Correlates of uptake of COVID-19 vaccines and motivation to vaccinate among Malawian adults

Hannah S. Whitehead · John Songo · Khumbo Phiri · Pericles Kalande · Eric Lungu · Sam Phiri +3 more

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Vaccine Coverage and Hesitancy SARS-CoV-2 and COVID-19 Research COVID-19 and Mental Health

Abstract

COVID-19 vaccine coverage in most countries in Africa remains low. Determinants of uptake need to be better understood to improve vaccination campaigns. Few studies from Africa have identified correlates of COVID-19 vaccination in the general population. We surveyed adults at 32 healthcare facilities across Malawi, purposively sampled to ensure balanced representation of adults with and without HIV. The survey, informed by the World Health Organization's Behavioural and Social Drivers of Vaccination Framework, asked about people's thoughts and feelings about the vaccine, social processes, motivation to vaccinate, and access issues. We classified respondents' COVID-19 vaccination status and willingness to vaccinate, and used multivariable logistic regression to assess correlates of these. Among 837 surveyed individuals (median age was 39 years (IQR 30-49) and 56% were female), 33% were up-to-date on COVID-19 vaccination, 61% were unvaccinated, and 6% were overdue for a second dose. Those up-to-date were more likely to know someone who had died from COVID-19, feel the vaccine is important and safe, and perceive pro-vaccination social norms. Despite prevalent concerns about vaccine side effects, 54% of unvaccinated respondents were willing to vaccinate. Access issues were reported by 28% of unvaccinated but willing respondents. Up-to-date COVID-19 vaccination status was associated with positive attitudes about the vaccine and with perceiving pro-vaccination social norms. Over half of unvaccinated respondents were willing to get vaccinated. Disseminating vaccine safety messages from trusted sources and ensuring local vaccine availability may ultimately increase vaccine uptake.

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2020A global survey of potential acceptance of a COVID-19 vaccine 2021A global database of COVID-19 vaccinations 2021Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment 2021COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries 2022COVID-19 vaccine hesitancy in Africa: a scoping review 2021Nudging toward vaccination: a systematic review 2021From Vaccine Nationalism to Vaccine Equity — Finding a Path Forward 2021Acceptance of COVID-19 vaccines in sub-Saharan Africa: evidence from six national phone surveys

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