Exploring Community Variation in COVID-19 Vaccine Coverage and Perceived Risks-Benefits in Bangladesh

Abstract

Since launching its nationwide COVID-19 vaccination campaign on February 7, 2021, Bangladesh’s Directorate General of Health Services (DGHS) reported that, as of June 3, 2025, approximately 83.5% of the targeted population had completed their primary vaccination series. Understanding how vaccine uptake varies across sociodemographic and geographic contexts remains crucial—not only for COVID-19 but also for informing future immunization campaigns and strengthening equitable vaccine access. In Bangladesh, factors such as geographic location, health-related knowledge, perceived risks-benefits, and sociodemographic characteristics have all been associated with vaccination behavior. This cross-sectional study used data from the Rapid Mortality Mobile Phone Survey (RaMMPS), collected via Random Digit Dialing (RDD) between December 22, 2021, and July 31, 2022. The primary objective of this study was to estimate and describe variation in coverage of at least one dose of COVID-19 vaccination across sociodemographic factors and Bangladesh’s 64 districts. The secondary objective examined how perceived risks and benefits varied by sociodemographic characteristics among non-vaccinated individuals. Gender-stratified mixed-effects regression models with district-level random intercepts and sociodemographic fixed effects were employed for the first objective, and descriptive statistics were used for the secondary objective. Findings revealed high overall vaccine uptake (87.1%) with modest geographic variation. However, individual-level factors, particularly gender, age, education, occupation, and healthcare decision-making autonomy were more strongly associated with vaccine uptake than district-level differences. Notably, gender played a distinct role: women’s uptake was more closely shaped by individual and relational factors, whereas men’s uptake was more sensitive to district-level variation. These findings underscore the importance of developing gender-responsive and context-specific strategies for future vaccination efforts.