Perception and attitudes towards COVID-19 vaccination among urban slum dwellers in Dhaka, Bangladesh

BACKGROUND: Vaccine hesitancy was identified as a major threat to global health by WHO in 2019. This hesitancy was also observed with COVID-19 vaccination rollout in many countries including Bangladesh, where it began on Feb 7, 2021. Reasons for this include lack of knowledge, misinformation, low trust in health systems, and so on. Vaccine hesitancy is context specific and varies across time, place, and socioeconomic groups. People living in urban slums should be prioritised for COVID-19 vaccination because they are more prone to COVID-19 infection due to their poor living conditions and inability to practice preventive measures. Therefore, we aimed to understand the perceptions and attitudes of urban slum dwellers in Dhaka, Bangladesh, towards COVID-19 vaccination through time. METHODS: This qualitative study was done in three urban slums of Dhaka city, Bangladesh. In-depth telephone interviews were done with 36 adults (25 women and 11 men) from Oct 21, 2020 to Jan 12, 2021, using a semi-structured guideline. Participants were selected by use of snowballing and opportunistic sampling techniques. Follow-up interviews were done in April and August, 2021. We did thematic analysis on the collected data. Informed verbal consent was obtained from the participants, and ethical clearance was obtained from BRAC James P Grant School of Public Health (Dhaka, Bangladesh; 2019–034-IR). FINDINGS: Before COVID-19 vaccine rollout, doubts, fears, and rumours about safety and effectiveness of the vaccine lead to hesitancy among many participants. With time, more people were willing to get COVID-19 vaccines when they found that many in their communities were getting vaccinated and that it was free of cost. Women knew more about the vaccine compared with men, due to the awareness sessions in courtyard meetings of non-governmental organisations (NGOs) attended by women. Trusted information sources were television news, community health workers, and government loudspeaker announcements. Youths (aged 18–24 years) in the slums were more interested in getting vaccinated as they had exposure to technology and social media where they learned about the benefits of vaccination, compared with people from older age groups. Besides structural inequities in the vaccination drive, such as the complicated online registration system, long queues at vaccination centres also meant many urban poor couldn't access COVID-19 vaccination as they worried about missing a day's work. INTERPRETATION: This study highlighted the importance of using sources such as NGO workers and television news to debunk myths and disseminate COVID-19 vaccine information to ensure compliance with vaccination among urban slum dwellers. Community perceptions shape individual practices, which can help policy makers design effective communication and strategies aimed at people who are poor to improve COVID-19 vaccine uptake. FUNDING: GCRF UKRI funded ARISE Consortium.