Country readiness in responding to COVID-19 Vaccine-Related Events (VREs) in Malawi: a mixed methods readiness assessment April—May, 2023

Abstract The Malawi Ministry of Health and partners developed a comprehensive COVID-19 VRE response plan in 2022. We explored MoH readiness to implement the plan by assessing the availability of VRE-related documents describing overall process of identifying, reporting, investigating, and coordinating a VRE response; and assessing the strengths, weaknesses and recommendations for improvements in the current system. We conducted a cross-sectional mixed methods assessment among MoH staff involved in VRE response at national, district, and health facilities levels using a survey and a semi-structured interview guide in ten districts in Malawi during April—May, 2023. Availability of ten VRE-related documents was assessed and visually confirmed. We assessed the count of each of the survey findings by district and zone. Ten key themes pertaining to VRE identification, reporting, investigation and response were explored in 109 Key Informant Interviews (KIIs) and six Focus Group Discussions (FGDs). Of the 109 KIIs, 91% of those interviewed worked at District or Health Facility levels. We conducted 6 FGDs at the Health Facility level. We analyzed 74 survey responses. More than 60% of respondents reported having access to VRE-related documentation, but less than 10% reported access to non-AEFI VRE related guidance. KII and FGD respondents identified existing processes for AEFI-related VREs, but noted the lack of training, coordination and budgetary support for non-AEFI VRE activities. Optimal deployment of Malawi’s COVID-19 VRE response plan will require expanded training opportunities, sustained funding and improved coordination across all levels of the health system and between surveillance and communications functions.