Global COVID-19 vaccine equity and the booster dose in low-resource countries : a decolonizing global health perspective

On July 30, 2021, the administration of a third (booster) dose of the COVID-19 vaccine was introduced to enhance immunity among vaccinated people. Many developed countries have introduced vaccine booster doses as additional protection for their population to mitigate the severity of the ongoing COVID-19 pandemic. However, this idea is currently being replicated by low- and lower-middle-income countries (LMICs), where full vaccination coverage is, as of now, still below 45%, which is considerably lower than that of high-income countries (73%). This commentary focuses on the critiques of introducing booster dose strategy in low-income countries. We highlight different decolonizing global health perspectives, including vaccine equity, effective resource utilization, and priority setup, in this commentary

COVID-19 vaccination coverage is extremely low among older population in Bangladesh : findings from a cross-sectional study

This cross-sectional study was conducted in September 2021 among 1,045 Bangladeshi older adults aged 60 years or above to explore the COVID-19 vaccination coverage and its associated factors. We used a semi-structured questionnaire to collect data on participants’ sociodemographic and lifestyle characteristics, and COVID-19 related information (selected based on an extensive literature review). A multinomial logistic regression model was used to identify the factors independently associated with vaccine receipt. Nearly, two-thirds of the participants (64.5%) were unvaccinated and 12.5% received a single dose. Among the unvaccinated, approximately 94% reported that there was a problem in accessing the vaccine. We found that participants with formal schooling had 42% lower risk of being unvaccinated (RRR (Relative Risk Ratio) = 0.58, 95% CI 0.42–0.80) or 39% lower risk of receiving a single dose (RRR = 0.61, 95% CI 0.39–0.96) than the participants having no formal schooling. The middle family monthly income groups had 65% higher risk (RRR = 1.65, 95% CI 1.17–2.32) and rural participants had 84% higher risk (RRR = 1.84, 95% CI 1.26–2.70) of not receiving vaccines compared to their counterparts. Also, the participants with non-communicable chronic conditions had a significantly lower risk of being unvaccinated (RRR = 0.49, 95% CI 0.35–0.68) or receiving a single dose (RRR = 0.49, 95% CI 0.31–0.77) compared to their counterparts. This finding may help strengthen the existing efforts to maximize vaccine coverage among older populations in Bangladesh and reach herd immunity to break the transmission chain and gain greater overall population protection more rapidly

Frequency distribution with sociodemographic factors, clinical symptoms, care seeking variables.

Frequency distribution with sociodemographic factors, clinical symptoms, care seeking variables.</p

Percentage of DR-TB patients who had long delays according to the study sites^b'*'.

Percentage of DR-TB patients who had long delays according to the study sitesb'*'.</p

Inclusivity in global research.

The emergence of Drug-Resistant Tuberculosis (DR-TB) has become a major threat globally and Bangladesh is no exception. Delays in healthcare seeking, proper diagnosis and initiation of treatment cause continuous transmission of the resistant tubercule bacilli through the communities. This study aimed to assess the different health care-seeking behaviors and delays among DR-TB patients in Bangladesh. A prospective cross-sectional study was conducted from November to December 2018, among 92 culture positive and registered DR-TB patients in four selected hospitals in Bangladesh. Data were collected through face-to-face interviews with survey questionnaire as well as record reviews. Among the 92 study participants, the median patient delay was 7 (IQR 3, 15) days, the median diagnostic delay was 88 (IQR 36.5, 210), the median treatment delay was 7 (IQR 4,12) days, and the median total delay among DR-TB patients was 108.5 (IQR 57.5, 238) days. 81.32% sought initial care from informal healthcare providers. The majority (68.48%) of the informal healthcare providers were drug sellers while 60.87% of patients sought care from more than four healthcare points before being diagnosed with DR-TB. The initial care seeking from multiple providers was associated with diagnostic and total delays. In Bangladesh, DR-TB cases usually seek care from multiple providers, particularly from informal providers, and among them, alarmingly higher healthcare-seeking related delays were noted. Immediate measures should be taken both at the health system levels and, in the community, to curb transmission and reduce the burden of the disease.</div

Median and IQR of different delays among DR-TB patients in Bangladesh.

Median and IQR of different delays among DR-TB patients in Bangladesh.</p

Map of study site locations presenting the distribution of different delays among DR-TB patients in Bangladesh.

The map was created by utilizing a shapefile sourced from the freely accessible GADM database (GADM; www.gadm.org).</p

Socio-demographic characteristics and personal history of DR-TB patients.

Socio-demographic characteristics and personal history of DR-TB patients.</p

Logistic regression analysis of the determinants of the patient, diagnostic, treatment, and total delay among the DR-TB patients.

Logistic regression analysis of the determinants of the patient, diagnostic, treatment, and total delay among the DR-TB patients.</p