Rural-urban disparties and COVID-19 vaccination coverage in Bulgaria

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.