Women’s Month: The unexpected urgency of vaccine hesitancy research before the pandemic

When Dr Elizabeth Oduwole, in 2017, decided to focus her PhD research on vaccine hesitancy in South Africa, she was the source of some ridicule for choosing an area so understudied and seemingly unimportant on the continent. Three years later, when the COVID-19 pandemic struck and vaccines became the ticket to a return to normal life, Dr Oduwole’s research proved to be critically important. Her journey to this point was a long one, and not always easy but today she looks back and says every step was worth it.

Today Dr Oduwole is the evidence-informed decision-making specialist research officer at the Vaccine for Africa Initiative (VACFA), a unit within the Department of Public Health in UCT’s Faculty of Health Sciences. At 54 years old, she is taking up her first research post as a PhD graduate.

From microbiology to motherhood

Oduwole grew up in Nigeria, completed high school with excellent marks and then went on to study microbiology at the University of Benin in Nigeria. She completed a course in laboratory science to ensure practical workplace skills, during which time she met and married her husband.

Both deeply religious people, Oduwole and her husband committed their lives to their church and it was this work that brought them to South Africa, first setting up a church in Polokwane. Oduwole’s time was split between raising her children — six and eight years olds — and helping to build the church. But money was tight for a family of four, and Oduwole realised her best option was to find a full-time job.

A long postgraduate journey

The Oduwole family relocated from Polokwane to Cape Town in 2004 as part of their work for the church. Here Oduwole started out as a volunteer worker for six weeks, then as a contract academic support staff for 6 months at the Department of Medical Biosciences of the University of the Western Cape. She decided to pursue a master's degree to increase her earning capacity. She was accepted to Stellenbosch University and completed a highly technical and quantitative research project in mass spectrometry using a very niche instrument, the Matrix assisted laser ionization-desorption Time-of-flight (Maldi-ToF), to explore strategies to better diagnose TB.

She jokes that her Masters was part biochemistry, part engineering, as so much of the work she ended up doing was maintenance and repair on the instrument. Despite all the challenges, she graduated four years later, in 2008, when she was 39. After completing her master’s her supervisor hired her to work in his company, which had the equipment she had been working on, but due to non-functionality of the instrument, she was retrenched after a few years.

“There followed the darkest time in my life,” she said. “The only thing that kept me going in the six years of unemployment that followed was my faith. I developed a much closer relationship to God during that time.”

Another door opens: trailblazing in vaccine hesitancy

Eventually, Oduwole decided to change track, and pursue a PhD at Stellenbosch University’s Department of Health Systems Strengthening and Public Health. Public health really appealed to her because, as a people person, she did not want to continue on a career path in which she would be locked away in laboratories, working with equipment.

“I registered for my PhD in 2017,” said Oduwole. “I was interested in vaccine hesitancy, but my supervisor cautioned me about it saying that it is not really a priority area of research in Africa, as it is more of a Global North issue.”

“I like to walk the path least travelled.”

But Oduwole, who considers herself a trailblazer, took up the challenge: “I like to walk the path least travelled.”

Prior to COVID-19 vaccines were primarily given to babies, so at this stage Oduwole’s study would be looking at decisions by caregivers as to whether to have their babies vaccinated.

Her research thus began by investigating the experiences of healthcare workers administering vaccines in the Cape Town Metro and the attitudes of the caregivers of the babies receiving the vaccines. Her initial findings revealed that overall mothers were very open to vaccines for their babies. The challenges tended to be external, where they were unable to get to clinics for their appointments.

Vaccine hesitancy in the limelight

Oduwole had only just completed her interviews with the healthcare workers when the COVID-19 pandemic struck, and the planned door-to-door community survey of caregivers was no longer an option.

“I now had to go back to the drawing board to figure out a new strategy,” she said.

As higher education had shifted online, the one community she knew she could reach for online surveys was the healthcare higher education and training community. She thus amended one of her research questions to looking at attitudes to the then soon to be implemented COVID-19 vaccination among prospective healthcare workers and their educators.

Her research found that vaccine hesitancy does not discriminate, it occurs across all socio-economic groups. Also, at least among caregivers in the Cape Metro, religion and internet misinformation are the two biggest drivers of vaccine hesitancy.

Another interesting finding was that while most of the prospective healthcare workers and their trainers surveyed in her research indicated their willingness to take the COVID-19 vaccines when one becomes available, a significant few were hesitant.

The timing of her PhD could not have been better. In a few short years vaccine hesitancy went from being a fringe topic to critical to the public health agenda. Her research was picked up in the news both locally and internationally. A team from Meta (the company that owns Facebook and Instagram) reached out to her for support in their efforts to try to build algorithms to block vaccine misinformation and she published several academic papers on her research.

“When I look back, I can clearly see the hand of God. I went from a laughingstock with my determination to research vaccine hesitancy, to a sought-after expert on this topic in Africa.”

It is through this PhD research that Oduwole secured her current role at VACFA and is looking forward to pursuing some of the other research questions that cropped up during her PhD research, including narrowing in on the vaccine-hesitancy hotspots in Cape Town.

“When I look back, I can clearly see the hand of God,” said Oduwole. “I went from a laughingstock with my determination to research vaccine hesitancy, to a sought-after expert on this topic in Africa. I don’t know what lies ahead, I know there will be many more challenges, but through my faith I know I am ready for them.”