Public response to the second COVID-19 booster vaccination in Bangladesh: exploring the intersection of health status, education, and vaccine acceptance

The global transmission of SARS-CoV-2’s new variant led to a public health emergency, overwhelming healthcare systems and causing significant loss of life. Despite the therapeutic potential of priming vaccine doses, the waning immunity from COVID-19 vaccines and the first booster vaccination underscore the unprecedented importance of administering a second booster dose to protect public health. This study aimed to assess the willingness of general people in Southern Bangladesh to receive a second COVID-19 booster or a new vaccine and the factors influencing their acceptance. Using a validated paper-based semi-structured questionnaire, this cross-sectional study employed a face-to-face data collection approach from April 1 through May 31, 2024, during the nationwide spread of the SARS-CoV-2 Delta variant. Binary logistic regression analysis was used to explore the crude significance of each predictor variable to the dependent variable. The pooled willingness for a second COVID-19 booster was 44.2% (95% CI: 42.1 − 46.3) among respondents. Underlying health conditions (AOR = 3.2, 95% CI: 1.58 − 5.43), education (AOR = 3.6, 95% CI: 1.89 − 5.96), area of residence (AOR = 1.7, 95% CI: 0.93 − 3.64), vaccine confidence (AOR = 3.9, 95% CI: 1.93 − 5.77), and equal safety (AOR = 2.48, 95% CI: 1.01 − 4.95) were significantly associated with acceptance of a second booster vaccine. In addition, this study found that perceived side effects (AOR = 1.89, 95% CI: 0.89 − 4.81) were a barrier and a key reason for skepticism about a second COVID-19 booster dose. The second booster vaccine dose is particularly essential for older adults, immunocompromised individuals, and other high-risk groups. These findings indicated that less than half of respondents across all demographic groups were willing to accept a second COVID-19 booster vaccine, while medical illness, education, and confidence were three key predictors of second booster acceptance. This study highlights the need for regionalized education and trust-building efforts to address booster hesitancy, with implications for global public health efforts.