Background and Objective:
Inequality in accessing healthcare services is well-documented worldwide. However, little literature discussed the inequality in accessing COVID-19 vaccination. Furthermore, the spatial dimension of this inequality is largely unexplored in the literature. Therefore, this study examined the regional variation of educational-related inequality in accessing COVID-19 vaccination in Tanzania to identify populations with greater disadvantages.

Methods:
The uptake of any complete dose of the COVID-19 vaccine was used to measure access to COVID-19 vaccination. The inequalities were assessed by using concentration curves and concentration indices (CI). The multivariable logistic regression was performed to identify the potential contributors to the inequalities in accessing COVID-19 vaccination.

Results:
A total of 22910 adults from four major cities in Tanzania were interviewed. About 20% of the respondents received the COVID-19 vaccine. The highest educational-related inequality in accessing COVID-19 was in favor of educated compared to uneducated adults. After disintegration by regions, the high extent of inequalities was observed among adults in Mwanza (CI: 0.093, P<0.001) and Arusha (CI: 0.062, P<0.001) compared to Iringa (CI: 0.011, P<0.05) and Morogoro (CI: 0.040, P<0.001) regions. The contributors to inequalities in accessing COVID-19 vaccinations were age, sex, marital status, and occupation.

Conclusion:
The current study is the first to investigate the regional variation of inequality in the COVID-19 vaccination in areas with high hesitancy. Establishing policies or strategies which will consider regional variations in educational inequality might be a way forward toward achieving universal coverage of COVID-19 vaccination, especially in areas with high hesitancy.