Interacting with the qualitative data generated from the Final Mile COVID-19 vaccine hesitancy study has been intriguing to say the least. It has been fascinating to understand how individuals of various demographics appraise their risk of acquiring the disease and progress in their journey towards inoculating against COVID-19. One fascinating group has been the grandmothers and their tight social network. In all the four countries of study, Burkina Faso, Kenya, Ivory Coast, and Pakistan, a common thread of influence from these closely-knit in-groups began to emerge. Surprisingly, and maybe not, similar observations surfaced from another pro-bono study conducted simultaneously in South Africa.
The many years of chronic medication collection and regular check-ups for arthritis, high blood pressure and diabetes have created a trusted support network for grandmothers to share personal life stories and empathise with each other. To the extent that some look forward to the clinic visits to interact with fellow grannies where discussions can range from personal stories about a grandchild that has married off to advanced discussions about treatment modalities and what works. It is in these corridors of trust that mostly grannies from South Africa shared the effectiveness of condom lubricants as effective remedies to manage knee joint pains. In recent times, personal stories about coping with the first dose of the COVID-19 vaccine have dominated the corridors.
It was interesting to observe the level of solidarity amongst the grannies as they caucus about the questions to pose to the clinical staff regarding vaccine side effects, the mindset being what is good for one of us is good for all of us. In the same vein, stories about fellow grannies who experienced severe side effects were murmured with trembling and unanimous decisions instantaneously adopted to abort the vaccination route or find a volunteer who will be brave to confront the robotic grumpy clinical staff with seemingly unending tasks. The outcome of the brave heart’s interaction with the clinical staff will be weighed with existing community stories.
It was clear from the research that many referred to the closed group interactions at social grant pay points and waiting areas at clinic’s safe information-sharing spaces. Stories of deaths post vaccinations get dissected with meticulous detail. Whenever news about the sudden passing of a beloved granny breaks, the immediate question was: vaccination status? If the deceased had recently been inoculated, a cause-and-effect analysis will be immediately drawn. Starting with the brand of the vaccine, if the rumour points to one of the demonised ones, more stories will emerge about the information they heard from their children and grandchildren confirming the same narrative.
Government campaigns and information shared by health workers would appear not compelling enough to counter the conclusions reached in these granny circles. While they have health seeking behaviours higher than other population groups, the trust built through several years of granny-to-granny interaction is formidable and cannot be broken easily. The granny circles also act as an influential decision support network for those with a positive vaccine appraisal. We saw groups that clearly understood the risk of contracting COVID-19 due to existing commodities and are considering but concerned about the side effects.
For grannies who heard counterparts narrate the mild symptoms experienced, quick recovery and return to life routine were encouraged to get inoculated and themselves became advocates to their families. As it turns out, their matriarchal status in the family often led to younger family members making emboldened decisions citing if their granny could tolerate the revered side effects, they could do the same.
In the communities we interacted with, older people live with their families and command respect for their wisdom and storytelling. One participant described how their family used herbal steaming during the hard lockdown as directed by their grandmother to strengthen themselves against COVID 19. When vaccines became available, the grandmother influenced the entire household to get inoculated as a better “tool” had arrived. It is important to underscore the fact that there was a long lag before vaccines became available in global south countries. People shared whatever they believed to be helpful, most of these approaches were later deemed ineffective by the World Health Organisation(WHO). That period of delay was by no means a time of inaction regarding the vaccine, instead, unregulated information spread widely as governments took a judicious approach about what to communicate. Social media wildly circulated misinformation that drowned official government communication. This misinformation was echoed in the in-depth interviews with the grannies.
Grannies are a vulnerable population given the prevalence of commodities that place them at a greater risk of acquiring COVID-19, other natural physiological changes also impede on their ability to handle the respiratory infection. However, they are influential members in their communities as they command lots of respect from the fundamental structure of human social organisation which is family. In our studies settings, they often provide guidance on life changing decisions, including health, marriage, family disputes and funerals. Understanding the grannies’ in-group dynamics, in-person information sharing interactions and their matriarchal influence in their respective families can provide insightful nudges for behaviour architects, social behaviour change communication practitioners, health care workers and policy makers to leverage on. At minimum, supporting conversations with accurate vaccine information especially in the clinical and social support spaces when they congregate can be the lowest hanging fruit. The COVID-19 vaccination decision journey that has come out of our qualitative study can be a powerful instrument to demonstrate the positive pathway towards vaccination and the possible drop-off points for individuals who remain hesitant.
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