Multi-dimensional potential factors influencing COVID-19 vaccine booster acceptance and hesitancy among university academic community in Bangladesh: A cross-sectional comparative study
Authors: Roy Debendra Nath , Azam Md. Shah , Islam Ekramul 
Published: April 2023

Background and aims
Vaccination is the most powerful public health intervention proven to be safe and effective in the battle against the coronavirus disease-2019 (COVID-19) pandemic. Despite the potential therapeutic benefits of primer vaccine dosage regimens, public perceptions of COVID-19 vaccine booster dose (VBD) acceptance and hesitancy vary among various sub-group populations. This study investigates COVID-19 vaccine booster dose acceptance and compares the multi-dimensional potential factors influencing VBD acceptance and hesitancy among university teachers and the student community in Bangladesh.

Methods
This web-based cross-sectional study employed an anonymous, validated, and self-administered questionnaire. The questionnaire items were adopted from a theoretical analysis of the recent relevant literature. The questionnaire was deployed in an on-line-enabled format (Google form) and conveniently distributed to 685 teachers and 990 students between 15th June, 2022 and 15th August, 2022 which resulted in the participation of 1250 (505 teachers vs.745 students) total respondents (response rate 73.72% vs. 75.25%) from various universities in Bangladesh. A non-parametric analytical tool (binary logistic regression) was applied to rationalize the study objectives and a Chi-squared test was performed to estimate the booster- hesitant risky group.

Results
The pooled COVID-19 vaccine booster dose acceptance rates were 84.6% (95% CI 81.5─87.7) and 67.2% (95% CI 63.8─70.6) for teachers and students in the university academic community, respectively. In employing a binary logistic regression, this study revealed that out of twelve (12)multi-dimensional key predictors, “equal safety”, “risk-benefit ratio”, and “variant control” had a significant positive association with VBD acceptance in both sets (p = 0.000, p = 0.000, and p = 0.005, respectively). Varied effects were found for several predictors; post-vaccination “side effects” had a significant negative association (p = 0.020) and “community protection” had significant positive association (p = 0.034) with vaccine booster dose acceptance in the teachers community while these variables were insignificant in the students cohort. “Trust” had a highly significant positive association (p = 0.000);“communication” and “academic attainment” had significant positive associations (p = 0.033 and 0.024, respectively) with VBD acceptance in the students cohort, while these predictors were insignificant in the teachers community. Women were more likely to receive a third dose of the vaccine (OR = 1.4 vs. 0.9 between teacher and student model); however, no significant association between gender and booster vaccine acceptance was found in a comparative Chi-squared model. Therefore, statistically, the booster vaccine-hesitant risky group was not found to implicate the massive booster vaccine drive among the university academic community.

Conclusions
COVID-19 booster vaccine acceptability among the student cohort was slightly lower than pre-roll-out intent. The teacher community was more inclined to get booster vaccinated. Moreover, differences were found between the multi-dimensional potential factors associated with VBD acceptance among teachers and students in university settings. This study explicitly confirmed positive attitudes toward the safety, health benefits, and variants control of the COVID-19 VBD under any circumstances. Post-vaccination side effect concern was found to be a barrier to administering booster shots and a reason for booster skepticism. Tailored communication and health education interventions need to be adopted to improve the public awareness of booster vaccine consequences, and limit booster skepticism.