National Trends in the Public's Likelihood of Getting a COVID-19 Vaccine in Bangladesh: Understanding the Strategies to Optimize Vaccination Coverage

Abstract

Background: Although the COVID-19 vaccine has been proved to be safe and effective, mass vaccination in Bangladeshi people remains a challenge even without a cost. A high percentage of reluctance to vaccine could result in poor control of the disease. We aim to identify the prevalence of vaccine acceptance in Bangladeshi adults and analyze the associated sociodemographic, clinical, and healthcare-related factors on the likelihood of getting a COVID-19 vaccine.Methods: This cross-sectional analysis from a household survey of 3646 adults aged 18 years or older was conducted in 8 districts of Bangladesh, from December 12, 2020, to January 7, 2021. Multinomial regression examined the impact of socio-demographic, clinical and healthcare-releated factors on uncertainty and reluctance to be vaccinated for COVID-19.Findings: Of the 3646 respondents (2212 men [60.7%]; mean [sd] age, 37.4 [13.9] years), 74.6% reported their willingness to vaccinate against COVID-19 when a safe and effective vaccine is available without a cost, while 8.5% were reluctant to vaccinate. The prevalence of vaccine acceptance will decline to 46.5% if the government introduces a minimum vaccine fee. Moreover, 612 (16.8%) of the 3643 respondents reported adequate adherence to health safety regulations for COVID-19, and 1294 (35.5%) of the respondents reported high confidence in the country's healthcare system. However, the COVID-19 vaccine refusal was significantly increased in elderly, rural, semi-urban, and slum communities, farmers, day laborers, homemakers, low-educated populations, and those who had low confidence in the country's healthcare system. Moreover, the prevalence of vaccine uncertainty is high in the elderly population, low-educated group, day-laborers, presence of chronic diseases, and people with low confidence in the country's healthcare system.Interpretation: A high prevalence of vaccine refusal and uncertainty is observed in rural people and slum dwellers in Bangladesh. This community of people also has a low literacy level, and we found a decreasing trend of prevalence in vaccine acceptance with decreasing education level. It is expected that an app-based registration system would not be appropriate for low-educated groups, and a feasible alternative strategy such as local spot-registration could be devised. Furthermore, for rural, semi-urban, and slum people, outreach centers for vaccination can be established to ensure the vaccine's nearby availability and limit associated travel costs. In rural areas, community health workers, valued community-leaders, and non-governmental organizations can be utilized to motivate and educate people for vaccination against COVID-19. Further, emphasis should be given to the elderly and diseased people with tailored health messages and assurance from healthcare professionals. The media may play a responsible role with the vaccine education program and eliminate the social stigma about the vaccination. Finally, free vaccination should be continued until the end of the vaccination program. Thus Bangladesh's Covid vaccination program can become a model for other low and middle-income countries.Funding Statement: None. Declaration of Interests: All other authors declare no competing interests.Ethics Approval Statement: The Institutional Review Board approved the study at North South University, Bangladesh (2020/OR-NSU/IRB/1003).