ABSTRACT
Purpose: Since early 2022, the COVID-19 vaccination rate in Bulgaria has remained low, with large regional differences. This study examines the association between the availability of vaccination sites and the number of administered doses, and the extent to which district-level variation is attributable to differences in vaccination services provision. Material(s) and Method(s): Data on COVID-19 vaccine doses administered by districts were used. This data set was combined with district-level information on available vaccination sites, such as general practitioners and temporary vaccination points. The district-level differences in vaccination coverage and service provision were illustrated through country heat maps, and the association between the variables was explored using two linear regression models. Result(s): According to the first regression model, the number of general practitioners and temporary vaccination points accounted for only 3.8% of the district-level variation in administrated doses. As covariates in the second model, sociodemographic and economic data were included. The combined influence of these factors explained 42.2% of the variance across districts. According to the findings, the average annual gross wage is a significant determinant of the district-level differences in the number of administrated doses. Conclusion(s): There is no statistically significant association between administered doses and vaccination sites by districts, which does not correspond to the findings of other international studies. District-level variation in vaccination rates is associated with some sociodemographic and economic differences. The paucity of district-level data impedes further analyses of the vaccine coverage differences and their underlying determinants.Copyright © 2023, Peytchinski, Gospodin Iliev ET. All rights reserved.
ABSTRACT
Rural and depreciated regions' population is more affected by the COVID-19 pandemic while facing a number of barriers to accessing health services. The aim of this study is to examine whether there are variations in COVID-19 immunisation coverage between urban and rural areas in Bulgaria and to what extent these differences are caused by certain aspects of vaccine access. Material and methods: Data on the number of COVID-19 vaccine doses administered by municipalities in Bulgaria from the beginning of the immunisation campaign until the end of 2021 were combined with some demographic variables and information on the availability of general practitioners and temporary immunisation sites. Correlation analysis was used to examine the relationship between datasets, supplemented by graphical analysis, grouping municipalities by the variables' average national values. Findings: The number of COVID-19 vaccine doses administered by municipalities has shown a moderate negative correlation with the proportion of the rural population, suggesting differences in immunisation coverage by type of settlement. In general, having more immunisation sites in a municipality does not considerably boost vaccination coverage because there is only a slight association between the number of administrated doses and the availability of vaccination points. There is no correlation between immunisations and the proportion of the adult population. Conclusion: Urban-rural disparities often affect the most vulnerable groups at higher risk of morbidity and mortality, and this, in turn, can exacerbate existing health inequalities. Additional efforts are needed to reduce structural barriers to access and overcome vaccine hesitance and mistrust by disseminating appropriate and reliable information and adequate communications.
ABSTRACT
Rural and depreciated regions' population is more affected by the COVID-19 pandemic while facing a number of barriers to accessing health services. The aim of this study is to examine whether there are variations in COVID-19 immunisation coverage between urban and rural areas in Bulgaria and to what extent these differences are caused by certain aspects of vaccine access. Material(s) and Method(s): Data on the number of COVID-19 vaccine doses administered by municipalities in Bulgaria from the beginning of the immunisation campaign until the end of 2021 were combined with some demographic variables and information on the availability of general practitioners and temporary immunisation sites. Correlation analysis was used to examine the relationship between datasets, supplemented by graphical analysis, grouping municipalities by the variables' average national values. Finding(s): The number of COVID-19 vaccine doses administered by municipalities has shown a moderate negative correlation with the proportion of the rural population, suggesting differences in immunisation coverage by type of settlement. In general, having more immunisation sites in a municipality does not considerably boost vaccination coverage because there is only a slight association between the number of administrated doses and the availability of vaccination points. There is no correlation between immunisations and the proportion of the adult population. Conclusion(s): Urban-rural disparities often affect the most vulnerable groups at higher risk of morbidity and mortality, and this, in turn, can exacerbate existing health inequalities. Additional efforts are needed to reduce structural barriers to access and overcome vaccine hesitance and mistrust by disseminating appropriate and reliable information and adequate communications.Copyright © 2022, Central Medical Library Medical University - Sofia. All rights reserved.
ABSTRACT
Rural and depreciated regions' population is more affected by the COVID-19 pandemic while facing a number of barriers to accessing health services. The aim of this study is to examine whether there are variations in COVID-19 immunisation coverage between urban and rural areas in Bulgaria and to what extent these differences are caused by certain aspects of vaccine access. Material(s) and Method(s): Data on the number of COVID-19 vaccine doses administered by municipalities in Bulgaria from the beginning of the immunisation campaign until the end of 2021 were combined with some demographic variables and information on the availability of general practitioners and temporary immunisation sites. Correlation analysis was used to examine the relationship between datasets, supplemented by graphical analysis, grouping municipalities by the variables' average national values. Finding(s): The number of COVID-19 vaccine doses administered by municipalities has shown a moderate negative correlation with the proportion of the rural population, suggesting differences in immunisation coverage by type of settlement. In general, having more immunisation sites in a municipality does not considerably boost vaccination coverage because there is only a slight association between the number of administrated doses and the availability of vaccination points. There is no correlation between immunisations and the proportion of the adult population. Conclusion(s): Urban-rural disparities often affect the most vulnerable groups at higher risk of morbidity and mortality, and this, in turn, can exacerbate existing health inequalities. Additional efforts are needed to reduce structural barriers to access and overcome vaccine hesitance and mistrust by disseminating appropriate and reliable information and adequate communications.Copyright © 2022, Central Medical Library Medical University - Sofia. All rights reserved.
ABSTRACT
Background Bulgaria faced significant COVID-19 morbidity and mortality rates, but many people underestimated the risk of transmission and severity of infection. Rising vaccine-related fear and misinformation exacerbated existing hesitancy and mass vaccination remained a challenge. This study aims to investigate the factors influencing COVID-19 vaccination uptake in Bulgaria. Methods A cross-sectional study was conducted in April 2022 in a sample of 1,200 respondents. Data were collected via an online self-administered questionnaire, measuring perceived risk of COVID-19, vaccine attitudes, trust in health system, and sociodemographics. Results were analyzed using bivariate and multivariate statistical methods. Results Bivariate analyses showed that the majority of vaccinated respondents (81.9%) expressed concern about infection, compared to 47.1% of non-vaccinated. Significant differences were related to perceived risk of COVID-19 vaccine: 61.0% of vaccinated assessed risk as small versus 7.4% of refusers. Non-vaccinated participants demonstrated distrust in vaccine benefits and lack of trust in health system, science and pharmaceutical companies. The multivariable regression revealed associations between age, income, vaccine perception, and vaccination uptake. The 45-54 and 55-64 age groups were less likely to refuse vaccination compared to the youngest age group (OR = 0.34, p = 0.009 and OR = 0.38, p = 0.036). Odds of refusing the COVID-19 vaccine decreased as income increased (OR = 0.33, p = 0.036). A high perceived risk of adverse effects increased the odds of vaccine refusal by 7.02 (p<.001). Conclusions The lack of confidence in the vaccine safety and effectiveness, coupled with an underestimation of the coronavirus disease, formed a critical barrier to the vaccine uptake. The misinformation fueled vaccination fear. Public health campaigns should address vaccine-related concerns and promote vaccination adherence in more consistent manner targeting also the spread of fake news. Key messages The lack of confidence became a crucial barrier for vaccination coverage in Bulgaria. Understanding driving factors for vaccine uptake is of utmost importance to design effective vaccination programs.
ABSTRACT
Background Vaccinations are an essential public health strategy to control preventable diseases. A much-discussed approach to increase coverage is mandatory vaccination;however, its legitimacy and effectiveness were put to question during the COVID-19 pandemic. As of March 1,2022, Bulgaria had one of Europe's lowest immunization coverage rates against COVID-19. Only 29.3% of Bulgarians had completed COVID-19 vaccination, compared to 71% in the EU and EEA, and the country ranked last in number of booster doses (9.9% vs 51.4 %). This study aims to investigate the public's attitudes toward proposed mandatory COVID-19 vaccination and toward the long-standing mandatory child immunization schedule in the context of the COVID-19 pandemic. Methods An online cross-sectional survey was conducted in April 2022 using a self-administered anonymous questionnaire to collect information on sociodemographic characteristics, vaccination status and attitudes toward mandatory vaccination to COVID-19 and the mandatory childhood immunization schedule. Results Out of 1433 reached respondents, 1200(84%) completed the survey. The largest relative share of respondents is between 35-44y-33.3%;72.7% were women;mainly highly educated (50.8%), and vaccinated participants (59.3%). There is a significant and large difference between vaccinated and unvaccinated regarding the full support of mandatory COVID vaccinations (46.1% vs 1.8%), and regarding mandatory child vaccinations (77.9% vs 50.4%). Mandatory childhood vaccination schedules are supported by 88.7% of those in favor of obligatory COVID-19 vaccinations and 56% of those who oppose them (p < 0.001). Significance is preserved after adjustment for vaccination status. Conclusions Public health authorities need to develop well-organized vaccination campaigns in which accurate evidence-based information is adequately disseminated with respect to individuals’ autonomy. More research on the determinants of vaccination attitudes in Bulgaria is necessary. Key messages Mandatory vaccination programs should be proceeded by investigation of the social readiness for acceptance. Exploration of cultural specificities to influence vaccination decision is needed.