs are a good idea, with little regard to vaccine hesitancy in certain groups, with some concerns regarding the ethical issues of vaccine access, and uncertainty about feasibility. To the authors’ knowledge, this is the first survey data published on the perspectives of HCWs on C19VPs and the associated ethical issues. Healthcare workers are trusted influencers of vaccination decisions, and their opinion on vaccination certificates may also influence the public’s perception and acceptance thereof. Future research into vaccine hesitancy itself in SA, especially in HCWs and students, would be valuable, as well as further research into the efficacy of C19VPs in reducing the transmission of COVID-19, and any beneficial effects they may have on individuals’ mental health or on economies of countries in which they have facilitated the lifting of restrictions.
The authors express their grateful appreciation to the South African Medical Association for the distribution of their survey to its members. The authors gratefully acknowledge the statistical guidance of Dr Nonhlanhla Yende-Zuma (CAPRISA Head of Biostatistics and Data Management).
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
C.J.J.v.V. drafted the manuscript and survey and assisted with data analysis and interpretation. J.M.J.v.V. conceptualised the study, distributed the survey, performed the data analyses and reviewed the manuscript.
The authors disclosed receipt of the following financial support for the publication of this article: This work was supported by the Centre for the AIDS Programme of Research in South Africa (CAPRISA).
All data available from the corresponding author, C.J.J.v.V., upon reasonable request.
The views and opinions expressed in this article are the authors’ own and do not necessarily reflect the official position of any affiliated agency of the authors.