Jabs or societal restrictions? Public preferences for vaccination programmes in South Africa

• Vaccines with higher effectiveness and longer protection were preferred • Risk of side effects significantly reduced vaccine acceptance likelihood • Vaccines from the US, UK, and EU were preferred over Chinese and Russian ones • Two latent classes identified: pro-vaccine and vaccine-resistant groups • Trust, attitudes, and prior experience derived class membership The objective of this study was to quantify public preferences for alternative vaccination programme strategies, combining vaccine attributes and policy measures, that could be deployed in future outbreaks similar to COVID-19 in South Africa. A discrete choice experiment (DCE) was conducted among 3,002 South African respondents. Attributes included vaccine effectiveness, duration of protection, side-effect risk, vaccine origin, approval time, and social restrictions including stringency of restrictions and vaccine mandate. Multinomial Logit (MNL) and Latent Class (LC) models were estimated to explore preferences. Vaccines with higher effectiveness were consistently preferred by South African respondents. Similarly, vaccines offering longer immunity durations and those approved after longer evaluation periods were preferred. Vaccines originating from the EU, UK, and US were preferred over those from China. In contrast, vaccines associated with higher risks of severe side effects were significantly less preferred. A latent class model identified two distinct groups: a majority (68.3%) classified as “provaccine,” who demonstrated strong preference for vaccination, often driven by trust in institutions and positive vaccine attitudes; and a minority (31.7%) categorised as “vaccine-resistant” who exhibited reluctance towards vaccination, likely driven by lower institutional trust, negative vaccine attitudes, and reduced health risk aversion. COVID19 vaccine preferences in South Africa were strongly influenced by perceived effectiveness, approval time, origin of the vaccine, duration of protection, risks of side effects, social restrictions and vaccine mandates. Respondents exhibited diverse preference patterns, and public health strategies should be designed to reflect these differences. Understanding how people make decisions about vaccines can help improve public health communication and planning. This research used a method that asked South Africans to imagine different vaccine scenarios and choose which ones they would prefer. People preferred vaccines that were highly effective, lasted longer, and had fewer side effects. Vaccines made in Western countries like the US, UK, and EU were preferred over those from China or Russia. Importantly, not everyone thinks about vaccines the same way. We found two main groups: one willing to vaccinate, trusting institutions and prioritising community health, and another prioritising individual rights, and not willing to vaccinate. By recognizing and addressing the diverse values that influence decision-making, public health initiatives can better support informed choices and strengthen community engagement during future outbreaks.