As a nurse in a country battling deadly diseases, Rich Sicina sometimes vaccinates other South Africans, but he says there is no way he will take a COVID-19 shot - he doesn’t believe it will be safe or effective.

South Africa’s decision on Sunday to suspend plans to roll out AstraZeneca’s vaccine, after data showed it may not offer sufficient protection against the country’s dominant coronavirus variant, has only added to Sicina’s concerns.

“We do not trust these politicians,” he said.

Many South Africans agree. The Indaba nurses union, to which Sicina belongs, has advised its 17,000 members to boycott the vaccine.

Two polls, a global one by IPSOS and a national one by South African fintech start-up CompariSure, in January suggested that half of South Africans would refuse the vaccine. A University of Johannesburg (UJ) survey, with the biggest sample size of 10,000, put the number more optimistically at a third.

The stakes are high: COVID-19 has hit South Africa harder than anywhere else on the continent, infecting nearly 1.5 million and killing more than 46,000, while a more infectious variant that evolved here has spread around the world.

South Africa hopes to vaccinate 40 million people, or two-thirds of the population, to achieve some herd immunity but has yet to administer a shot.

“We don’t know whether to trust it or not. So, honestly, no,” Bonnie Legwale, 25, a financial advisor, told Reuters TV on Monday, when asked if she would take the vaccine.

THE DEVIL’S JAB

Efforts to eradicate certain diseases have foundered before in Africa when a section of the population rejects vaccination - often driven by religious beliefs and mistrust of Western pharmaceutical companies.

In 2003, Muslim clerics instigated a boycott of polio shots in northern Nigeria. There have been similar appeals against COVID-19 shots.

Tanzanian President John Magufuli told citizens to avoid the vaccines - calling them a foreign plot - and protect themselves by praying while inhaling steam.

The governor of Nigeria’s Kogi state, Yahaya Bello, was filmed in January saying vaccine makers “want to ... introduce the disease that will kill you, God forbid.”

In December, South Africa’s Chief Justice Mogoeng Mogoeng prayed that “any vaccine that is of the devil ... may it be destroyed by fire”, in remarks he declined to recant despite fierce criticism.

Mogoeng had no further comment, his spokesman said.

Such concerns are not uncommon on a continent where sickness is often seen as resulting from supernatural forces - and where big pharmaceutical companies have run dubious clinical trials resulting in deaths.

Added to the mix are conspiracy theories available online, some of which from “anti-vaxxers” in wealthier countries.

South Africa’s Department of Health has run a publicity campaign to counter popular myths, including that Bill Gates, whose foundation helped fund the development of COVID-19 vaccines, put a microchip in them that he plans to use for world domination.

The UJ survey found that less-educated people were more willing to be vaccinated, and white South Africans, who tend to be wealthier and have access to better schools, were more hesitant than Blacks.

“People with ... degree-level education are often the ones very interested in their smart phones, so they have greater access to conspiracy theories” than poorer folk who get information from radio and TV, survey co-author Kate Alexander said.

“DISTRUST OF GOVERNMENT”

Elsewhere in the world, trust in vaccines has improved since last year, with most happy to take them, and only 12% reporting no trust at all, according to a YouGov survey of 15 countries.

Influential figures, such as anti-apartheid icon Archbishop Desmond Tutu, say they will take the COVID-19 shot.

Yet trust in South Africa’s handling of the pandemic has deteriorated, over perceived failures such as a shortage of protective equipment for medical staff and allegations of corruption in government COVID-19 relief contracts.

“You see people lining up to steal money and ... you’ve got a high level of distrust of government,” said William Bird, director of Media Monitoring Africa, which fights misinformation online.

A Department of Health spokesperson did not respond to a request for comment on criticism of its handling of the crisis. But officials have said that governments with better resources than South Africa have struggled to respond to the pandemic.

Social worker and “holistic medicine” healer Debasalam Bloom said she is wary of vaccines and will avoid the COVID-19 one.

“I don’t believe it’s been tested for long enough. So we don’t really know, long term, what the side effects are,” she said.

Some experts favour legal measures to force compliance.

“If you implement a coercive policy properly, it works regardless of whether or not there is trust in government,” Oxford bioethics expert Alberto Giubilini told Reuters. “We do that with taxes ... and I don’t see why vaccines should be any different.”

He suggested lockdown restrictions on individuals who refuse the vaccine, barring them from public indoor places.

Aslam Dasoo, convener of Progressive Health Forum, an advocacy group, disagrees.

“To win this battle, you can’t do it at the expense of rights. Only the people in the end can stop the pandemic,” he said.