On rage, distrust and Covid-19 lockdowns: Why vaccine hesitancy is irrational but not incomprehensible

The recent announcement by President Cyril Ramaphosa that the government might introduce new measures to allow only individuals vaccinated against Covid-19 to participate in certain activities or to access certain venues (what is often called a vaccine mandate or a vaccine passport), unleashed a firestorm of protest from critics across the political spectrum. What should we make of the intense anger, rage and (in some cases) despair of so many of the people responding to this announcement?

As anyone with a presence on social media must surely know, it is the height of foolishness to read the responses to anything one posts on Twitter, not only because these comments are not representative of the views of Twitter users (let alone of the larger population), but also because so many of the responses are likely to be abusive, hateful, bigoted, or mendacious, or to include demonstrably false claims. But I am no less foolish than the next person, so I do sometimes dip into these comments in the hope to find a clever, witty, original, or informative response among them. This is mostly, but not always, a waste of time.

I was therefore not too surprised when I checked the often angry responses to an article I shared, in which Justice Malala argued that President Cyril Ramaphosa needed to decisively implement vaccine mandates for all adults. Homophobia. Check. Racial bigotry. Check. Conspiracy theories. Check. Threats. Check. False claims. Check.

What did strike me as slightly unusual was the dominant tone of rage and fury in the responses: “Go fuck yourself moron”; “Fuck. Them. All.”; “Voetsek, jou nai.”. I also noticed more threats – the kind that people who feel helpless but are truly furious tend to make: “Shoot all AIDS spreaders”; “You wanna see this country in ashes”; “Righteous retribution will be poured out on your head”; “May Allah punish u severely and destroy you.”

But while most people – presumably also most people who are vaccine hesitant or who oppose the implementation of vaccine mandates on libertarian “free choice” grounds – would not react in in this way, I see signs of Covid-19 related fury and rage everywhere. And it is not only the Covid-10 deniers and the anti-vaxxers who are furious at the world we live in now.

There are many valid reasons to be furious. Covid-19 has so far killed an estimated 250 00 people in South Africa alone. Many more have fallen seriously ill, or continue to suffer from “long Covid”. The pandemic has also had a devastating effect on the economy, disproportionately impacting on the well-being of those who are already vulnerable and/or poor. The manner in which the government managed the lockdown, especially in the early months, is also infuriating. The lockdown regulations seemed to assume that all South Africans live middle class lives, and could easily isolate themselves in spacious homes. It was also assumed that the best way to ensure compliance was to unleash undisciplined, badly trained, and often corrupt and violent, police officers and soldiers on the public, to tragic effect.

Our lives have become smaller and more inward looking during the pandemic, and even for those of us who are privileged enough to remain employed, our jobs have become more difficult and less rewarding to do.

It has exposed the hypocrisity and Afrofobia of countries in the global North, who continue to block a waiver for intellectual property rights on Covid-19 vaccines, thus leaving the distribution of vaccines to the vagaries of the (distorted) market. And who of us have not quietly or not so quietly cursed Boris Johnson and his government in recent weeks for instituting a completely unnecessary travel ban on South Africa – with devastating effects for our economy – while praising our scientists and mouthing meaningless platitudes about “our South African friends”.

There are also good reason to be furious at anti-vaxxers who spread disinformation about Covid-19 vaccines, and at some opponents of vaccine mandates, who spread disinformation about vaccines or advance arguments aimed at exploiting the distrust and  anger of citizens, not least because it unnecessary put the lives of those they influence at risk.

In short, we have all discovered that it is shit to live through a global pandemic. What we have also discovered since Covid-19 vaccines became more widely available in South Africa, is that not everyone will respond rationally to the situation, by directing their fury at solving the problem, not at making the problem worse. To understand why, it might be helpful to look at what academic experts have to say about the impact of a global pandemic on the public’s collective emotions. A paper by Chou and Budenz, published in the Journal of Health Communication last year, is a good starting point:

The COVID-19 pandemic has heightened the public’s collective emotions due to dramatic societal changes, including the loss of loved ones, isolation, and loneliness in part due to social distancing measures, trepidations about the management of pandemic, fear of contracting the virus, fears over vaccine safety, and financial hardships. Heightened negative emotional responses to the pandemic have taken the form of myriad emotions such as fear/anxiety and anger, which are coupled with a sense of uncertainty and negative attitudes such as racism and xenophobia.

One might have thought that this widespread fear, anxiety, and anger about the impact of Covid-19 on our lives would make people more eager to get vaccinated and less receptive to anti-vaxxer disinformation, not least because vaccines is currently by far the most effective way to save lives and to reduce the economic impact of Covid-19 on our lives. However, this is not true for everyone, and anger and other negative emotions are thus also linked to lower levels of vaccine acceptance in a society.

There are many reasons for this, but as Freedman and others point out in a paper published in Psychological Medicine, the willingness to take a vaccine is linked to trust: trust that the vaccine is needed, that it will work, and that it is safe. Individuals who are mistrustful of experts, of authority more generally, of institutions, and of the government are more likely to be vaccine hesitant or anti-vax, and to resist vaccine mandates. Such individuals are also more likely to be receptive to, and embrace, the message of hardcore anti-vaxxers, who exploit emotions to promote misinformation and conspiracy theories, and sow confusion. Freedman points out that mistrust is fuelled  by anger at societal institutions and at the government. Intense anger is therefore likely to increase the kind of mistrust that fuels vaccine hesitancy and that make people receptive to anti-vaxxer conspiracy theories and misinformation.

It is not surprising that some South Africans are angry at our government and view it with distrust. Nor is it surprising that some remain angry about the imposition of lockdowns in general, or about the manner in which lockdowns were managed in South Africa. Because the initial lockdowns were influenced by the advice of health experts, it does not surprise me either that some South Africans remain angry and distrustful of medical experts, and that they view the vast body of evidence on the efficacy and safety of Covid-19 vaccines with distrust.

While it is obviously irrational for such individuals to take out their anger at the government, at lockdowns, or at health experts, on Covid-19 vaccines, and to cheer on any evidence they can find that the vaccines are not 100% effective at stopping the spread of Covid-19 or at preventing serious illness or death, I don’t find this incomprehensible. Similarly, just because it is irrational to reject the scientific evidence on the safety and efficacy of Covid-19 vaccines because of your distrust of the government and health experts (who did not develop or manufacture the vaccines), does not mean that this response is incomprehensible. It’s a bit like a spouse involved in a bitter divorce taking his or her anger at their divorcing spouse out by emotionally harming their child. It is a really bad and harmful thing to do, but it is not beyond comprehension.

Of course, I do find it incomprehensible that anyone could possibly believe any of the bizarre conspiracy theories peddled by the extremist anti-vaxxers, but I am not concerned here with this group of people.

I suspect it is unlikely that the levels of anger and distrust in our government, in facts and science, and in medical experts, will subside in the near future, and thus that it is unlikely that the overwhelming majority of the 30% of South Africans who surveys have found were either vaccine hesitant or anti-vax will rush to get vaccinated in the coming year. I hope that the surveys overestimate vaccine hesitancy and anti-vax sentiments in South Africa and that I am wrong about many people changing their minds on the issue.

But if I am not wrong, I would argue that the only rational response would be to implement a countrywide government vaccine mandate that restricts access to some activities and venues to vaccinated individuals only (or perhaps also to those who produce a very recent Covid-19 negative test). While such a mandate will be difficult to enforce effectively across the country, it will dramatically increase the number of non-hesitant individuals to get vaccinated, and will reduce (but not eradicate) the risk that unvaccinated individuals pose to the life, health and economic welfare of everyone in the society. The introduction of such a mandate will also serve as an important endorsement of the idea that social solidarity (not only individual self-interest) is a something that we as a society cherish.

If this sounds rather timid and defeatist, it is probably because the more I think about this, the more I worry that in a profoundly unequal and politically and racially fractured country like South Africa (one in which the government has done everything to squander the trust of voters), it is rather optimistic to think we are ever going to achieve a 90% vaccination rate like Portugal.

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