Understanding communities to improve vaccine uptake: new EVI-led study sheds light onto malaria-in-pregnancy vaccine acceptance in Malawi

Vaccine acceptance is shaped by far more than the science behind a product. Trust, language, cultural context, and lived experience are all important factors for communities to decide whether to accept or reject a new vaccine designed to protect them. Recognising this, EVI has increasingly focused on social science research as an essential complement to its clinical and translational work generating the community-level evidence needed to design interventions that are not only scientifically sound, but culturally resonant and practically effective.

April 2026

A new publication in Vaccines reflects this commitment. Led by EVI in collaboration with the Malawi University of Science and Technology (MUST), a community-based cross-sectional survey was conducted among women of reproductive age in southern Malawi. The study explored participants  knowledge, perceptions, and practices around malaria in pregnancy, and their attitudes toward a future placental malaria vaccine. The main objective of the study was to generate evidence that can guide the design of social and behaviour change interventions to raise awareness of placental malaria and improve vaccine acceptance.

The study data showed that almost all surveys participants (97%) expressed willingness to accept a future vaccine, if becomes available. This is a strong foundation to build on. Yet the study also revealed complex challenges that could affect successful vaccine implementation and uptake. Geographic disparities in knowledge gaps, and persistent concerns about safety and the growing number of recommended vaccines were significant. Women in Mpemba showed substantially lower malaria knowledge and risk perception compared to Thyolo, while women in Madziabango were less likely to use health clinic when sick - a pattern that persisted even after adjusting for age and education. These are not incidental variations. They signal where outreach efforts must be concentrated and how delivery strategies should be tailored if a future vaccine is to reach the women who need it most.

Perhaps the most thought-provoking finding concerns language. In Malawi the word malungo is used colloquially to describe many different kinds of fever and illnesses, not just malaria. This language gap can have direct implications for vaccine introduction as intervention targeting placental malaria may not resonate with existing illness frameworks, potentially limiting the uptake. Effective communication around a future vaccine will require more than translation: it will require genuine conceptual bridging between how disease is understood in clinical settings and how it is lived and named in communities.

The study emphasises that before the introduction of new malaria vaccines for women of reproductive age, it will be important to share clear information, that bridges biomedical concepts of PM with local illness concepts and addresses safety concerns directly. These findings point to uneven access to information and care, highlighting the need for context-specific delivery strategies.

“The openness with which women shared their experiences of pregnancy and illness. These are deeply personal topics, and the trust that is placed in us is responsibility to represent their perspectives accurately.” – Mandeep Kaur, Social Science Project Manager at EVI and lead author.

Conceptual relationship between the illness category malungo and biomedical malaria in local languages in Malawi. (Kaur et al. 2026)

Authors concludes that, while vaccine acceptability was high, local context-specific delivery strategies will be essential for an effective future PM vaccine introduction. In other words, willingness is necessary, but it is not sufficient. The social, cultural, and structural factors that mediate between intention and action must be understood long before a vaccine reaches a community.

For EVI, this publication is part of a broader commitment: the science of vaccine development must be accompanied by the science of human context. EVI is currently coordinating the ADVANCE-VAC4PM consortium to advance vaccine candidates targeting VAR2CSA, the malaria parasite protein that enables infected red blood cells to bind to placental tissue. Furthermore, EVI and partners are conducting a Phase II clinical trial to evaluate the safety, tolerability, immunogenicity, and protective efficacy of the R21/Matrix-M malaria vaccine in women of childbearing age and assess its effect on future pregnancy outcomes.

Community readiness research, such as this study in Malawi, lays the social and community engagement groundwork that clinical trials alone cannot provide. Understanding communities is not a preliminary step in vaccine development. It is part of the work itself.

Read full study: Kaur M, D'Alessio F, Kajombo MC, Nkolokosa M, Olesen OF. "Assessing Readiness for Future Maternal Malaria Vaccines: Knowledge, Practices, and Vaccine Attitudes Among Women of Reproductive Age in Malawi." Vaccines 2026; 14(4):316. https://doi.org/10.3390/vaccines14040316

Images captured during field work for ethnographic study in Malawi, including Mandeep Kaur (EVI) and Dr Marion Kajombo (MUST) during Focus group discussion with women from Chepuka village (18.07.2024); Community engagement with Katslabande village women on the last day of my visit (19.07.2024).

Read more about this field work: https://www.euvaccine.eu/post/chronicles-from-malawi-africa

This research was funded by the Directorate-General for International Cooperation (DGIS) of the Netherlands and the European Union, under grant agreement No 101057882 (ADVANCE_VAC4PM project). The views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency. Neither the European Union nor the granting authority can be held responsible for them.