PT - JOURNAL ARTICLE AU - Tibbels, Natalie AU - Kaseghe, Rominie AU - Chisambi, Alvin Blessings AU - Ndovi, Vitima AU - Mang’ando, Alfred AU - Figueroa, Maria Elena TI - Perceptions of the COVID-19 Vaccine and Other Adult Vaccinations in Malawi: A Qualitative Assessment AID - 10.9745/GHSP-D-23-00146 DP - 2024 Feb 20 TA - Global Health: Science and Practice PG - e2300146 VI - 12 IP - Supplement 1 4099 - http://www.ghspjournal.org/content/12/Supplement_1/e2300146.short 4100 - http://www.ghspjournal.org/content/12/Supplement_1/e2300146.full SO - GLOB HEALTH SCI PRACT2024 Feb 20; 12 AB - Key FindingsThough Malawi faced a “twindemic” of COVID-19 and cholera, participants in this qualitative study tended to fear cholera and other health issues more than COVID-19, leading to low uptake of COVID-19 vaccines.Convenient access to COVID-19 vaccines in one’s home or while accessing other health services, encouragement from health workers to vaccinate that was perceived to be sincere, and an understanding of the benefits of the vaccines all contributed to vaccine confidence.Specific elements of COVID-19 vaccine delivery strategies—such as having a separate vaccination card and an emphasis on the individual’s choice to get vaccinated—set COVID-19 vaccines apart from other adult vaccinations and contributed to low vaccine uptake.Key ImplicationPublic health practitioners should bundle COVID-19 vaccination strategies with other, more trusted vaccinations and strengthen messaging about the benefits of vaccination for the public good.In Malawi, various brands of the COVID-19 vaccine have been offered to the population, but factors including fear of side effects or other risks, uncertainty about benefits, and misinformation created hesitancy toward them. In early 2022, 4% of Malawians were fully vaccinated for COVID-19. Despite multiple promotion efforts, by August 2022, COVID-19 vaccination nationwide was around 15%. To increase COVID-19 vaccination uptake, the research team collected qualitative data in 4 districts with vaccine coverage levels ranging from 1% to 11%. This data collection happened during a cholera outbreak that began in March 2022 and the vaccination efforts to address it. Study participants included male and female members of the general population, social workers, people with comorbidities, health workers, and community leaders (224 participants total, 47% female). In focus group discussions (n=27) and in-depth interviews (n=17), participants compared COVID-19 vaccines with other adult vaccines, such as cholera and tetanus toxoid. A thematic analysis identified themes related to 3 research questions on COVID-19 vaccine concerns, confidence, and delivery affecting uptake. Differences in promotion, delivery (oral versus injection), COVID-19 vaccine card structure, the various brands and boosters, and vaccines being described as required or optional all played a role in distinguishing COVID-19 vaccines from other vaccines and creating suspicion or indifference. Barriers to vaccination in general, such as rumors or knowledge gaps, were amplified by how novel the COVID-19 vaccines were perceived to be and the changing guidance provided over time. By April 2023, more targeted campaign efforts helped increase vaccination rates to 28%. The findings contribute information about how individuals conceptualize and make decisions about adult vaccination, which can, in turn, inform strategies to integrate COVID-19 promotion and delivery with other disease responses in Malawi as well as routine health services in similar settings.