The COVID-19 pandemic, caused by SARS-CoV-2, has had a profound impact on global health, economic stability, and social structures [1] . This has led to a multifaceted global crisis that affects health, economic activities, and international relations [2] [3] . The COVID-19 pandemic has had an extreme and wide-ranging impact on Bangladesh, from economic and healthcare challenges to changes in social behavior and mental health [4] . The country has faced difficulties in various sectors, including journalism, healthcare, the economy, and social life, with the pandemic exacerbating existing vulnerabilities and creating new ones [5] [6] . The pandemic’s broader effects on the country include challenges in managing the spread of the virus, economic disruptions, and strain on healthcare systems. Mental health has also deteriorated, with high prevalence rates of loneliness, depression, anxiety, and sleep disturbances among the population [7] . Lockdown measures have influenced attitudes and lifestyles with varying responses based on demographic factors [8] . At the societal level, the pandemic has led to the postponement of childbearing plans for many, highlighting its influence on personal and family decisions [6] . Ethnic minority communities, including those of Bangladeshi origin, face specific barriers to vaccine uptake owing to a confluence of factors. These include isolation from the mainstream, concerns about the speed of vaccine roll-out and potential health impacts, mistrust of official information, exposure to misinformation, and negative messaging outweighing positive information [9] . Additionally, there is a lack of culturally appropriate interventions and a need for an increased understanding of how to address vaccine hesitancy within these communities. Interestingly, while interventions to increase vaccine uptake have been identified, such as education, persuasion, and enablement, there is no strong evidence to recommend specific interventions, highlighting the complexity of the issue [10] . Moreover, barriers, such as vaccine-induced HIV infection fears, side effects, and mistrust, which were identified in the context of HIV vaccine trials, may also resonate with COVID-19 vaccine hesitancy. Furthermore, the disproportionate burden of COVID-19 on ethnic minority communities and the lack of targeted interventions contribute to the low vaccine uptake [11] .

The government initiatives and policies in Bangladesh aimed at COVID-19 vaccination are characterized by efforts to manage and overcome challenges associated with the vaccination process. According to [12] , Bangladesh, with its large population, has faced significant risks during the pandemic. The study reviews the management of the vaccination campaign and process, highlighting both the commendable initiatives and the shortcomings. Interestingly, [13] provides a different perspective by analyzing the sentiments of Bangladeshi netizens on social media regarding the vaccination program. The sentiment analysis reveals that a majority of the social media reactions are positive, indicating an overall favorable public perception of the vaccination efforts. Bangladesh has approximately two million people from 27 officially recognized ethnic minority groups, constituting around 1.25% of the population [14] . These ethnic minority groups have historically been marginalized socially and politically, and often reside in isolated and economically disadvantaged regions. They have also received minimal attention from local and national politicians. Although government health services are generally lacking in Bangladesh, ethnic minorities face two significant challenges in accessing healthcare services: the remote location of many communities and discrimination. Hence, the study aimed to shed light on exploring the challenges of up taking COVID-19 vaccine among ethnic minority communities. This study also attempted to develop an approach for strengthening government initiatives to ensure the inclusive vaccine uptake among ethnic minority communities of Bangladesh.

The implementation of a vaccination program, which varies among population groups, is crucial for successful execution. Implementing vaccines may exclude people from all socioeconomic groups if the interventions are not targeted in accordance with the needs, concerns, and barriers to vaccine uptake that are understood [15] . Minority ethnic groups are disproportionately affected by the COVID-19 pandemic, experiencing higher morbidity and mortality due to their low vaccination uptake [16] . Compared to 79% of white respondents, only 57% of respondents from minority ethnic groups in the UK said that they were inclined to take the COVID-19 vaccine [17] . Additionally, in San Francisco, those who were identified as Black, Latinx, Asian, Multiracial, and other races (ethnic minorities) were markedly less likely than those who were identified as White to have a high readiness to receive vaccinations. A quarter of Black respondents said that they would not be vaccinated because they did not trust the firms that provide COVID-19 vaccines and did not think a vaccine would work to prevent infection [18] . Access to and acceptance of vaccinations by racial and ethnic minorities are hampered by a variety of social, geographic, political, economic, and environmental issues [19] . These include disparities in education, income, wealth, barriers to employment and working conditions, access to healthcare, accessibility to transportation, unfavorable neighborhood circumstances, and most importantly, a lack of confidence in medical services [20] . As a result, vaccination rates among ethnic minorities were reduced. Lack of accessibility, inadequate risk perception, and gaps in disease prevention and healthcare promotion are the main barriers to vaccination that ethnic minority communities encounter in the healthcare system [21] . Language difficulties have been noted as deterrents to vaccination in ethnic minority communities [22] . Despite the numerous deaths the virus has caused in these areas, these barriers make it difficult to learn about and obtain information on COVID-19 vaccines, and they may also result in a general lack of understanding of their significance [23] . The Bangladeshi government started administering COVID-19 vaccines on January 27, 2021, and expanded vaccination on February 7, 2021, in an effort to combat the pandemic [4] . Due to Bangladeshi people’s hesitation to receive vaccinations, Bangladesh’s average vaccination rate is among the lowest in South Asia [24] . Despite the great success of the global COVID-19 vaccine uptake, not all Bangladeshi populations have received the vaccine. The ethnic minority communities in Bangladesh are very conservative and isolated from mainstream communities, which leads them to keep away from important government information and other facilities [25] . The government of Bangladesh is trying to bring the entire country’s population under vaccination through a decentralized healthcare system [26] . However, the current infrastructure and supplies may not be adequate to ensure a swift vaccination campaign. To ensure the COVID-19 vaccine’s actual success, the government must demonstrate its ability to obtain vaccine supplies and plan and implement successful and inclusive vaccination campaigns [27] . Many researchers have conducted studies on the socioeconomic conditions, gender discrimination, human rights, identity crises, and cultural diversity of ethnic minorities in Bangladesh; however, few researchers have focused on government initiatives for effective COVID-19 vaccine uptake. This informs the researcher’s interest in filling the gap.

This qualitative study employed the philosophy of social constructivism to explore the challenges of up taking COVID-19 vaccines among indigenous communities. The participants’ experiences, attitudes, and interactions regarding vaccinations among Bangladeshi ethnic minority communities were investigated using a qualitative research approach in order to fulfill the study’s objective. Constructivism, which seeks to understand the situation’s specifics and the reality that underlies them, can help social scientists better understand the big picture and the current state of affairs [28] . A qualitative study aims to create an avenue for an in-depth understanding of societies through observation via learning from the community’s experiences and knowledge [29] [30] . Unlike the quantitative method, the qualitative method emphasizes the participatory approach using dialogue and negotiation, which has emerged as a successful approach for effective community participation [31] [32] . Similarly, [29] [33] stated that the qualitative research approach focuses on a target population to investigate their experiences and behavior through non-numerical information rather than numerical data. Hence, subjective research seeks an in-depth comprehension of societies, learning through individuals’ points of view, experiences, and narratives, and the consequences of exploration are likely to be unmistakable as opposed to prescient [34] . A qualitative study aims to create an avenue for an in-depth understanding of societies through observation by learning from the community’s experiences and knowledge [29] [30] . Through qualitative research, the researcher can explore and document the participants’ perceptions, attitudes, and interactions in real-life situations [35] . Moreover, qualitative research enables the researcher to conduct an in-depth study of a broader aspect of the issue that may be anomalous in other research methodologies [36] . Finally, the data obtained from the qualitative approach are rich and subjective, and are considered highly valid [33] . Researchers have conducted a field study on the Sylhet division. There should be a rationale for site selection for any research using both qualitative and quantitative approaches. To conduct significant and useful research, the site selected should be the place where 1) entry is possible; 2) there is a high probability of the presence of a mix of people, processes, programs, interactions, structures, and interests; 3) the researcher can build a trust relationship with the respondents; and 4) data quality and credibility can be assured [37] . Hence, the Sylhet Division (Sylhet, Sunamganj, Moulvibazar and Habigonj Districts) was suitable for conducting this study. The divisional map is shown in Figure 1 . The Sylhet division has a strong history, and heritage is a diversified culture with Manipuri, Khasia, Garo, Tripura, and Hajong, Munda, Santal, Telegu, Rabidas, and Kairi ethnic groups from neighboring states of India. Ethnic minorities constitute 1.5% of the overall population in the Sylhet division [38] . A large number of local government agencies are working in this region to develop this area. The purpose of selecting multiple cases is to demonstrate different perspectives and processes [39] .

For this study, 49 participants were selected, including manipuri women and men, local leaders in Manipuri communities, and local health care providers. The reason for this is that in order to respond to the research questions, the participants or respondents must possess the requisite knowledge and experience [40] . The sample size for qualitative research should be sufficient to reveal the most important perceptions, but an excessively large sample can lead to repetition and be unnecessary [41] . For the qualitative study, the sample size is expected to reach between 20 - 30 [39] or 30 - 50 [42] . Bernard and Bernard [43] recommend that 10 - 20 learned individuals are sufficient to discover and recognize the core categories in any well-defined social space or inquiry into lived experience. Creswell and Poth [39] suggest that the selection of 20 to 30 participants for a qualitative study, 4 to 5 cases for case study research, and 2 or 3 individuals for narrative research can bring meaningful findings. Furthermore, while the sample size in qualitative research is less important, the quality of information is the main consideration in an excellent study [44] . Hence, the sample size for this study was determined from a saturation point of view. Purposive (non-probability) sampling was chosen because probability sampling is not required for qualitative research [45] . Purposive sampling was applied to unique cases. Determining information-rich cases that are in line with research goals and can teach a lot is the aim of purposeful sampling [46] . Norris [47] mentions purposive sampling as one of the most effective methods for gathering accurate data. A field study was carried out by researchers in order to gather the essential firsthand data about the study’s objectives. The investigators employed a methodological triangulation of the qualitative approach, incorporating interviews and FGDs, in order to arrive at a rational response to the research questions. The most popular method for conducting research is interviewing people [48] . As Abejirinde et al. [49] and Nilsen et al. [50] noted that people who participate in qualitative research should be chosen based on their familiarity with and understanding of the specific topic under investigation. [51] outlined three forms of interviews: structured, semi-structured, and unstructured. A structured interview is more closed, with little flexibility; a semi-structured interview presents a series of open-ended questions, and an unstructured interview offers a limit-free option to respond. The researchers used a semi-structured interview format as it is more flexible in exploring the topic more deeply, which diminishes the chance of bias [52] . Semi-structured interviews included key queries that helped outline or describe the area to be investigated. In addition, it permits the inquirer or respondents to seek afterthoughts or reactions in more detail. This interview design is employed the most when researching social aspects because it offers respondents some direction on what to discuss, which many find useful. This approach’s flexibility, particularly when compared to organized interviews, also permits the disclosure or elaboration of material essential to participants but previously not considered significant by the research team [53] . A maximum of six participants participated in each of the two Focus Group Discussions (FGDs) held with community leaders. With so much flexibility and room for respondent reaction to other respondents’ responses, (FGDs) make it easier to frame a dynamic and synergistic approach. The number of participants and the nature of the inquiries are listed in Table 1 .

To interpret the primary data, we focused on theoretical perspectives from the literature concerning government initiatives for managing vaccine uptake among indigenous communities in Bangladesh. Government initiatives for the effective vaccine uptake of indigenous communities are generally impeded by the paternalistic social structure, sociocultural norms and practices, workload, lack of information, and isolation. The main barriers to vaccine uptake are summarized in Table 2 . The themes that emerged from the study covering interpretative alignments based on the participants’ reflective experiences regarding the challenges and enhancement of vaccine uptake among indigenous communities are discussed in the following section.

In the following section, researchers discuss emerging themes regarding existing facilities, challenges, and opportunities for vaccine uptake among ethnic minority communities in Bangladesh.

Ethnic minorities have faced many challenges in terms of their survival, but ethnic groups in Bangladesh have been facing sociocultural, economic, political, and religious challenges over time owing to their isolation from mainstream society. They are hardworking and have a distinct culture. They preferred to live in natural settings without interference from outsiders. Most of them have little knowledge about basic health issues and rely on traditional herbal treatment. Hence, this study aims to explore the challenges faced by ethnic minorities while taking COVID-19 vaccines. A qualitative research approach was used in this study. Data were collected through semi-structured interviews, scheduled by applying methodological triangulation (Interviews and FGDs). Researchers have used a thematic analysis method to organize and analyze data by applying two coding cycles: structural coding and provisional coding. Ethnic minority groups in Bangladesh are unaware of their health. During the COVID-19 pandemic, the government took different initiatives to cover people from all strata, irrespective of gender, religion, culture, caste, and distance, under the vaccination program with the aim of developing an inclusive national health policy. Consecutively, some initiatives of government and non-government organizations, such as visiting door-to-door to raise awareness and provide information, distributing masks, sanitizers, observing quarantine, and encouraging them not to panic, motivated ethnic groups to take up vaccines. Furthermore, TV channels, local headmen, educational institutions, and free vaccinations also worked as motivating factors for up taking COVID-19 vaccines. The government also took some tricky strategies to cover all the people of Bangladesh, such as getting passport or visa services from the concerned authority, flying on board, and working in industries even using public transports required or mandatory to show vaccine certificates. The ethnic groups who worked in tea or rubber gardens and local healthcare centers (nearby gardens) arranged vaccinations for them. However, most ethnic minority communities are strictly bounded by their own social systems and cultures, which, in some cases, create obstacles to the popular vaccination process. They feel unwilling to get registration and take up vaccines owing to their long distance from the city or healthcare centers. In addition, registration fees, technological inaccessibility, and unavailable mobile networks for receiving vaccines related to SMS also demotivated them from receiving vaccines. The ethnic minority groups had some misconceptions regarding COVID-19 vaccines, such as the fact that only corrupted people will be affected by the COVID-19, as it was a natural punishment. They were unwilling to take vaccines, believing that their traditional herbal medicine is far better than vaccines for quick recovery from any type of disease, as they learned from their ancestors. Vaccination time is another problem. During working time (9 AM to 5 PM), they were reluctant to visit health centers for up taking COVID-19 vaccines. In addition, ethnic minority women were obeyed by their family heads, who rarely permitted them to visit community clinics or healthcare centers with male care providers. Considering these issues, enhancing collaboration with community-based organizations, strengthening communication systems, maintaining the proper flow of information to ensure transparency and accountability, arranging gender-specific healthcare providers, and establishing close community-knit service centers are indispensable for developing inclusive vaccination approaches. Since this study explored the challenges of vaccination uptake among ethnic minority communities, the findings of this study would facilitate the initiatives taken by policymakers, NGOs, communities, and other development organizations to enhance the strategies for developing inclusive vaccination approaches for ethnic minority communities. Future researchers could conduct a quantitative approach by applying longitudinal studies including a broader range of respondents to address the missing perspectives in the current study.

¹Heads of the clan.

²Who practices ayurved.

³One kind of homemade hot fluid made with water and leaves of plants.