Uptake of the COVID-19 vaccine and its association with vaccine information and misinformation in Malawi

Introduction

During public health crises, information can shape individuals’ knowledge of and/or attitudes about health interventions, and ultimately inform their behaviors^{1, 2, 3–4}. The COVID-19 pandemic, which occurred amidst widespread technology use and social media connectedness, was deemed an “infodemic” by the World Health Organization – i.e., it was characterized by an overabundance of information, both accurate and inaccurate, about the virus, its origins, and control measures, including vaccines⁵. Misinformation can contribute to vaccine hesitancy^{6, 7–8}, and the spread of vaccination misinformation accelerated during the COVID-19 pandemic⁹ which has been linked to decreased COVID-19 vaccination intent and behavior^10,11.

The spread of misinformation on social media platforms, in particular, has been identified as a contributor to vaccine hesitancy. Social media can rapidly spread false information about vaccines, eroding trust in critical health communication institutions¹². Vaccine hesitancy has been linked to following, sharing, and interacting with untrustworthy and low-quality online sources¹³. Vaccine uptake has also been found to be influenced by the type of information encountered on social media; those who received the vaccine were exposed to more pro-vaccination messages, while those who did not get vaccinated encountered significantly more anti-vaccination content¹⁴. While social media use has been linked to vaccine hesitancy, the extent to which social media contributes to vaccine hesitancy varies across platform and population¹⁵ so understanding this dynamic in diverse contexts is essential.

The COVID-19 information and misinformation landscape in low- and middle-income countries – and how it is associated with low COVID-19 vaccine uptake in these settings¹⁶ – remain poorly understood¹⁷. In Malawi, only approximately 1 in 4 people have received a COVID-19 vaccination¹⁸ and although misconceptions and conspiracy theories about the COVID-19 vaccine have been documented in Malawi and elsewhere in the region^{19, 20, 21, 22–23}, the broader information environment has not been well-characterized, nor has its association with vaccination behavior. Globally, much of the literature on the COVID-19 “infodemic” has focused on the dissemination of (mis)information online and via social media^24,25, and this is also relevant in low-income countries where access to technology is rapidly changing.

Understanding what information people are exposed to, the sources and tone...