Exploring the Drivers of Vaccine Hesitancy Toward Childhood and Adolescent Vaccination in Malawi: A Qualitative Study

Abstract

Background: Vaccine hesitancy is the delay or refusal of vaccines despite the availability of vaccination services. Although it is considered an important global health threat, it has only rarely been systematically studied within the African context. In this study, we explored the factors that influence vaccine hesitancy among caregivers of children and adolescent girls that are eligible for routine childhood immunisation and the human papillomavirus (HPV) vaccine in Malawi. Methods: The study employed a qualitative exploratory research design. In-depth information was obtained from caregivers of children and adolescent girls eligible for routine immunisation (RI) and the HPV vaccine, respectively, as well as national and district-level representatives of the expanded program on immunisation (EPI) and community stakeholders through key informant interviews and focus-group discussions. These participants were purposively selected using predefined criteria A total of 25 key informant interviews and two focus-group discussions with 13 participants were conducted. Data collection took place between April 20 and May 24, 2020. The interviews were audio-recorded, transcribed verbatim, and then analysed using a thematic content analysis approach. Results: The study shows that most of the vaccine-hesitancy drivers for RI also influenced the newly introduced HPV vaccine. Such drivers were inadequate awareness of the vaccination schedule, rumours and conspiracy theories exacerbated by religious beliefs, inability to translate knowledge and attitudes into actual vaccination behaviour, low literacy levels of caregivers, complacency occasioned by the stress of distance and transportation logistics, and disconnection between the community healthcare system and community leaders, among others. Conclusion: This study provides deeper insights into the determinants of vaccine hesitancy within the Malawian context. The findings can inform the design of context-specific interventions by decision-makers. While the study provided behavioural insights regarding vaccination behaviour in Malawi, there is need for further quantitative studies that can assess the prevalence of the determinants as well as their causal relationships to vaccine uptake.

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“…Consistent with previous studies, the main reasons for not being vaccinated here included being out of the district during the vaccination campaign, lack of transport to the vaccination post and little information on the vaccination campaign(18,22). Access to healthcare is a common reason for vaccine hesitancy in Ghana and elsewhere, for example, in Malawi(24,25). This calls for consented efforts by health care workers to stay motivated in order to reach hard-to-reach communities to deliver quality health care service.…”