Attitudes to malaria vaccination in children: what can be learned from their consistency with the temporal dynamics of COVID-19 vaccination intention? A prospective cohort study in rural Senegal (July 2020-November 2023).

Introduction: Several sub-Saharan African countries are launching malaria vaccination programmes for children. We assessed how attitudes to malaria vaccination for children could be better understood by considering the individual dynamics of COVID-19 vaccine intention/uptake over the 2021-2023 campaigns, with a view to highlighting barriers likely to affect malaria vaccine uptake.

Methods: We conducted a six-wave telephone-based survey of 600 randomly selected Senegalese households. A latent class mixed model was used to assess temporal changes in COVID-19 vaccine intention/uptake and to identify clusters of individuals sharing similar intention/uptake patterns across the waves. Time-invariant and time-varying correlates were assessed using logistic and probit models. Attitudes to malaria vaccination (wave 6) were compared with the various COVID-19 patterns.

Results: Of the 600 households contacted, 558 (93.00%) agreed to participate in the study (558 heads of household and 457 spouses). Very strong positive attitudes to malaria vaccination (65.28% of participants) were associated with higher personal COVID-19 vaccine uptake (p<0.001). With regard to the individual dynamics of COVID-19 vaccination, three temporal patterns were identified: continuously strong intention (34.88% of participants), increasingly strong intention (33.40%) and increasingly less strong intention (31.72%). Along with socioeconomic factors, these patterns were explained by early levels of risk perception and trust in health authorities, and temporal fluctuations of these factors. Households where both surveyed members had continuously strong COVID-19 vaccination intention were also more likely to have strong positive attitudes to malaria vaccination for children (p=0.001).

Conclusion: Further investigation would be necessary to assess the generalisability of using individual dynamics of COVID-19 vaccination as a reference for studying attitudes to newly offered vaccines. As regards the real-world dynamics of uptake of the four scheduled malaria vaccine doses, targeting of parents who need incentives to address barriers to compliance could be improved by accounting for their dynamics of COVID-19 vaccination.