Acceptance of the COVID-19 Booster Vaccine Amid the Omicron JN.1 Surge in Southern Bangladesh: A Comparative Analysis of Rural-Urban Disparities.

Authors

Debendra Nath Roy, Shaheb Ali, Asma Aktar, Md Ekramul Islam, Md Shah Azam

Published in

Risk analysis : an official publication of the Society for Risk Analysis. Volume 46. Issue 9. Pages e70353.

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, χ² = 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.

PMID:
42702940
Bibliographic data and abstract were imported from PubMed on 07 Sep 2026.

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