Examining enablers of vaccine hesitancy toward routine childhood and adolescent vaccination in Malawi

Abstract

Background The contribution of vaccination to global public health and community wellbeing has been described as one of the greatest success stories of modern medicine. However, 13.5 million children still miss at least one of their routine vaccinations, and this contributes to about 1.5 million deaths from vaccine-preventable diseases. One of the contributing factors has been associated with vaccine hesitancy. Vaccine hesitancy is the delay or refusal of vaccines despite their availability. The study explored factors from multiple perspectives that influence hesitancy among caregivers of children and adolescent girls eligible for childhood routine immunisation and the Human Papillomavirus vaccine in Malawi. Methods The methodology used was qualitative such as key informant interviews and focus-group discussion. Information was obtained from caregivers, community and religious leaders, leaders of civil society groups, teachers in schools where Human Papillomavirus vaccine were piloted, healthcare workers, national and district-level officials of the expanded program on immunisation. There were 25 key informant interviews and two focus-group discussions, with 13 participants. The study was conducted between April to May 2020. The Interviews and discussions were audio-recorded, transcribed, and analysed using a thematic content approach. Results Most vaccine-hesitancy drivers for routine immunisation were also relevant for the HPV vaccine. The drivers included inadequate awareness of the vaccination schedule, rumours and conspiracy theories exacerbated by religious beliefs, low literacy levels of caregivers, distance and transport to the vaccination clinic, gender role and a disconnect between community healthcare workers and community leaders. Conclusions The study demonstrated that a network of factors determines vaccine hesitancy for childhood Routine Immunisation and Human Papillomavirus, and some of them are interrelated with one another. This has implications both for current levels of vaccine acceptance and the introduction of any new vaccine, such as those against Malaria, HIV/AIDS, HPV or COVID-19 (coronavirus disease 2019). Therefore, strategies developed to address vaccine hesitancy must be multi-component and wide-ranging.

Factors associated with malaria vaccine uptake in Nsanje District, Malawi

“…Since mothers/caregivers from these religions are likely not be found at under 5 clinic to learn the importance of malaria vaccines, even if they are willing to be vaccinated their religous leader will prevent them from accessing the health services. This was also evidenced in a study conducted by Adeyanju et al, 2022 in Malawi, which reported that religious groupings, for example Zion and Apostolic faith, were prohibiting their members from visiting the hospital and accessing vaccines [19].…”

Armed Violent Conflict and Healthcare-Seeking Behavior for Maternal and Child Health in Sub-Saharan Africa: A Systematic Review

“…These situations are complicated during armed conflicts where husbands are deployed to defend the community or prosecute a war. Masculinity, as a significant determinant of healthcare-seeking behavior in SSA and an emerging area of global health research, have been strongly linked to child health outcomes [70][71][72]. However, this review shows that its effects extend beyond child health to include maternal health and possibly other health-seeking behavior within households in SSA.…”

Malawian caregivers’ experiences with HPV vaccination for preadolescent girls: A qualitative study

“…Caregivers therefore face a dilemma about whether to protect their daughter’s reproductive future with a vaccine that might compromise this very capacity. This fear that the HPV vaccine could affect fertility has been noted in LMIC settings [14] , [15] , [16] , [17] , [18] , [19] , [20] ; and there are many similar rumors in Malawi and throughout Africa about infertility related to vaccines and other public health interventions [21] , [22] . Research should further interrogate these perceptions—including survey questions about this belief rather than generic “side effects,” as it appears to be a specific and salient concern; and the public health community should work to develop effective approaches to reassuring caregivers in Malawi about the safety of the vaccine and lack of evidence showing fertility-related impacts.…”