The Journey to increase COVID-19 Vaccine acceptance in Malawi



Why is it that most people are shunning away from Covid-19 vaccines? And why are most religious and community leaders encouraging their followers not to take the vaccines? Where are all the myths, misconceptions and misinformation coming from and why are they easily believed? And what strategies could work best to create demand and bust the myths surrounding covid-19 vaccines? What could be the most important lessons learnt through unearthing underlying issues in the quest to answer these questions?

These are among the few essential spheres this impact report will try to uncover, expounding more on the individual responses and perceptions of the COVID-19 pandemic, the treatment, and the vaccine by the general public in Malawi.


In the past year, the CTAP Malawi team has done a lot of work around getting people vaccinated and raising conversations on the state of Health Sector Accountability in the country.  


Leading the above conversation, it’s essential to highlight the activities which led to the massive disbelief of the citizens towards the COVID-19 vaccines and also affected their understanding of the pandemic. In Malawi, the political response and the lackadaisical attitude in communicating critically with the people was the number one reason for the hesitancy.  

When the COVID-19 pandemic spread throughout Europe and  America in 2019, Malawi went to the tripartite election to vote for the members of parliament, the councillors and the president. The results were challenged in court, culminating in the ruling that the president should be re-elected within 90 days. By that time, Malawi was registering COVID-19 cases mainly from people returning and visiting Malawi; local transmission was pretty low. Political parties started conducting rallies to woo voters, and the government came up with COVID-19 prevention measures, which among other things, was the ban on public gatherings, including campaign rallies to curb the spread. The opposition interpreted this as a strategy to bar their rallies from giving an advantage to the ruling party. The measure was contested and then politicised; opposition leaders were up in arms, telling their supporters in rallies that there was no COVID-19, as its government’s gimmick to frustrate the presidential re-election. So, the opposition parties continued conducting rallies, which resulted in the ruling parties also conducting rallies in fear of being left behind. That was happening amidst the rising numbers of local transmissions and death from the COVID-19 pandemic.

The results came in, and the opposition led the race. However, this ushered in the second wave of the COVID-19 virus. Malawi registered unprecedentedly high infection cases and death rates, which compelled the government to devise strict measures to contain the spread. This directly contradicts their earlier position that COVID-19 was a political hoax. This was too little too late; the general public was already made aware of and believed that the pandemic was not real. There was a backlash, leading to mistrust of the health and the political system. The general public questioned and protested whatever was said about the pandemic until the proposed lockdown was denied through protests and court injunction until it failed to take effect.   


COVID-19 became a health emergency 


The was a sharp upsurge of COVID-19 cases, the health system capacity failed to cope with the numbers, and there were fewer beds and fewer resources and personnel to manage the situation. Most countries have been affected by the lockdown and travel restrictions, including closing borders for non-essential travellers. Malawi’s death rate to COVID-19 was at its worst, but the general public’s view of the pandemic and its effects was still indifferent. It was difficult for the very same leaders who told them there was no COVID-19 when they were in opposition to say to them that there was COVID-19 when they took over the government.

The reactions were devastating. People stopped going to the hospitals even with entirely different illnesses; they trusted less and less the health service providers, and most believed in myths and misinformation. Religious leaders aggravated the issues by spreading take of the pandemic that it was the biblical introduction of the 666 mark of the beast, and whoever accepts the vaccine will die within two years or will be sinning because it means he or she has denied Jesus. 


The CTAP Research Studies 

To unearth the depth of the issues surrounding the COVID-19 vaccine and the health system’s capacity, transparency and accountability, we conducted two research exercises to find out the situation in the healthcare service delivery in Malawi and vaccine equity and uptake. The main findings from the two studies helped shape our interventions which have been very successful and have aided us in developing more ideas for future interventions. 

We discovered that the turnout for vaccination in metropolitan areas was high, while in rural areas was low. We engaged in community engagement efforts to boost the turnout in the rural areas and educated health workers to visit and inoculate people in villages. Some community members, including some health workers, were putting up a resistance against the COVID-19 vaccination. In addition, there was vaccine hesitancy due to misinformation, disinformation, and a lack of general knowledge about the COVID-19 vaccines. Malawi also faced vaccine supply chain challenges, including a delay in vaccine supply, which resulted in COVID-19 vaccine stockout at the peak of the third wave. When stocks became available, the uptake dwindled tremendously; there was a strong correlation between the increase in COVID-19 cases and deaths.   Deaths increase became a genuine reason for people to take the vaccines, and when the numbers lowered, the demand also was reduced. 

The research found that the government’s roll-out strategy of the vaccines didn’t consider issues of trust and the prevailing unacceptance of the vaccines. The government cut off the health surveillance assistants, mainly those that live with the people in the communities, in favour of the nurses and the clinicians in the district and central hospitals to administer the vaccines, resulting in denial and mistrust of the vaccines by the community leaders, and the health surveillance assistants themselves, due to being indifference of the strategy that cut them out, thereby making them not to benefit financially and professionally from the exercise. To resolve this issue, we had to emphasise the need to keep a level of surveillance alive as this will be the method of monitoring the government’s efforts, which goes into the rural areas. 


Responses to the Challenges Exposed by the Research

The CTAP Malawi team’s overall intervention goal was to ensure that the COVID-19 vaccine is available everywhere, accessible to everyone all the time. Looking at the data we collected, availability was not a significant issue. The research found out that the country even destroyed an enormous number of COVID-19 doses due to a lack of uptake of the vaccines. We figured out that creating demand was paramount if the vaccination campaign was to be successful. 

Most of the participants engaged in the research also mentioned that the engagements of the health care workers who were less or not known at all by the communities increased fear and mistrust among the local people.

The awareness campaign strategies employed by the government of using public address vehicles going to villages to talk about the importance of the vaccines was less effective due to the lack of interfacing mechanisms whereby people could ask questions. We took it forward with town halls and one-on-one meetings with citizens. 


 Improving vaccine intake, what we did. 

We engaged different stakeholders in the quest to create demand for the COVID-19 vaccines, busting the myths preventing people from getting the vaccination and engaging religious and community leaders who were conversant with the vaccines as champions. We utilised the participants engaged during the country-specific health sector research and the Vaccine Equity and distribution research. It is worth sharing that the data collection activities for both studies used the Participatory Action Research methodology, whereby the researchers and the participants discussed issues and suggested solutions in their context without imposition from outside expert knowledge; it was data collection and brainstorming sessions, whereby champion leaders were identified. 

After the findings, we engaged the same groups, filling in the gaps identified during the research and developing the participant’s actionable points, with the champions leading the processes. The main sectors engaged through these strategies were the community and religious leaders, mainly for two reasons; 1. They had easy access to their followers and a platform where they speak every other time, and 2. They are respected and believed easily by their followers. This is where the project registered tremendous progress. There was unprecedented creation of demand for the vaccines, and that was affirmed by the health surveillance assistants, who were the second group of changemakers strategically engaged in achieving the same goals, excerpts;

During the research, trust was another barrier to vaccine uptake, as most people felt the strangers deployed in their areas had a hidden agenda. These assertions were affirmed by their religious and community leaders. We took up these findings to the District Health Management Committees, and they agreed that there was a need to utilise the trust and healthy relationships the communities had already built with the health surveillance assistants. We engaged them in separate strategic meetings to figure out how best that could be carried out; they were capacitated with the right messages and approaches to be used in their already existing community health campaigns which proved worthwhile in the end; the communities now were hearing positive messages from all people of influence, starting from the religious leaders, the traditional leaders and then the health surveillance assistants. 


The strides the project made were also enhanced by the efforts of the government and other stakeholders alike; one of the significant enablers for COVID-19 vaccine uptake was the example set by the president and the vice president, who was publicly vaccinated during the launch of the vaccination campaign. We emulated the same strategies and asked the health surveillance assistance, together with the political, religious and traditional leaders, to publicly get jabbed during the vaccination campaigns in their respective areas. 

The most significant boost to the campaign was a strategy devised by all stakeholders, including the government, to roll out a door-to-door campaign. This strategy achieved the best results in the areas that the CTAP project was working in as the health surveillance assistants that were engaged in the vaccination campaign already built rapport with the community members and were also assisted by the political, religious and traditional leaders we were utilising as champions for change during the campaign.

Concluding, it’s worthy of note that the research findings and the gaps the research unearthed played a significant role in developing the interventions that effectively addressed the gaps and created demand for vaccination in Malawi. 

As earlier stated, religious and traditional leaders significantly influenced the uptake and hesitancy of the COVID-19 vaccines that were available in Malawi. (AstraZeneca, Johnson and Johnson and Pfizer). Some religious leaders were at the forefront, informing their flock that taking up the vaccine symbolizes them accepting the mark of the beast, which resulted in many people boycotting the vaccine uptake. 

Some of the myths advanced by the political and traditional leaders were that taking up the vaccines would make people infertile and that the western agenda to make Africa sterile would eventually wipe out the black race. And also, some believed that whoever took up the vaccine would die in the next two years. And some thought that the COVID-19 pandemic was a hoax meant to generate money for western pharmaceuticals and that people were not dying from the pandemic. Still, the government is being given money to cook up figures to create fear, resulting in many people seeking vaccination. All these myths, our campaigns and interactions have burst and shared real-life examples as to why these myths are not only lies but disingenuous to attainting immunity against the COVID-19 virus. 

In Malawi, we have created a coalition of Journalists, civil society members and other relevant stakeholders who have made it a duty to be forever vigilant in campaigning against COVID-19 vaccine hesitancy and ensuring the health sector works for all citizens of Malawi.