Examining Enablers of Vaccine Hesitancy Toward Routine Childhood and Adolescent Vaccination in Malawi

Abstract Background: Vaccine hesitancy is the delay or refusal of vaccines despite their availability. Here, we explored factors that influence hesitancy among caregivers of children and adolescent girls eligible for routine immunisation and the human papillomavirus (HPV) vaccine in Malawi. Methods: The study used key informant interviews and focus-group discussions. Information was obtained from caregivers and national and district-level representatives of the expanded program on immunisation (EPI) and community stakeholders. There were 25 key informant interviews, and two focus-group discussions with 13 participants conducted April May 2020. Interviews were audio-recorded, transcribed, and analysed using a thematic content analysis. Results: Most vaccine-hesitancy drivers for routine immunisation were also relevant for the HPV vaccine. 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, and a disconnect between community healthcare and community leaders. Conclusion: This study provides insights into determinants of vaccine hesitancy within the Malawian context. The findings can inform context-specific interventions by decision-makers. There is need for further study around the prevalence and impact of each factor, as well as their causal relationships to vaccine uptake.