---
title: "Social network influences on COVID-19 vaccine willingness in rural South Africa"
id: "pubmed-42556300"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42556300"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42556300/"
doi: "10.1016/j.vaccine.2026.128998"
published_at: "2026-08-30T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Social network influences on COVID-19 vaccine willingness in rural South Africa
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42556300
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42556300/)
- **DOI:** [10.1016/j.vaccine.2026.128998](https://doi.org/10.1016%2Fj.vaccine.2026.128998)
- **Published At:** 2026-08-30T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This study analysed 2022–23 data from the Sixhumene social network study in three rural KwaZulu‑Natal communities to examine how **personal networks** influence **COVID‑19 vaccine willingness**. - The primary outcome was a six‑level ordinal measure combining past vaccination status and hypothetical willingness to vaccinate. - Participants were predominantly female, median age 21 years (IQR 18–28), and reported a median of three key social contacts; networks were strongly kin‑based and locally concentrated. - Network geographic composition was associated with willingness: urban respondents whose networks extended within or beyond the village had higher willingness (aOR 2.54 and aOR 3.26 respectively) compared with urban respondents with household‑concentrated networks. - Among rural respondents, networks based in the household, village, or beyond the village were each associated with higher willingness (aORs 1.95, 1.63, and 1.64 respectively) compared with the reference. - **Emotional support** showed a modest positive association with vaccine willingness (per 30 contact‑days: aOR 1.15, 95% CI 1.01–1.32). - **Physical support** showed an inverse association with willingness (aOR 0.84, 95% CI 0.72–0.98). - The findings indicate that both individual characteristics and network dynamics shape vaccination decisions in this rural setting; emotional support may help promote vaccine willingness while high levels of physical support may be associated with lower willingness. - Conflict of interest: authors declared no competing financial interests or personal relationships.
## Clinical Analysis & Structured Key Points
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Epub 2026 Aug 5. # The association of individual, interpersonal and social support factors with willingness to vaccinate against COVID-19 in rural South Africa [Lusanda Mazibuko](https://pubmed.ncbi.nlm.nih.gov/?term=Mazibuko+L&cauthor_id=42556300)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#full-view-affiliation-1 "Africa Health Research Institute, KwaZulu-Natal, South Africa; University College London, London, United Kingdom. Electronic address: rejbnlc@ucl.ac.uk."), [Dorottya Hoór](https://pubmed.ncbi.nlm.nih.gov/?term=Ho%C3%B3r+D&cauthor_id=42556300)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#full-view-affiliation-2 "University College London, London, United Kingdom."), [Vuyiswa Nxumalo](https://pubmed.ncbi.nlm.nih.gov/?term=Nxumalo+V&cauthor_id=42556300)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#full-view-affiliation-3 "Africa Health Research Institute, KwaZulu-Natal, South Africa."), [Siyabonga Nxumalo](https://pubmed.ncbi.nlm.nih.gov/?term=Nxumalo+S&cauthor_id=42556300)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#full-view-affiliation-3 "Africa Health Research Institute, KwaZulu-Natal, South Africa."), [Nuala McGrath](https://pubmed.ncbi.nlm.nih.gov/?term=McGrath+N&cauthor_id=42556300)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#full-view-affiliation-4 "Africa Health Research Institute, KwaZulu-Natal, South Africa; University of Southampton, Southampton, England, United Kingdom; University of KwaZulu-Natal, Durban, South Africa."), [Janet Seeley](https://pubmed.ncbi.nlm.nih.gov/?term=Seeley+J&cauthor_id=42556300)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#full-view-affiliation-5 "Africa Health Research Institute, KwaZulu-Natal, South Africa; London School of Hygiene and Tropical Medicine, London, United Kingdom; University of KwaZulu-Natal, Durban, South Africa."), [Maryam Shahmanesh](https://pubmed.ncbi.nlm.nih.gov/?term=Shahmanesh+M&cauthor_id=42556300)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#full-view-affiliation-6 "Africa Health Research Institute, KwaZulu-Natal, South Africa; University College London, London, United Kingdom; University of KwaZulu-Natal, Durban, South Africa."), [Nellie Myburgh](https://pubmed.ncbi.nlm.nih.gov/?term=Myburgh+N&cauthor_id=42556300)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#full-view-affiliation-7 "Africa Health Research Institute, KwaZulu-Natal, South Africa; University of the Witwatersrand, Johannesburg, South Africa."), [Guy Harling](https://pubmed.ncbi.nlm.nih.gov/?term=Harling+G&cauthor_id=42556300)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#full-view-affiliation-8 "Africa Health Research Institute, KwaZulu-Natal, South Africa; University College London, London, United Kingdom; University of KwaZulu-Natal, Durban, South Africa; University of the Witwatersrand, Johannesburg, South Africa. Electronic address: g.harling@ucl.ac.uk.") Affiliations Expand ### Affiliations * 1 Africa Health Research Institute, KwaZulu-Natal, South Africa; University College London, London, United Kingdom. Electronic address: rejbnlc@ucl.ac.uk. * 2 University College London, London, United Kingdom. * 3 Africa Health Research Institute, KwaZulu-Natal, South Africa. * 4 Africa Health Research Institute, KwaZulu-Natal, South Africa; University of Southampton, Southampton, England, United Kingdom; University of KwaZulu-Natal, Durban, South Africa. * 5 Africa Health Research Institute, KwaZulu-Natal, South Africa; London School of Hygiene and Tropical Medicine, London, United Kingdom; University of KwaZulu-Natal, Durban, South Africa. * 6 Africa Health Research Institute, KwaZulu-Natal, South Africa; University College London, London, United Kingdom; University of KwaZulu-Natal, Durban, South Africa. * 7 Africa Health Research Institute, KwaZulu-Natal, South Africa; University of the Witwatersrand, Johannesburg, South Africa. * 8 Africa Health Research Institute, KwaZulu-Natal, South Africa; University College London, London, United Kingdom; University of KwaZulu-Natal, Durban, South Africa; University of the Witwatersrand, Johannesburg, South Africa. Electronic address: g.harling@ucl.ac.uk. * PMID: **42556300** * DOI: [ 10.1016/j.vaccine.2026.128998 ](https://doi.org/10.1016/j.vaccine.2026.128998) Free article Item in Clipboard # The association of individual, interpersonal and social support factors with willingness to vaccinate against COVID-19 in rural South Africa Lusanda Mazibuko et al. Vaccine. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Vaccine Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Vaccine%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Vaccine%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42556300/) . 2026 Aug 30:89:128998. doi: 10.1016/j.vaccine.2026.128998. Epub 2026 Aug 5. ### Authors [Lusanda Mazibuko](https://pubmed.ncbi.nlm.nih.gov/?term=Mazibuko+L&cauthor_id=42556300)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#short-view-affiliation-1 "Africa Health Research Institute, KwaZulu-Natal, South Africa; University College London, London, United Kingdom. Electronic address: rejbnlc@ucl.ac.uk."), [Dorottya Hoór](https://pubmed.ncbi.nlm.nih.gov/?term=Ho%C3%B3r+D&cauthor_id=42556300)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#short-view-affiliation-2 "University College London, London, United Kingdom."), [Vuyiswa Nxumalo](https://pubmed.ncbi.nlm.nih.gov/?term=Nxumalo+V&cauthor_id=42556300)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#short-view-affiliation-3 "Africa Health Research Institute, KwaZulu-Natal, South Africa."), [Siyabonga Nxumalo](https://pubmed.ncbi.nlm.nih.gov/?term=Nxumalo+S&cauthor_id=42556300)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#short-view-affiliation-3 "Africa Health Research Institute, KwaZulu-Natal, South Africa."), [Nuala McGrath](https://pubmed.ncbi.nlm.nih.gov/?term=McGrath+N&cauthor_id=42556300)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#short-view-affiliation-4 "Africa Health Research Institute, KwaZulu-Natal, South Africa; University of Southampton, Southampton, England, United Kingdom; University of KwaZulu-Natal, Durban, South Africa."), [Janet Seeley](https://pubmed.ncbi.nlm.nih.gov/?term=Seeley+J&cauthor_id=42556300)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#short-view-affiliation-5 "Africa Health Research Institute, KwaZulu-Natal, South Africa; London School of Hygiene and Tropical Medicine, London, United Kingdom; University of KwaZulu-Natal, Durban, South Africa."), [Maryam Shahmanesh](https://pubmed.ncbi.nlm.nih.gov/?term=Shahmanesh+M&cauthor_id=42556300)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#short-view-affiliation-6 "Africa Health Research Institute, KwaZulu-Natal, South Africa; University College London, London, United Kingdom; University of KwaZulu-Natal, Durban, South Africa."), [Nellie Myburgh](https://pubmed.ncbi.nlm.nih.gov/?term=Myburgh+N&cauthor_id=42556300)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#short-view-affiliation-7 "Africa Health Research Institute, KwaZulu-Natal, South Africa; University of the Witwatersrand, Johannesburg, South Africa."), [Guy Harling](https://pubmed.ncbi.nlm.nih.gov/?term=Harling+G&cauthor_id=42556300)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42556300/#short-view-affiliation-8 "Africa Health Research Institute, KwaZulu-Natal, South Africa; University College London, London, United Kingdom; University of KwaZulu-Natal, Durban, South Africa; University of the Witwatersrand, Johannesburg, South Africa. Electronic address: g.harling@ucl.ac.uk.") ### Affiliations * 1 Africa Health Research Institute, KwaZulu-Natal, South Africa; University College London, London, United Kingdom. Electronic address: rejbnlc@ucl.ac.uk. * 2 University College London, London, United Kingdom. * 3 Africa Health Research Institute, KwaZulu-Natal, South Africa. * 4 Africa Health Research Institute, KwaZulu-Natal, South Africa; University of Southampton, Southampton, England, United Kingdom; University of KwaZulu-Natal, Durban, South Africa. * 5 Africa Health Research Institute, KwaZulu-Natal, South Africa; London School of Hygiene and Tropical Medicine, London, United Kingdom; University of KwaZulu-Natal, Durban, South Africa. * 6 Africa Health Research Institute, KwaZulu-Natal, South Africa; University College London, London, United Kingdom; University of KwaZulu-Natal, Durban, South Africa. * 7 Africa Health Research Institute, KwaZulu-Natal, South Africa; University of the Witwatersrand, Johannesburg, South Africa. * 8 Africa Health Research Institute, KwaZulu-Natal, South Africa; University College London, London, United Kingdom; University of KwaZulu-Natal, Durban, South Africa; University of the Witwatersrand, Johannesburg, South Africa. Electronic address: g.harling@ucl.ac.uk. * PMID: **42556300** * DOI: [ 10.1016/j.vaccine.2026.128998 ](https://doi.org/10.1016/j.vaccine.2026.128998) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Trust in vaccines and those who deliver them is often shaped by personal social networks, yet empirical data on these dynamics remain limited in low-and middle-income settings. Social networks shape exposure to information, norms, and reinforcement processes that influence vaccine decision-making. We examined how rural South Africans' social network composition and content influence their willingness to receive a COVID-19 vaccine. **Methods:** We analysed 2022-23 data from the Sixhumene social network study conducted primarily among young adults in three rural KwaZulu-Natal communities. Our primary outcome was a six-level ordinal measure combining past vaccination and hypothetical willingness. Using multivariable ordinal logistic regression, we evaluated associations between vaccine willingness and social network size, kinship composition, geographic proximity, gender homophily, support received, and respondent characteristics. **Results:** Respondents were predominantly female with median age 21 years (IQR 18-28) and identified a median of three key social contacts, with networks characterised by strong kinship and local ties. Vaccine willingness varied by the geographic composition of networks. Compared with urban respondents whose networks were concentrated within the household, willingness was higher among those with more geographically dispersed networks, including urban respondents with alters in the same village (aOR 2.54, 95% CI 2.40-2.70) or outside the village (aOR 3.26, 95% CI 2.04-5.20). Similarly, among rural respondents, willingness was higher among those with household-based networks (aOR 1.95, 95% CI 1.57-2.41), village-based networks (aOR 1.63, 95% CI 1.40-1.90), and networks extending beyond the village (aOR 1.64, 95% CI 1.50-1.79). Emotional support was positively associated with willingness (per 30 contact-days: aOR 1.15, 95% CI 1.01-1.32), while physical support was inversely associated (aOR 0.84, 95% CI 0.72-0.98). **Discussion:** Vaccine willingness in this rural setting was shaped by both individual factors and network dynamics. Emotional support showed a modest positive association with willingness, suggesting supportive social ties may help promote vaccination willingness. **Keywords:** COVID-19; Personal networks; Vaccine acceptance; Vaccine uptake; Vaccine willingness. Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## Similar articles * [ Behavioural and social drivers of COVID-19 vaccination in Papua New Guinea: A cross-sectional study. ](https://pubmed.ncbi.nlm.nih.gov/41512506/) Giduthuri JG, Vengiau G, Vutliu V, Manineng C.Giduthuri JG, et al.Vaccine. 2026 Feb 27;74:128207. doi: 10.1016/j.vaccine.2026.128207. Epub 2026 Jan 8.Vaccine. 2026.PMID: 41512506 * [ Understanding vaccine willingness in post-COVID America: Key determinants and demographic differences. ](https://pubmed.ncbi.nlm.nih.gov/40945178/) Yang Y, Jin SW, Lee S, Lartey S, Pichon L, Levy M.Yang Y, et al.Vaccine. 2025 Oct 3;64:127740. doi: 10.1016/j.vaccine.2025.127740. Epub 2025 Sep 12.Vaccine. 2025.PMID: 40945178 * [ Online Media Use and COVID-19 Vaccination in Real-World Personal Networks: Quantitative Study. ](https://pubmed.ncbi.nlm.nih.gov/39454189/) Oană I, Hâncean MG, Perc M, Lerner J, Mihăilă BE, Geantă M, Molina JL, Tincă I, Espina C.Oană I, et al.J Med Internet Res. 2024 Oct 25;26:e58257. doi: 10.2196/58257.J Med Internet Res. 2024.PMID: 39454189Free PMC article. * [ Facilitators to strengthening vaccine uptake post-pandemic amongst underserved populations considering social norms and health beliefs: a global systematic review. ](https://pubmed.ncbi.nlm.nih.gov/41016229/) Chaudhry T, Tum P, Morrow F, Hargreaves S, Kielmann K, Kunst H, Griffiths C, Campbell NJC, Zenner D.Chaudhry T, et al.Vaccine. 2025 Oct 24;65:127769. doi: 10.1016/j.vaccine.2025.127769. Epub 2025 Sep 27.Vaccine. 2025.PMID: 41016229 * [ Deter
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