Vaccine Decision-Making in Bangladesh
Ryan Rego
Impact Scholar, Center for Global Health Equity
Above. Rego (left center) at the Leda Refugee Camp outside Cox’s Bazar, Bangladesh, with research partners (l-r) Sirajul Islam, International Centre for Diarrhoeal Disease Research, Bangladesh; Ashok Kumar Barman, Medical Director-Leda Diarrhea Treatment Center icddr,b; and A. K. M. Zakir Hossain, Senior Field Research Officer—conducting meetings with community leaders to refine their survey on vaccination decision-making.
Ryan Rego, Impact Scholar with the Center for Global Health Equity, was in Bangladesh recently working with research partners there to lead a large study on vaccine hesitancy. The survey will engage 1600 households from four populations within Bangladesh:
- Permanent residents of informal settlements in Dhaka
- Recently arrived residents of informal settlements in Dhaka who were forced from their homes in the Bangladeshi coastlands due to climate change
- Permanent residents of Teknaf, a region in southeast Bangladesh near to the Myanmar border
- Recently arrived refugees of the Leda Refugee Camp—just outside Cox’s Bazar and just miles from the Myanmar border—who were forced to leave Myanmar
Population 2 are considered internally displaced persons (IDPs), because they were forced to leave their homes but did not have to leave their country of residence. Population 4 are considered refugees because they had to cross a national border in their forced migration. 1 and 3 are people who live there normally, not displaced.
The photos below tell some of the story around Rego and team’s research as they meet with community leaders to refine their surveys on vaccination decision-making. By better understanding vaccine hesitancy and delay, they hope their work will support improved healthcare, access, and communication around vaccines leading to increased uptake and reductions in vaccine-preventable diseases.
Matlab, Bangladesh
On the left of the image, Ashok Barman (left) and Sirajul Islam (right) with Rego (center) lead a training for field workers (right side of photo) to share in detail the goals of the research and to practice administering the vaccine hesitancy survey. On the right (middle), is project manager Zakir Ahmed.
Matlab, Bangladesh
Field workers (on the right) interview participants (not pictured) in Matlab to understand the community’s awareness of mpox and receptiveness to mpox vaccinations. The study team and other field workers observe.
Dhaka, Bangladesh
Dwelling for a family of five in an urban informal settlement in Mirpur, a neighborhood in the capital city Dhaka. The research team was in the field to conduct the survey interviews with participants. The study will look at vaccination hesitancy for a range of vaccines, from newer shots like the Covid and HPV vaccines to well-established childhood inoculations like the polio and MMR vaccines to forthcoming vaccines like an HIV vaccine and a gonorrhea vaccine.
Participants are also asked if they have even heard of HIV and HPV. In Bangladesh’s relatively conservative culture, not everyone has an understanding of STIs and how they are transmitted.
But Bangladesh also has a very strong national vaccination program with high levels of government trust. Most respondents are reporting that they would be willing to receive vaccines for diseases they do not know a lot about as long as they are recommended by the government.
Dhaka, Bangladesh
Another view from the Mirpur settlement. Due to its many miles of coastline and the erosion of that coast, Bangladesh is among the countries most impacted by climate change. Much of land along the coast of Bangladesh has been used for agriculture for many years but is no longer viable for farming as it has become saturated with salt water. Many people are moving from rural areas near the coast into the capital city of Dhaka and living in settlements like this one.
Dhaka, Bangladesh
In these settlements, corrugated metal edifices with multiple rooms are constructed, one room for each family. The team interviewed several family members in this building in hopes of refining their vaccine hesitancy survey. They were able to get feedback in that regard, but much of what they heard was the unbearable nature of living in these structures due to the incredible heat. Typical temperatures in tropical Bangladesh are in the 80s and 90s. Within these structures they get well over 100, often as high as 110.
Dhaka, Bangladesh
The research team with Farhana Yeasmin (middle)—faculty at International Centre for Diarrhoeal Disease Research and a co-director on the study. Yeasmin knows the community well and was helping the team build trust with the community as they recruit for the study. In general, Bangladeshis report high levels of vaccine uptake and high levels of trust in vaccines. The only exception is a significant reduction in uptake among survey respondents who are pregnant.
Rego engaged with fellow Center Impact Scholar HaEun Lee—who works on reproductive and maternal health and women's empowerment—and with U-M medical student Neyat Fishea to refine the questions on the survey intended for participants who are or have recently been pregnant.
The team included questions about which stages of pregnancy women might be willing to receive a vaccine and how that decision maps on to empowerment, that is, whether the woman is making the vaccine decision herself or if the decision is made by others in the household, like spouses or parents.
Dhaka, Bangladesh
A variety of containers for collecting rainwater. Taps are on only a few hours each day in these settlements. Rainwater collected during the rainy season is considered relatively safe to drink.
Cox’s Bazar, Bangladesh
The research team at an entrance to the Leda Refugee Settlement southeast of Cox’s Bazar.
Cox’s Bazar, Bangladesh
Just outside the Cox's Bazar refugee settlement is the Naf River, which forms the border between Myanmar and Bangladesh. In Cox's Bazar, the team is surveying displaced Bangladeshis, who are not considered refugees and consider themselves part of the local community. There is tension between the local community and the refugee population, and there is always a push to offer to locals the same health services that are being provided in the settlement to refugees. These are similar groups ethnically, but because the British drew a line along a river, some of them ended up in Myanmar and some in Bangladesh.
Cox’s Bazar, Bangladesh
Arnab Ahmed, a field technician with the study, administers a vaccine hesitancy survey to a family in the Leda Refugee Settlement.
Cox’s Bazar, Bangladesh
A field technician puts on gloves before administering a vaccine hesitancy survey to a family in the Leda Refugee Settlement. Part of the survey is to provide stool samples.
Other members of the study team include Abram Wagner, Bradley Carlson, Akbar Waljee, Pauline Jones, Achyuta Adhvaryu, Matthew L. Boulton, Joseph Kolars, Gurpreet Kaur Rana, Samuel Watson, Rubhana Raqib, Abdur Razzaque, and Brooke Kenney.