COVID-19 vaccine information, misinformation, and vaccine uptake in Malawi.

BackgroundCOVID-19 vaccine information - including source, content, and tone - may be an important determinant of vaccination, but this dynamic is not well-understood in low-income countries where COVID-19 vaccine uptake remains low. We assessed the COVID-19 vaccine information environment in Malawi, and its correlation with vaccine uptake. MethodsA survey was administered among 895 adult ([≥]18 years) clients at 32 Malawian health facilities in mid-2022. Respondents reported their COVID-19 vaccination history, exposure to information about the COVID-19 vaccine from different sources and its tone (positive, negative, or neutral/factual), and whether they had heard of and believed in ten COVID-19 and COVID-19 vaccine conspiracy theories. We described the COVID-19 vaccine information environment in Malawi and used logistic regression analyses to assess the association of exposure to information sources and conspiracy theories with uptake of the COVID-19 vaccine. ResultsRespondents had received information about the COVID-19 vaccine most commonly from friends and neighbors, healthcare workers, and radio (each reported by >90%). Men, urban residents, and respondents with a higher education level were exposed to more COVID-19 vaccine information sources. COVID-19 vaccine uptake was positively associated with exposure to a greater number of COVID-19 vaccine information sources (aOR 1.09, 95% CI 1.03-1.15), and more positive information (aOR 4.33, 95% CI 2.17-8.64) - and was negatively associated with believing COVID-19 vaccine conspiracy theories to be true (OR 0.76, 95% CI 0.68-0.87). ConclusionsMalawian adults were exposed to a variety of COVID-19 vaccine information sources, with less access to information among women, rural residents, and people with lower educational attainment. Exposure to misinformation was common, though infrequently believed. Vaccination was associated with exposure to high number of COVID-19 vaccine information sources, exposure to positive vaccine information and endorsing fewer conspiracy theories. Vaccination programs should disseminate communication with positive messaging, through multiple information sources, prioritizing the less exposed groups we identified.