Covid-19 Vaccination Uptake Among Remote Communities In Malaysia: A Cross-Sectional Study

Abstract

Since its emergence in December 2019, COVID-19 has posed a major global public health threat, prompting Malaysia to launch a National COVID-19 Immunisation Programme (PICK) that offered free, voluntary vaccination to all residents, including non-citizens, with a target of vaccinating at least 80% of the population by February 2022. While national vaccination coverage has been well documented, uptake among remote communities—populations living in areas of 1,000 to 10,000 residents with limited access to nearby towns and essential services—remains less understood. Variations in sociodemographic background, particularly among those residing in more distant and geographically isolated locations, may substantially influence vaccine uptake and, in turn, health policy and practice disparities across subgroups. This study aimed to investigate the prevalence of COVID-19 vaccine uptake and its associated factors among remote communities in Malaysia. A cross-sectional study was conducted in two phases (September 2021 and April 2023) among remote communities across Peninsular Malaysia, Sabah, and Sarawak, using a two-stage stratified sampling method. Data were collected via validated, interview-administered questionnaires from heads of household (N=1,005; 504 from East Malaysia and 501 from West Malaysia). Descriptive statistics summarised sociodemographic characteristics and vaccine uptake, while multivariate logistic regression identified factors independently associated with second-dose vaccine uptake. Model fit was assessed using the Hosmer-Lemeshow test, classification table, and area under the ROC curve. Vaccine acceptance and uptake were exceptionally high: 99% of participants were willing to receive the COVID-19 vaccine, 99% received at least one dose, 92.5% received a second dose, and 95.5% completed the recommended vaccination series—figures exceeding both regional Asian countries (60–70%) and several high-income nations, as well as Malaysia's overall national coverage. In multivariate analysis, Malay (adjusted OR 4.272; 95% CI 2.285–7.987) and Indigenous (adjusted OR 8.939; 95% CI 4.444–17.981) participants had significantly higher odds of vaccine uptake compared with other racial groups. Living within 40 km of the nearest town was associated with higher odds of uptake (adjusted OR 1.929; 95% CI 1.142–3.261), whereas, unexpectedly, living within 5 km of a health clinic was associated with lower odds of completing two doses (adjusted OR 0.061; 95% CI 0.018–0.201). The final model demonstrated good fit (classification accuracy 92.4%; AUC-ROC 0.796). Remote communities in Malaysia demonstrated remarkably high willingness to vaccinate and high vaccine completion rates, exceeding both regional and several high-income country benchmarks, likely attributable to the multisectoral, whole-of-government National COVID-19 Immunisation Programme, which combined free vaccination, targeted community outreach, mobile vaccination services, and digital verification through My Sejahtera alongside non-digital alternatives such as physical vaccination cards for those with limited access to technology. Nonetheless, race, geographic distance, and proximity to healthcare facilities remained significant determinants of uptake, indicating that high aggregate national coverage does not fully eliminate underlying geographic and socioeconomic inequities in access. Future pandemic and routine immunisation programmes should sustain mobile vaccination teams, community-based delivery centres, transportation assistance, and culturally and linguistically appropriate risk communication to ensure equitable access for geographically isolated, digitally excluded, and socioeconomically disadvantaged populations.