This document outlines a proposed research study on COVID-19 vaccine hesitancy in Cox's Bazar, Bangladesh. The study aims to evaluate the current vaccination status and identify factors influencing vaccine refusal and indecision. The methodology involves surveying 10,000 individuals across locations in Cox's Bazar using questionnaires, interviews, and focus groups. Data will be analyzed using descriptive statistics and SPSS. It is anticipated that the study will find health beliefs around side effects and efficacy influence vaccination preferences, and targeted information programs could help address concerns and increase immunization rates.

1. Noakhali Science &Technology University
Course Title: Research Methodology
Course Code: BGE 4109
Submitted By Submitted To
Name: Shuhylul Hannan
Roll: ASH1813024M
Department of Biotechnology &
Genetic Engineering
Noakhali Science & Technology
University
Farzana Akter
Tanvir Hossain Emon
Lecturer
Department of Biotechnology &
Genetic Engineering
Noakhali Science & Technology
University
Date of Submission: 24 July 2022
COVID-19
Vaccine Hesitancy & its Determinants:
Evidence from a Large Sample
Study in Cox’s Bazar

2. TABLE OF CONTENT
SN Type of Content Page No.
01 Executive Summary 3
02 Statement of the Problem 3
03 Objectives of Research 4
04 Review of Relevant Literature 4-5
05 The benefit of the Study 6
06 Methodology 6
07 Sampling and Sample size 7
08 Sources of Data 7
09 Data Collection 8
10 Work Plan 8
11 Plan for Data Analysis 9
12 Qualification of the key persons 9
13 Budget 10
14 Limitations 10
15 Anticipated Results 11
16 Reference 12-14

3. Type of research: Statistical Data Analysis
Field of research: Virology
Executive Summary
An infectious disease commonly known as Covid-19, characterized by SARS-CoV-2, causes a
deadly pandemic that has affected the whole world and so it is a public health concern. Although
multiple possible strategies and efforts have been implemented to control this disease, the most
effective and reliable way to control the COVID-19 pandemic, in the long term, is through the
vaccination of mass people.
Achieving effective outcomes of vaccination depends not only on its availability, which
remains a major challenge in Bangladesh but also on the public's acceptance and willingness
to receive vaccinations. Thus, vaccine hesitancy or vaccine refusal is one of the main obstacles
to achieving high vaccination coverage. The purpose of this study, which was carried out after
the vaccination was introduced in Bangladesh, is to evaluate and pinpoint the causes of vaccine
ambivalence.
Statement of the Problem
In 2019, a new coronavirus has been identified and many efforts have been directed toward the
development of effective vaccines. (Troiano & Nardi, 2021) Widespread acceptance of
COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global
pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income
countries, particularly Bangladesh. (Solís Arce et al., 2021) However, the willingness to
vaccination is deeply influenced by several factors. (Troiano & Nardi, 2021) Therefore, the
primary priorities of our study will be to further explore and analyze the theme of vaccine
refusal and indecision during the COVID-19 pandemic, with a focus on vaccine hesitancy
toward the COVID-19 vaccine, through a narrative analysis of the population across the Cox's
Bazar district of Bangladesh.

4. Objectives of the Research
The major goals of this study are to "evaluate the current status of unvaccinated individuals
in Cox's Bazar, Bangladesh as well as to pinpoint the factors influencing the tendency for
refusal and indecision regarding a vaccine against COVID-19. Additionally, to assess the
vaccine's adoption in light of various effectiveness and negative effect scenarios. "
And other objectives are:
 To understand the types of vaccines that are administered in Bangladesh.
 To understand the unvaccinated population's age, location, level of education, and
employment.
 To identify the primary reason for immunization reluctance and refusal.
 To determine Covid-19's negative impacts on health.
 To offer suggestions for resolving vaccine hesitancy.
Review of relevant literature
To perform this study, we have reviewed a variety of relevant literature to gain a clear
understanding of the elements that contribute to COVID-19 vaccination hesitancy in Cox's
Bazar, Bangladesh. My team and I have researched many types of literature online, including
articles, thesis papers, and other pertinent literature through the internet.
The existing literature cites concern about COVID-19 vaccine safety, including the rapid pace
of vaccine development, as a primary reason for hesitancy in higher-income settings. (Wouters
et al., 2021), (Boyon & Silverstein, 2021).
Other reasons may feature more prominently in low and middle-income countries (LMICs).
For example, reported COVID-19 cases and deaths have been consistently lower in most
LMICs relative to higher-income countries. (Biccard et al., 2021), (Biccard et al., 2021),
(Biccard et al., 2021). If individuals feel the risk of disease is less severe, they may be less

5. willing to accept any perceived risks of vaccination (Brewer et al., 2007). Previous studies of
healthcare utilization in LMICs have also highlighted factors such as negative perceptions of
healthcare quality(Christensen, Dube, Haushofer, Siddiqi, & Voors, 2020), negative historical
experiences involving foreign actors (Lowes & Montero, 2021), (Martinez-Bravo & Stegmann,
2021), weak support from traditional leaders (Jegede, 2007)and mistrust in government (Blair,
Morse, & Tsai, 2017) as barriers to uptake, which could apply to COVID-19 vaccination as
well.
When reviewing COVID-19 Vaccine Hesitancy in High-Income Countries, factors associated
with vaccine hesitancy were grouped into four themes (vaccine-specific, individual, group, or
contextually related factors). Younger age, females, not being of white ethnicity and lower
education were common contextual factors associated with increased vaccine hesitancy. Lack
of recent history of influenza vaccination, lower self-perceived risk of contracting COVID-19,
lesser fear of COVID-19, belief that COVID-19 is not severe, and not having chronic medical
conditions were most frequently studied individual/group factors associated with increased
vaccine hesitancy. Common vaccine-specific factors associated with increased vaccine
hesitancy included beliefs that vaccines are not safe/effective and increased concerns about the
rapid development of COVID-19 vaccines. (Aw, Seng, Seah, & Low, 2021)
Reasons Why Respondents Avoid Vaccination
By reviewing these we find that concerned about side effects, concerned about getting
coronavirus from the vaccine, not concerned about getting seriously ill, don’t think vaccines
are effective, don’t think Coronavirus outbreak is as serious as people say, doesn’t like needles,
allergic to vaccines, won’t have time to get vaccinated, mentions a conspiracy theory and other
reasons are the main causes of COVID-19 vaccine hesitancy in most of the developing country
mostly in Bangladesh. (Solís Arce et al., 2021)

6. Benefits of the Study
 Obtaining public understanding of COVID-19's harmful effects.
 Keep spreading awareness about the importance of receiving the COVID-19 vaccine to
stop the pandemic as soon as feasible.
 Examine the current vaccination acceptance status and implement legal frameworks in
Bangladesh to minimize misinformation regarding vaccine side effects.
 Go over the various aspects of the vaccine's efficacy in preventing and treating disease.
 Disseminate important study findings that identify effective strategies for lowering
vaccine reluctance.
 Properly implementing the vaccine act to immunize a large number of individuals.
 Raise public awareness of the need for vaccinations and hasten vaccine acceptance to
protect the next generation from the pandemic's ravaging effects.
 Community, youth, and family mobilization and campaign development to greatly
reduce vaccine reluctance.
Methodology of the Study
This study involves fieldwork and survey techniques. In the beginning, I have chosen every
division and a few unions in the Cox's Bazar region to make it easier to survey the subject I
had chosen. I will choose locations with high populations at random for data gatherings, such
as Dulahazara Safari Park, the Chakaria bus stop, the Edgar Islamabad, the Cox's Bazar bus
terminal, the courthouse, the Moheshkhali launch ghat, etc.

7. Sampling & Sample size:
Prior to the primary survey, a quick field visit to the chosen study locations will provide insight
into the population density and its makeup. This will also aid in deciding how to approach the
final study samples. Five enumerators, who will be briefed on the study, visit the designated
locations from midday to midnight to conduct a head count and create a map with points
designating various population concentrations. 100 respondents will be selected from each
location through multiple visits over one week. There will be an effort made to include
individuals from all socioeconomic groups in the sample. So, a total of 10,000 individuals from
three locations will be studied.
Sources of data:
## Primary Source of data
• Questionnaire Survey
• Interview
• Counseling
• Focus Group Discussion
## Secondary Source of data
• Literature Review
• Journals
• Newspaper
• Website

8. Data Collection Procedure
This study will be based on the survey method. Skilled interviewers will be recruited for data
collection. A seven-day intensive training will be given to them which will consist of lectures,
mock interviews, role play, and field practice at the community level. An instruction manual
explaining the key terms in the questionnaire will be developed and provided to the
enumerators as a guide. Three teams each consisting of five members will be formed. On the
day of the interview, the team will identify the first respondent. Secondly, they will apply
various techniques to identify further respondents present in the spots for interview. The study
will include only those who will be interested. Verbal consent will be taken before the
interview. The field activities will be supervised by the researchers.
Work Plan
6%
6%
13%
25%
25%
25%
100%
0 2 4 6 8 10 12 14 16 18
Selection of interviewers
Training of the interviewers
Designing of the questionnaire
Conduct of interview
Analysis of DATA
Writing of the final report
Total
The work plan and estimated timeframe
Selection of interviewers Training of the interviewers Designing of the questionnaire
Conduct of interview Analysis of DATA Writing of the final report
Total
Week

9. The work plan and estimated timeframe:
S.N Activities Month/Week
01 Selection of interviewers 1 week
02 Training of the interviewers 1 week
03 Designing of the questionnaire 15 days
04 Conduct of interview 1 month
05 Analysis of data 1 month
06 Writing of the final report 1 month
Total 4 Months
Data Analysis
Both descriptive and Statistical Package for the Social Sciences (SPSS) will be used to analyze
the data. For the quantitative phase, we will also do descriptive, bivariate, and multivariate
analyses using the R program version 4.0.5, and we will conduct manual content analyses for
the qualitative phase.
Qualification of the Key Persons
The study team will consist of-
• One principal investigator
• One co-investigator
• One secretarial service
• One Research assistant
• Two data entry operator

10. Budget
The budget outlines the costs associated with the research endeavor and often consists of a
budget narrative (sometimes referred to as a budget justification) that covers the various
expenses which are covered in the following:
S.N Element of cost Rate Total cost
01 Selection of interviewers 12,000
02 Training of the interviewers 20,000
03 Designing of the questionnaire 30,000
04 Conduct of interview 1,00,000
05 Questionnaire printing 5,000
06 Administrative Supply 15,000
07 Editing and Computer programming 15,000
08 Traveling 25,000
09 Dissemination seminar 5,000
10 Reporting, Printing, and mailing 10,000
11 Miscellaneous expenses 15,000
Total cost 2,52,000
Limitations of the Study
• The study will be confined to only different specific spots in Cox’s Bazar city due to
time limitations.
• There is potential for biased data e.g. self-selection bias & self-report bias.
• No control over the variables of interest, sampling frame, and recruitment method.
• Shortage of relevant books, journals, magazines & inefficient facilities of the library
• Insufficient legal support.

11. Anticipated Results
The examination of preferences for various fictitious vaccinations reveals that people place
higher importance on a vaccine's minor adverse effects than its efficacy. This demonstrates the
relevance of comprehensive human testing for all vaccines and the value of informing the
public about any negative effects. These used together will have a direct impact on people's
vaccination preferences and choices.
We will also discuss the important health beliefs that either favorably or unfavorably influence
people's hesitation and reluctance to receive a hypothetical COVID-19 vaccine. These should
be incorporated into the creation of public health policy, and more especially, the promotion
of the vaccination. Additionally, targeted promotional programs can be used to influence
beliefs, cues to action, and perceptions of severity (side effects and effectiveness), benefits,
hurdles, and motives among various anti-vaccine and indecisive populations, including
younger individuals.
One way would be to employ public health communication tactics to combat anti-vaccine
movements using the factors that explain the rejection. By sharing information through
affiliations with doctors and other medical professionals as well as social networks, these
techniques should successfully address individuals' worries about side effects and potential
health hazards. On the other hand, the promotion plans to reduce reluctance might place more
emphasis on the government's communication response and raise public awareness of the
vaccine's risks, benefits, and adverse effects. Given sufficiently high vaccination rates in the
broader population, even reluctant groups could be protected through herd immunity. As a
result, the immunization rate might increase, which is important for preventing COVID-19
outbreaks and recurrent infections. (Cerda & García, 0001)

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