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A qualitative exploration of perceptions of the COVID-19 vaccine in Malawi during the vaccine rollout phase

Aim: Although the COVID-19 vaccine in Malawi has been well taken up and encouraged by the current administration, many individuals either are hesitant to get vaccinated for COVID-19 or refuse to do so. Research has uncovered associated demographic and psychological reasons, but there is a lack of qualitative work involving individuals across Malawi to explore reasons for this hesitancy. We aimed to explore factors leading to hesitation and/or refusal to COVID-19 vaccination in Malawi. Methods: The study utilized an online survey to collect free-text responses to assess factors leading to hesitation or refusal of COVID-19 vaccination in Malawi. The respondents were part of an ongoing community project in Central Malawi. In total, 284 individuals took part (72 males, 212 females). The mean age was 47.94 (SD = 8.36). Sixty-nine respondents (24.3%) had been vaccinated and 215 (75.7%) had not. An inductive thematic analysis was conducted. Results: Four themes were yielded, describing semi-colon fear of vaccination, becoming vaccinated to protect others, perceived pressure to be vaccinated, and perceptions of the COVID-19 vaccine being ineffective and experimental. Conclusion: Measures to increase COVID-19 vaccine uptake and acceptance should target fear and misinformation as constraints. Interventions such as individual sensitization and motivational interviewing should be considered for guiding individuals towards considering COVID-19 vaccination.