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Knowledge, beliefs, attitudes and perceived risk about COVID-19 vaccine and determinants of COVID-19 vaccine acceptance in Bangladesh

Sultan Mahmud, Md. Mohsin, Ijaz Ahmed Khan, Ashraf Uddin Mian, Miah Akib Zaman

arXiv:2103.15206v2cs.CYcs.AI

TL;DR

The paper examines vaccine acceptance in Bangladesh amid a lukewarm registration response and context-specific determinants of uptake. It surveys acceptance and associated factors, finding substantial willingness alongside prevalent delay and safety concerns. The authors recommend targeted campaigns and evidence-based communication, while noting limits to representativeness and self-reported data.

  • Problem

    Bangladesh’s lukewarm vaccine registration response and context-specific acceptance factors made public willingness and its correlates important to assess.

    Source: Introduction · p. 3, Discussion · p. 15

  • Method

    The study classified respondents by vaccine acceptance and immediate versus delayed timing, then examined factors associated with acceptance and immediate vaccination.

    Source: Statistical analysis · p. 5, Discussion · p. 15

  • Results

    61.16% (370/605) accepted vaccination, but most intended to delay because of uncertainty about the new vaccine’s safety and efficacy.

    Source: Results · p. 5, Discussion · p. 15

  • Takeaways & Limitations

    The authors recommend vaccination campaigns, with special attention to rural people, females, and people aged 70 and older, alongside evidence-based safety communication.

    Source: Conclusion · p. 16, Discussion · p. 16

    Online recruitment reached only people with internet and smart-device access, potentially limiting representativeness; self-reported information may also introduce information bias.

    Source: Discussion · p. 16

Abstract

from arXiv · show

A total of 605 eligible respondents took part in this survey (population size 1630046161 and required sample size 591) with an age range of 18 to 100. A large proportion of the respondents are aged less than 50 (82%) and male (62.15%). The majority of the respondents live in urban areas (60.83%). A total of 61.16% (370/605) of the respondents were willing to accept/take the COVID-19 vaccine. Among the accepted group, only 35.14% showed the willingness to take the COVID-19 vaccine immediately, while 64.86% would delay the vaccination until they are confirmed about the vaccine s efficacy and safety or COVID-19 becomes deadlier in Bangladesh. The regression results showed age, gender, location (urban/rural), level of education, income, perceived risk of being infected with COVID-19 in the future, perceived severity of infection, having previous vaccination experience after age 18, having higher knowledge about COVID-19 and vaccination were significantly associated with the acceptance of COVID-19 vaccines. The research reported a high prevalence of COVID-19 vaccine refusal and hesitancy in Bangladesh.

Introduction

COVID-19 vaccine development had advanced, but uptake remained a distinct challenge shaped by safety concerns and context-specific factors. This study examines Bangladeshi public attitudes and vaccine acceptance to inform efforts to encourage uptake.

Introduction

  • COVID-19 spread globally and prompted border restrictions, travel bans, and quarantine amid the absence of proven treatments or medicines.The passage reports more than 111 million infections and 2.4 million deaths worldwide as of February 20, 2021.Source: Introduction · p. 2
  • Vaccines were presented as a means of building lasting immunity, with about 100 COVID-19 vaccines in preclinical or clinical trials and some approved for mass inoculation.The passage notes vaccination avoids about 2–3 million deaths per year.Source: Introduction · p. 2
  • Vaccine development alone may not ensure uptake; prior pandemic experience and safety concerns support planning for rollout and adoption.Reported willingness varied from 55% in Russia to 89% in China in a 19-nation survey.Source: Introduction · p. 2
  • Prior evidence linked vaccination intentions to beliefs and sociodemographic characteristics, but uptake factors may vary by territory, culture, and socioeconomic conditions.Earlier studies associated lower intention with beliefs that COVID-19 dangers were exaggerated, younger age, and Black and minority ethnicity.Source: Introduction · p. 2
  • Bangladesh had reported substantial public unawareness, rumors, and misinformation about COVID-19 from early in the pandemic.Source: Introduction · p. 2
  • Vaccine rollout remained a challenge: Bangladesh revised its February 2021 inoculation target from 6 million to 3.5 million after lukewarm online registration.The government had ordered at least 30 million Oxford-AstraZeneca doses and expected another 68 million through Covax.Source: Introduction · p. 3
  • The study aimed to assess Bangladeshis’ vaccine knowledge, attitudes, and intentions and identify factors associated with acceptance, using an anonymous online survey.The authors positioned the findings as a guide for government efforts to encourage uptake.Source: Introduction · p. 3

Study design and study participants

The study used a cross-sectional, anonymous web survey in Bangladesh from January 30 to February 6, 2021, with voluntary, self-reported participation after consent and eligibility screening.

Study design and study participants

  • The cross-sectional, anonymous web survey ran January 30–February 6, 2021, and permitted Bangladesh residents aged 18 or older to participate after electronic consent and an eligibility check.Participants provided their own responses using an electronic questionnaire.Source: Study design and study participants · p. 3
  • The English questionnaire was translated into Bangla, validated, and pilot tested before online circulation; no sensitive or personal information was collected.Participants were asked to share the survey link with their contacts after completion.Source: Study design and study participants · p. 3
  • Participation was voluntary and open to respondents who lived in Bangladesh and were at least 18 years old.Source: Study design and study participants · p. 3

Sample size

The researchers estimated a required sample of 591 using assumptions of 50% prevalence, 65% response, 5% precision, and a 95% confidence interval.

Sample size

  • 591 respondents were estimated as the required sample, assuming 50% prevalence, 65% response, 5% margin of error, and a 95% confidence interval.The estimate used a stated population size of 1,630,046,161 and an online sample-size calculator.Source: Sample size · p. 3

Instruments

The questionnaire covered demographics, COVID-19 and vaccine knowledge, beliefs and attitudes, perceived barriers and risk, and vaccine acceptability.

Instruments

  • The questionnaire comprised five sections covering demographics, COVID-19 and vaccine knowledge, beliefs and attitudes, perceived barriers and risk, and vaccine acceptability.It was based on previous research.Source: Instruments · pp. 3–4
  • Demographic questions collected age, residence, sex, religion, marital and occupational status, monthly household income, and prior vaccination experience.Source: Instruments · p. 4
  • Knowledge was assessed with yes/no questions about COVID-19 severity, transmission, causes, treatment, testing, and common misconceptions.Examples asked whether COVID-19 is lethal, spreads through contact, or is caused by the influenza virus.Source: Instruments · p. 4
  • Beliefs and attitudes were assessed with agree, neutral, or disagree responses to statements about vaccination, safety, public routines, isolation, and government vaccine distribution.Source: Instruments · p. 4
  • Perceived likelihood, severity, and barriers were measured with three-option responses about future infection risk, illness severity, access to a provider, and vaccine side effects.Source: Instruments · p. 4
  • Vaccine acceptability questions assessed willingness to take the vaccine, timing, reasons for refusal, willingness to pay, and who should receive the first shipment.Source: Instruments · p. 4

Consent and ethical consideration

Participants gave voluntary online consent through a form shared via social media or messaging. The form outlined the research purpose and brief survey instructions.

Consent and ethical consideration

Statistical analysis

The analysis described respondents’ characteristics and compared acceptance and timing groups. Logistic regression was used to identify factors associated with decisions to accept the vaccine.

Statistical analysis

  • Acceptance was defined by respondents’ answers to whether they would take the vaccine; acceptors were further classified as immediate or delayed.Those choosing “will take as soon as possible” were immediate; other listed responses were delayed.Source: Statistical analysis · p. 5
  • Knowledge scores counted valid or correct answers across 12 questions and ranged from 0 to 12.Source: Statistical analysis · p. 5
  • Logistic regression identified factors associated with vaccine acceptance and with immediate versus delayed vaccination decisions.Models reported odds ratios, 95% confidence intervals, and P-values.Source: Statistical analysis · p. 5
  • Descriptive analyses examined respondent characteristics and vaccine-related perceptions, beliefs, and attitudes; chi-square tests compared the two outcome-group pairs.Source: Statistical analysis · p. 5

Results

Among 605 respondents, 61.16% accepted COVID-19 vaccination, but most accepters did not plan to take it immediately. Acceptance was associated with demographic, socioeconomic, knowledge, and perceived-risk factors.

Results

  • The sample included 605 respondents; 82.78% were under 50, 62.15% were male, and 60.83% lived in urban areas.18.68% reported previous vaccination experience after age 18.Source: Results · p. 5, Table 1 · p. 6
  • 61.16% (370/605) accepted vaccination; among accepters, 35.14% (130/307) planned to take it immediately, while 47.84% (240/605) wanted to delay.Fig 1 presents vaccine acceptance in Bangladesh.Source: Results · p. 5, Figure 1 · p. 7
  • 78.52% of unwilling respondents worried about vaccine side effects or safety, and 76.17% doubted its efficacy.Other stated concerns included the vaccine’s origin in India and the belief that vaccination was unnecessary because COVID-19 was going away or respondents were young.Source: Results · pp. 5–6
  • 39.67% had good knowledge, 44.97% medium knowledge, and 16.36% limited knowledge about COVID-19 and vaccination.74.71% agreed vaccination effectively prevents and controls disease; 39.01% were neutral about whether COVID-19 vaccines were effective and safe.Source: Results · p. 7, Table 2 · p. 8
  • Acceptance was associated with age, gender, residence, education, income, adult vaccination history, perceived infection likelihood and severity, vaccine beliefs, and knowledge.Good knowledge was associated with 22.23 times higher odds of acceptance than limited knowledge.Source: Results · pp. 9, 11, 14, Table 3 · p. 10
  • Among accepters, immediate-vaccination odds were 47% lower for women than men and 2.03 times higher for rural than urban respondents.Immediate-vaccination odds were also 3.79 times higher for Hindu than Muslim participants, and nearly twice as high for married than unmarried participants.Source: Results · p. 14

Discussion

Acceptance nearly reached the 60% herd-immunity threshold, but most willing respondents planned to delay vaccination over safety and efficacy uncertainty. Acceptance and immediate-vaccination intentions had distinct associated factors, and the authors note limits to the survey’s representativeness and self-reported measures.

Discussion

  • Bangladesh’s dose-administration rate was 3% on March 24, below the reported rates in the UK (46%), United States (38%), Maldives (41%), and India (3.6%).The authors argued that projecting acceptance and identifying its predictors were important for equitable vaccine distribution.Source: Discussion · p. 15
  • Acceptance nearly reached the 60% herd-immunity threshold, but most willing respondents would delay vaccination because of uncertainty about the new vaccine’s safety and efficacy.The authors describe acceptability as context-specific, with factors varying by time, place, and vaccine type.Source: Discussion · p. 15
  • Higher acceptance was associated with being male, older, highly educated, urban, and higher-income, as well as with employment status.The study also found associations with perceived infection risk and severity, adult vaccination experience, and good COVID-19 and vaccine knowledge.Source: Discussion · p. 15
  • Immediate-vaccination intentions were associated with gender, religion, region, and marital status; rural residents and males were more likely to vaccinate immediately.Prior adult vaccination experience was associated with acceptance but not immediate vaccination; employment and knowledge were not significant for immediate decisions.Source: Discussion · p. 15
  • The authors recommend targeted campaigns for rural people, women, and older adults, including evidence-based safety and efficacy communication and checks on social-media rumors.They also suggest sharing vaccine experiences through mass media and including infectious-disease prevention and vaccination in textbooks.Source: Discussion · p. 16
  • The study presents itself as the first inquiry into acceptance of the newly developed COVID-19 vaccine among people in Bangladesh and identifies priority groups for campaigns.Those groups include people over 70, rural residents, and women.Source: Discussion · p. 16
  • Online recruitment limited participation to people with internet access and smart devices, potentially reducing sample representativeness; self-reported information may also differ from the real scenario.The authors call for further study of changes in vaccination intention and its determinants during the pandemic.Source: Discussion · p. 16

Conclusion

The study reports substantial vaccine refusal and hesitancy in Bangladesh, with safety concerns the main stated reason for unwillingness. It calls for campaigns and evidence-based communication, especially for groups needing more attention.

Conclusion

  • A high prevalence of COVID-19 vaccine refusal and hesitancy was observed in Bangladesh, and safety concern seemed to be the main reason for unwillingness.Source: Conclusion · p. 16
  • Campaigns should give special attention to rural people, females, and senior citizens aged 70 and older to increase immediate vaccination and acceptance.Source: Conclusion · p. 16
  • The authors state that evidence-based communication and health education can reduce public vaccine hesitancy and concern about vaccine safety.Source: Conclusion · p. 16
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