Cultural determinants of COVID-19 vaccines misinformation in Malawi

The study addresses how global COVID-19 misinformation interacts with local cultural and religious narratives in Malawi to shape perceptions of the disease and vaccines, contributing to vaccine hesitancy. Contextually, Malawi initiated COVID-19 vaccination in March 2020, including highly publicized vaccinations of the president and vice president, yet uptake remained low: by May 12, 2022 only 2,054,585 people (5.5% of ~17.5 million) were vaccinated, and doses risked expiry, indicating persistent hesitancy. The introduction frames vaccine resistance as historically rooted and exacerbated by digital media, with misinformation and information overload complicating access to accurate information. The purpose is to explore the cultural determinants—particularly religious and gendered dimensions—that make global misinformation resonate locally, to inform culturally sensitive public health communication.

Prior work establishes long-standing opposition to vaccines (e.g., resistance since the 1853 UK smallpox law) and identifies drivers such as religious beliefs, philosophical objections, safety concerns, and information needs. WHO and UNESCO distinguish disinformation (intentional) from misinformation (unintentional), noting social media’s validation dynamics that encourage sharing. African studies indicate media platforms—especially social media—are primary sources for COVID-19 information, with high reliance on social platforms (e.g., 88% in some contexts), which lack editorial gatekeeping and can fuel confusion and hesitancy. Research highlights social media’s dual role in supporting connectivity and mental health while also facilitating exposure to misleading content; trust in familiar sources online can propagate misinformation. Studies from Nigeria show exposure to misinformation reduces belief in accurate news and fosters negative attitudes toward vaccines, while Malawian research links social media information to lower vaccine intent compared to traditional media. Literature also introduces the concept of “glocal” misinformation—globally sourced but locally tailored—often appealing to cultural identities, gendered narratives, and emotions such as fear and guilt. Trust dynamics matter: Malawians tend to trust religious leaders more than political leaders, and conflicting elite narratives in Africa created “multiple regimes of truth,” further complicating public understanding.

Design: Qualitative study employing key informant interviews (KIIs), in-depth interviews, and focus group discussions (FGDs) to capture gendered and cultural determinants of knowledge and attitudes toward COVID-19 and vaccines. Setting and sampling: Three Malawian districts representing varied contexts—Zomba (urban, south), Dowa (peri-urban, central), Nkhata Bay (rural, north). Participants included members of the general population as well as traditional/community leaders, religious leaders, youth leaders, women’s group leaders, and community influencers. Data collection: Five in-depth interviews (three in Dowa: two females, one male; two in Zomba: two females). Five FGDs: two in Nkhata Bay (one heterogeneous, one homogenous-female), two in Dowa (both homogenous-female), one in Zomba (homogenous-male). Eleven KIIs (four in Zomba, four in Nkhata Bay, three in Dowa). FGDs had six participants each to comply with COVID-19 preventive measures. Interviews were conducted in Chichewa. Data analysis: Audio was transcribed, translated into English, and analyzed using thematic analysis. A latent thematic approach (per Braun and Clarke) was used to interpret underlying meanings, assumptions, and ideologies shaping responses about COVID-19 and vaccines. Ethics: Approval from the University of Malawi Research Ethics Committee (No: P.11/21/101), with permissions from district commissioners and community leaders. Written informed consent obtained (fingerprints accepted when signatures not possible). Confidentiality ensured via participant codes; adherence to COVID-19 safety measures. No anticipated physical or psychological risks; participants could skip questions or withdraw.

• Knowledge: Participants generally understood COVID-19, transmission, and preventive measures. However, information-seeking was hindered by misinformation about origins and causes (e.g., narratives that COVID-19 was manufactured in China or transmitted via animals like pigs).
• Religious framing: Religious leaders often interpreted COVID-19 through spiritual lenses. Some Christian narratives framed the pandemic as the work of the devil; Muslim perspectives viewed it as a disease permitted by the creator. Despite this, many religious leaders accepted vaccination contingent on medical assurance of safety.
• Traditional leaders: Chiefs showed limited understanding and tended to avoid direct responses, navigating tensions between governmental expectations to support vaccination and local religious/cultural influences that discouraged it.
• Dominant misinformation themes: Strong prevalence of narratives linking vaccines to the biblical “mark of the beast”/“666” (Revelation). Other recurring themes included fears of infertility (vaccines as birth control to curb African population growth), imminent death within five years post-vaccination, and doubts about vaccine safety due to rapid development compared to unresolved diseases like malaria.
• Gendered and demographic resonance: Infertility myths particularly influenced women; men expressed fear of death post-vaccination; youths feared fatal outcomes due to vaccination and struggled to access reliable information.
• Online–offline spread: Although originating largely from social media and the Internet, misinformation effectively permeated offline spaces (churches, marketplaces, social gatherings), aided by trust in personal networks and limited fact-checking capacity.
• Hesitancy determinants: Many declined vaccination despite availability, preferring to observe others first, citing safety/efficacy concerns, pre-existing health conditions, and the short development timeline. Trust deficits in political leadership further undermined uptake.
• Quantitative contextual markers: By May 12, 2022, only 2,054,585 Malawians (~5.5% of 17.5 million) were vaccinated; authorities previously destroyed nearly 2000 expired AstraZeneca doses and feared expiry of about 1.2 million doses due to low uptake.

Findings demonstrate that while misinformation is disseminated globally via social media, its impact in Malawi is primarily shaped by local cultural, religious, and gendered narratives—“cultural determinants.” Social media’s participatory nature accelerates spread, with trust in familiar sharers reducing skepticism and critical evaluation. In Malawi’s highly religious context, apocalyptic symbolism (e.g., “666”) and culturally salient fears (notably infertility) render misinformation persuasive. Gender dynamics magnify consequences for women due to the social centrality of childbearing. Trust configurations are pivotal: low trust in political leaders versus higher trust in religious leaders affected message reception, making government-led vaccination campaigns less effective. Conflicting statements by African leaders contributed to fragmented “regimes of truth,” eroding public confidence. Despite low internet penetration, online narratives diffuse into “pavement media” and other offline venues, where verification is limited. Overall, the study argues for culturally grounded strategies that engage trusted local actors, counter fear-based and gendered narratives, and address glocal dynamics of misinformation across both online and offline ecosystems.

COVID-19 misinformation in Malawi largely originates from global digital platforms but gains persuasive power through local cultural, religious, and social dynamics. Recognizing these cultural determinants is essential for designing effective public health communication. Strategies should be culturally sensitive, engage trusted community and religious leaders, and directly address fear-based and gendered myths (e.g., infertility, apocalyptic symbols). Because misinformation circulates seamlessly between online and offline spaces, interventions must operate across both realms. Insights from this study can inform responses to misinformation in future health crises by foregrounding local cultural contexts alongside global information flows.

• The study did not explicitly identify the actors spreading misinformation or their motives, which limits understanding of propagation mechanisms and targeted countermeasures.
• Findings are based on qualitative data from three districts, which may limit generalizability beyond the studied contexts.