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Vaccine Coverage and Hesitancy · Journal article
Risk Analysis · September 1, 2026
Reinforces what was already believed, rather than introducing something new.
This cross-sectional survey of 707 adults in southern Bangladesh documents a rural–urban disparity in COVID-19 booster vaccine acceptance (62.5% rural vs 78.4% urban), with fear of side effects as a consistent barrier and education, trust, and communication as facilitators. The findings confirm established patterns of vaccine hesitancy but are observational and cannot establish causality.
Cross-sectional observational study. Adults in rural and urban communities in southern Bangladesh. Refusal rates: 16.7% rural, 23.2% urban. Eligibility criteria not specified.. Intervention: COVID-19 booster vaccine dose (exposure measured, not experimentally administered). Compared with: No booster vaccine acceptance (binary outcome). n = 707. Southern Bangladesh.
Overall booster acceptance rate 69.9%, significantly lower in rural areas (62.5%, 95% CI 60.6–64.8) than urban areas (78.4%, 95% CI 76.2–80.6, χ² = 20.87, p < 0.001) Fear of side effects was negatively associated with acceptance in both rural and urban settings Rural respondents: communication with vaccination services, trust in booster vaccine, and social influence positively predicted acceptance
Fear of side effects was negatively associated with acceptance in both rural and urban settings Urban respondents: community protection and risk–benefit ratio positively predicted acceptance; reliance on non-pharmaceutical measures negatively predicted acceptance
This study documents persistent rural–urban vaccine acceptance disparities and identifies modifiable factors (communication, risk perception, trust) that could improve booster uptake in underserved populations. Clinicians and public health programmes should prioritize tailored health communication and risk–benefit education, particularly in rural and marginalized settings.
A rigorous cross-sectional survey with adequate sample size and stratified design that confirms known disparities in vaccine acceptance between rural and urban populations, with identified predictors of booster uptake.
As stated by the source record.
Quoted from the source exactly as published.
This study documents persistent rural–urban vaccine acceptance disparities and identifies modifiable factors (communication, risk perception, trust) that could improve booster uptake in underserved populations. Clinicians and public health programmes should prioritize tailored health communication and risk–benefit education, particularly in rural and marginalized settings.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
ABSTRACT Rapid spread of SARS‐CoV‐2 variants, including Omicron JN.1, has revived significant challenges to health systems and regenerates microbial risk to public health security. Although COVID‐19 booster vaccines have ensured enhanced protection against new variants, there remain persistent disparities in vaccine acceptance and uptake between rural and urban populations. This study assesses COVID‐19 booster vaccine acceptance and compares antecedents of acceptance across rural and urban communities in Southern Bangladesh. A cross‐sectional observational study was conducted between December 15, 2023, and March 15, 2024, in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. By using stratified random sampling, 707 adults comprising 379 rural and 328 urban respondents (refusal rate: 16.7% rural, 23.2% urban) were surveyed. The study employed descriptive statistics and binary logistic regression analysis to identify socio‐psychological predictors of booster acceptance, with statistical significance set at p < 0.05. The acceptance rate of COVID‐19 vaccine booster dose was 69.9% overall, with a significantly lower rate in rural 62.5% (95% CI: 60.6–64.8) compared to urban areas 78.4% (95% CI: 76.2–80.6, χ 2 = 20.87, p < 0.001). Logistic regression estimation revealed that rural and urban participants perceived booster dose as “equally safe” were more likely to accept booster vaccination. Conversely, fear of “side effects” was negatively associated with acceptance in both settings. Among rural respondents, communication with vaccination services, trust in booster vaccine, and social influence, showed strong positive associations with booster vaccine acceptance. In urban settings, “community protection” and “risk–benefit ratio” were revealed as significant predictors of booster acceptance, whereas reliance on non‐pharmaceutical preventative measures following the primary vaccination series was negatively associated with booster uptake in urban areas. The acceptance of booster vaccines was higher among rural and urban populations with higher educational levels. In addition, rural healthcare professionals and urban individuals with comorbidities exhibited greater acceptance of booster vaccines. The study highlighted substantial rural–urban disparities in COVID‐19 booster vaccine acceptance in southern Bangladesh, shaped by differences in risk perception, trust, and communication. Fear of side effects remains a key barrier across both populations and a major reason of booster skepticism. Strengthening health communication, improving vaccine risk‐benefit knowledge, and integrating public health surveillance as a tool for community education to improve booster uptake, particularly in marginalized areas.
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