Covid-19 Vaccination: Willingness and practice in Bangladesh

Bangladesh is no stranger to vaccination and is largely considered to be vaccine-friendly. But currently, the country is going through the complexities and uncertainties attributed to adult immunisation through the Covid vaccination programme. 

Unlike past child immunisation programmes, the situation is far more challenging. Because this time the required coverage of vaccination is very high (around 80%) to reach herd immunity, and there are several constraints surrounding vaccine supply as well. 

A recently published report by the Brac Institute of Governance and Development (BIGD), titled "Covid-19 Vaccination: Willingness and Practice in Bangladesh" sheds light on the demand-side aspect of vaccination. The study utilised data from three different telephone surveys conducted over various periods early this year, from late January to the end of March. 

This timeframe allowed investigating the willingness prevailing among adult people regarding vaccination and also the ensuing registration nature post one and a half months of the launch of the programme. 

Vaccine willingness in early February

Around the time when Bangladesh commenced the mass immunisation programme, over 80% of the respondents showed a willingness to vaccinate. The majority of the adult respondents reported they were definitely willing whereas some said that they were probably willing to take the Covid vaccine. 

The overall high willingness at the start of the programme in February 2021 indicates that some of the anticipated demand-side challenges in adult immunisation will not be a problem in the vaccine rollout. 

Most unwilling respondents reported that they do not feel the necessity of a vaccine. Another common reason was distrust in the vaccine. 

Trust in public service delivery has a role 

Those who thought there were significant irregularities in the relief distribution during shutdown or who had low levels of satisfaction- were more hesitant to be vaccinated. Besides, those who perceived higher effectiveness of the government's response to the Covid-19 crisis were more willing to be vaccinated. 

A similar relationship holds for the confidence level with the efficiency of the vaccine distribution in Bangladesh.

Low willingness among the urban slum dwellers and the youth

Willingness to vaccinate is relatively higher in rural regions as compared to urban counterparts. From analysing an urban slum sample from a survey, we found the vaccine hesitancy is relatively higher in urban slum settlements, compared to overall urban sample respondents. 

The perceived lack of necessity is relatively a more prominent reason among urban slum residents compared to the urban adult respondents. Moreover, urban slum dwellers tend to have more polarised views regarding confidence in the efficiency of vaccine distribution compared to overall urban respondents. 

Additionally, a fall in willingness by around 13% was observed among the youth group from February to March. The youth are usually very engaged in social media and vulnerable to disinformation and active actors in the information space. 

Looking back to February and March of this year, all the rumours and concerns raised on the safety and effectiveness of the vaccines could have influenced to change their decisions.

Many do not know about registration

We also extended our analysis to examine the vaccination in practice—vaccination registration. The findings from a survey portray the concerns prevalent in rural and urban slum settlements. 

Unfortunately, more than one-third of the rural and urban slum residents are not informed about the vaccination registration. A higher proportion of urban slum dwellers had heard about the Covid-19 vaccine registration than the rural respondents. 

This shows a possible benefit of the higher access to information prevalent in urban regions. In both regions, proportionately more men heard about Covid-19 registration.

Registration rate is low despite eligibility

The registration rate among all the respondents is merely about 6%. Nonetheless, a promising sign is the compliance rate among those who registered was considerably high—more than 90%. Some of those who did not register despite knowing were not sure about their eligibility, but most were. 

The main reasons among the self-reported eligible respondents for not registering are lack of interest, time management issues, not knowing how to register or who to ask for help, and concerns about side effects. The disinterested nature is significantly higher among the urban slum dwellers. 
 
The Covid-19 registration has been online from the beginning. Most of the registrations, in both rural and urban slum regions, were completed with the help of others. This has a direct cost but also indirect ones creating constraints for the poor, illiterate and women. These equity considerations will have to be taken into account when designing the vaccination campaign and support.

Role of personal networks and mass media

Personal networks and mass media played a significant role in disseminating information and encouraging rural and urban slum residents to immunise themselves. Less than 10% of respondents who registered stated social media platforms as a source of information. This indicates how rural and urban slum residents still resort to the traditional media platforms for news. 

Additionally, the majority of those who took vaccines mentioned the role of personal networks—family, friends, coworkers, relatives and neighbours—in motivating them. The influence of friends and occupation networks has been surprisingly greater than family members and relatives. 

Since trust in public service delivery appears to matter for an individual's willingness, ensuring and maintaining the quality of service will be beneficial too. The government could also engage the non-governmental organisations and adopt a collective approach. Policymakers need to bear in mind both supply and demand-side aspects to ensure the ultimate success of the vaccination programme.

Ishmam Al Quddus and Avinno Faruk are Research Associates at Brac Institute of Governance and Development.