The main findings of this chapter is outlined below:
• Proportionately more urban slum dwellers had heard about the registration compared to rural residents.
• Women are falling behind in terms of both registration knowledge and completion. The same is also true for certain occupation groups.
• Social networks and mass media are vital sources of information, and the former is also a major source of encouragement.
• There is a lack of interest or necessity in knowing further information regarding vaccination among the respondents who knew, especially in the rural region. Among those that did want to know, most respondents reported not knowing the details of the registration process despite hearing about it.
• Majority of the respondents who knew did not register, and mostly not because of self-reported ineligibility or confusion regarding eligibility but
other reasons.
• Excluding ineligibility and confusion regarding eligibility status, top reasons across both samples for not registering included being uninterested to be vaccinated, being unable to manage time, not knowing how to register, not knowing who to ask to get registered, and fear of getting sick if vaccinated. The lack of interest in being vaccinated was significantly higher in urban slums than in rural areas.
• Majority of the registrations had occurred with the help of intermediaries.
• There is a high level of compliance among the few who have registered, excluding those who had not
received the SMS or their date is due.
• Potential Intra-household spillovers observed from HH head’s behaviour.
Chapter 5
Concluding Remarks
With the beginning of the first phase of vaccination, the GoB has begun executing its plan to ensure maximum COVID-19 immunization coverage, and 3.3% of the population of the country had received the first dose as of 31 March 2021 (Mathieu et al., 2021). On 8 April 2021, GoB started giving the second doses of Covishield and successfully fully immunized over 81,000 people (“Over 81,000 People Receive Second Dose,” 2021, April 8). This report has attempted to present a chronological narrative of developments associated with the COVID-19 vaccination program in Bangladesh and highlighted underlying factors which may have played a role in the WTV of the population at large in early February 2021 and the role of governance in it. An analysis of temporal changes in youth’s WTV has been presented, followed by the state of WTV in urban slums. In the end, practical aspects of the vaccination process have been discussed for the rural and urban slum regions in March 2021.
Insofar, the GoB has been adaptive to local developments, as demonstrated by lowering the age limit to 40 years and bringing in teachers under the first phase (Sujan, 2021 February 10). Although, supply disruptions had caused halts in the rollout, the focus of this report is on demand-side aspects. Thus setting aside supply-side challenges such as procurement and equity in terms of vaccine distribution, a number of demand-side challenges has been identified here: ensuring vaccine uptake by increasing registration rates, addressing the gender gap in vaccine registration knowledge and completion, communicating
vaccine necessity and details of the eligibility status and registration process, and tackling misconceptions and mistrust.
Although our survey period did not cover the commencement of second dose of the vaccine, which was on 8 April 2021 as mentioned earlier, ensuring full or complete immunization is also important.
To conclude, while there exists uncertainty in the effectiveness of the vaccines,
especially in the event of new strains of the virus, the ideal option right now is to trust the results of the vaccine trials and ensure maximum participation in the inoculation. Effective communication strategies and other lessons learnt from the Expanded Program on Immunization (EPI) can be of great value here to address the challenges in WTV. Adopted measures should include creating awareness about the health risk of the virus and vaccine necessity, effectiveness, and safety;
bringing confidence in vaccine distribution efficiency; addressing religious concerns (especially in urban slums); presenting information about registration eligibility and step-by-step guidelines for registration.
Convincing people of vaccine necessity is crucial while informing them of registration details, as there appears to be a prevailing disinterest in knowing more about the registration process as well. Information campaigns regarding the registration process should especially target the rural population and women. Frequent mobile phone message reminders, social media, community-level vaccination awareness program and partnership with Non-Governmental Organisations and
other development organisations might be fruitful. Setting up booths designated for registration will help to eliminate intermediaries and may reduce the cost burden on the people, as most registration appears to be occurring by secondary means. Organizational support for vaccine registration can also be extended by employers. Since we found social network
to be an important source of information and encouragement, “vaccinated status”
through low cost signals might be effective in encouraging higher vaccine uptake (Karing, 2021). Policymakers need to bear in mind both supply- and demand-side features to ensure the ultimate success of the vaccination program.
Appendix A
Survey Methodology
The report uses six samples from three different telephone surveys. The first survey is the State of Governance Bangladesh 2021 (SOG’21) survey, denoted as Feb’21 in the discussions of the report. The telephone survey of SOG’21 includes three sampling frames (from three existing BIGD survey samples). The second survey considered for our analysis is the National Youth Survey 2021 (YS’21). In the third one, we used the rural and urban slum samples of the third phase of the study “Livelihoods, Coping and Recovery During COVID-19 Crisis (LS’21)” (Rahman et al., 2020). Both YS’21 and LS’21 are referred to as Mar’21 in the discussions. A timeline of the three surveys is presented in Figure A1 while Table A1 below summarizes the key figures.
Figure A 1. Timeline of the Surveys
Table A 1. Sampling Summary
Survey Sample List Approached Surveyed Response
rate (%) Final Samplea SOG’21
General 3,856 3,856 2,751 71.34 2,731
Youth 1,000 947 501 52.90 448
Urban Slum 1,200 1,200 398 33.17 395
YS’21 Youth 3,790 3,790 1,943 51.26 1,929
LS’21 Rural 3,360 3,360 2,710 80.65 2,710
Urban Slum 4,277 4,277 3,389 79.23 3,389
Note: aAfter accounting for sampling error.
A.1 State of Governance Bangladesh 2021 Survey