A national survey of COVID-19 vaccine acceptance in Nigeria

IntroductionThe COVID-19 vaccine is essential to reduce the global impact of the pandemic. Understanding its acceptance is key to Nigeria’s national COVID-19 control strategies.MethodsBetween the 6th and 22nd of January 2021, we conducted a non-probability convenience sampling of 3076 respondents using online and in-person interviews to assess the prevalence and predictors of the COVID-19 vaccine acceptance in Nigeria.FindingsOf the 3076 recruited participants, 74.7% (n = 2300/3076) had tertiary education. The median age group was 30–39 years (35.1%, n = 1097/3076) whereas 31% (n = 952/3076) of all respondents had a monthly income<30,000 Naira (65 USD). The survey results indicated that a wide range of the respondents were in government employment (34.1%, n = 1050/3076). The majority of our study participants (92.2%, n = 2835/3076) believe that COVID-19 is real and not a hoax. Only 27.9% (n = 858/3076) of the study participants have been tested for COVID-19 and 17.8 % (n = 152/858) of the tested respondents were COVID-19 positive by PCR. Half (50.7%; n = 1560/3076) of the study participants were willing to take the vaccine once available. The majority of the respondents (81.1%, n = 2496/3076) were not willing to pay for the vaccine. Only 15.9% (n = 483/3076) of the respondents rated the government’s handling of the pandemic above average. The potential acceptance of the COVID-19 vaccine was significantly affected by the age and the monthly income of the respondents. Respondents older than 60 years old (OR: 3.02, 95% CI: 1.69,5.41; p < 0.001) and those that earn between 250,000–500,000 Naira monthly (OR: 1.38; 95% CI: 1.11,1.70; p < 0.001) were more likely to accept the COVID-19 vaccine respectively. In addition, the respondents’ perception of the existence of the disease (OR: 1.45; 95% CI: 0.99,2.18; p > 0.05), the need for a COVID-19 vaccine (OR: 16; 95% CI: 11.63,22.10; p < 0.001), the willingness to pay (OR: 1.68; 95% CI: 1.39,2.01; p < 0.001) and the rating of the government handling of the pandemic (OR: 2.25; 95% CI: 1.57,3.23; p < 0.001) were critical to the acceptance of the COVID-19 vaccine.InterpretationWith 50.7% vaccine acceptance, Nigeria’s public health policymakers must prioritize and develop strategies that will effectively increase COVID-19 vaccine acceptance across the country with emphasis on trust, transparency and strong leadership.     

UAE efforts in promoting COVID-19 vaccination and building vaccine confidence

The United Arab Emirates (UAE) is leading globally in many indicators for tackling the COVID-19 pandemic. This ranges from taking adequate preventive measures to the free vaccination drive and viable public health strategy. As of 18 August 2021, the UAE has significantly reduced the number of cases and successfully administered 17,454,250 doses. Furthermore, efforts and plans are underway to provide the third dose to high-risk people three months after completing the second dose and six months later to others. The UAE is considered one of the leaders globally for vaccinating “medically eligible” residents against COVID-19, with over 70% of the population currently fully vaccinated in the drive towards achieving herd immunity. The UAE's vaccination program is on track, covering a significant part of the population. The massive efforts of the National Vaccination Program's roll-out made by the UAE government and the various health authorities and stakeholders were vital for the general public's active participation in its success.     

Healthcare worker perspectives on COVID-19 vaccines: Implications for increasing vaccine acceptance among healthcare workers and patients

ObjectiveTo understand COVID-19 vaccine perspectives among healthcare workers serving diverse communities.MethodsA dual English/Spanish survey was distributed to healthcare workers in the United States from 3/12/2021–4/22/2021 by the Migrant Clinicians Network, Society of Refugee Healthcare Providers, a Federally Qualified Healthcare Center, and social media advertisement to general primary care workers.Results517 responses were at least 50% complete and included in the analysis. Among these, 88% (457/517) indicated vaccine acceptance. Factors associated with acceptance included not reporting any vaccine concerns, identifying as male, ≥65 years of age, being a physician or advanced practice provider, and interacting directly with patients from refugee, immigrant, and migrant (RIM) communities. Participants identified educational information as most helpful for themselves when making a vaccine decision, but a healthcare provider’s recommendation as most helpful for their patients.ConclusionHealthcare workers, especially those serving RIM communities, are vaccine accepting. Tailoring vaccine-related information to healthcare workers may improve vaccine confidence for both themselves and patients who rely on them for information.     

A meta-analysis of influenza vaccination following correspondence: Considerations for COVID-19

BackgroundHigh vaccination rates are needed to protect against influenza and to end the COVID-19 pandemic. Health authorities need to know if supplementing mass communications with direct correspondence to the community would increase uptake.ObjectivesThe primary objective is to determine if sending a single written message directly to individuals increases influenza vaccine uptake, and a secondary objective is to identify any identified content shown to increase influenza vaccine uptake.MethodsMEDLINE, Embase, Cochrane CENTRAL, PsycINFO, and PubMed were searched for RCTs testing a single correspondence for members of the community in OECD countries to obtain influenza vaccination. A meta-analysis with inverse-variance, random-effects modelling was used to estimate a mean, weighted risk ratio effect size measure of vaccine uptake. Studies were quality assessed and analysis was undertaken to account for potential publication bias.ResultsTwenty-eight randomized controlled trials were included, covering 45 interventions. Of the 45 interventions, 37 (82.2%) report an increase in influenza vaccination rates. A formal meta-analysis shows that sending a single written message increased influenza vaccine uptake by 16%, relative to the no contact comparator group (RR = 1.16, 95% CI [1.13–1.20], Z = 9.25, p < .001). Analysis shows that the intervention is effective across correspondence type, age group, time, and location, and after allowing for risk of publication bias.LimitationsThe generalizability of results across the OECD may be questioned.Conclusions and implicationsThe implication for public health authorities organizing vaccination programs for influenza, and arguably also for COVID-19, is that sending written vaccination correspondence to members of the community is likely to increase uptake.This study is pre-registered on osf.io; details can be found at https://osf.io/98mr7.     

COVID-19 vaccination intention and behavior in a large,diverse, U.S. refugee population

IntroductionRefugees often face increased risk of exposure to COVID-19 due to their disproportionate representation in the essential workforce and crowded household conditions. There is a paucity of data about risk factors for under-immunization for COVID-19 among refugees.MethodsRefugees were surveyed in two phases that corresponded to before and after wide availability of COVID-19 vaccines. Participants were asked about their attitudes, and perceptions about COVID-19, previous acceptance of vaccines, sources utilized to obtain trusted health information, and intent to get vaccinated. The overall participant vulnerability was assessed using the social vulnerability index. In-depth semi-structured interviews were completed with key stakeholders through snowball sampling.ResultsOf 247 refugees, 244 agreed to participate in the initial survey. Among those, 140 (57.4%) intended to get vaccinated, 43 (17.6%) were unsure, and 61 (25%) did not intend to get vaccinated. In the follow up survey, all 215 who were reached, agreed to provide information about their vaccination status. Among those respondents, 141 (65.6%) were either vaccinated or expressed intent to do so, and 74 (34.4%) remained hesitant. We did not observe any significant correlation between socio-demographic variables, country of origin, and vaccination status/intent. Among those who initially intended to get vaccinated, nearly 1 in 5 changed their mind and decided to forego vaccination, and among those who initially did not plan getting vaccinated, 1 in 3 changed their mind and got vaccinated. Fears related to the vaccine, concerns that the vaccine is religiously prohibited, “wait and see” how others did with the vaccine, communication and transportation barriers were commonly cited as reason not to get vaccinated.ConclusionsOver a third of refugees in our study were hesitant to get vaccinated. Refugees desired additional education about the benefits and safety of vaccines along with easier access to vaccination clinics in their communities.     

Covid-19 vaccine hesitancy and resistance amongst parents of children under 18 years of age in Ireland

As COVID-19 vaccination for children becomes commonplace in Ireland, it is important to understand parent’s willingness to vaccinate their children and factors associated with hesitancy and resistance. Amongst a nationally representative sample of parents from Ireland, surveyed in March/April 2021, 52.1% had, or were intending to have their child vaccinated; 30.1% reported they might vaccine their child; and 17.8% reported they would not vaccinate their child. Compared to vaccine-accepting parents, hesitant parents were more likely to be younger, less educated, poorer, to not know somebody who was sick from COVID-19, to believe the COVID-19 vaccines were unsafe, and to hold negative beliefs about scientists and healthcare professionals. Vaccine-resistant parents were more likely to be younger, living alone, to distrust scientists, and to believe the COVID-19 vaccines were unsafe. Public health messaging should target younger, lower income parents with clear information about the safety of COVID-19 vaccines for children.     

Individual-level factors associated with COVID-19 vaccine acceptance among U.S. patients with cancer

IntroductionVaccine hesitancy in the wake of the COVID-19 pandemic is a major public health concern in the US. Cancer patients are especially vulnerable to adverse COVID-19 outcomes and require targeted prevention efforts against COVID-19.MethodsWe used longitudinal survey data from patients seen at Moffitt Cancer Center to identify attitudes, beliefs, and sociodemographic factors associated with COVID-19 vaccination acceptance among cancer patients. Patients with confirmed invasive cancer diagnosis through Cancer Registry data were asked about vaccine acceptance through the question “Now that a COVID-19 vaccine is available, are you likely to get it?” and dichotomized into high accepters (already received it, would get it when available) and low accepters (waiting for a doctor to recommend it, waiting until more people received it, not likely to get it).ResultsMost patients (86.8% of 5,814) were high accepters of the COVID-19 vaccine. High accepters had more confidence in the effectiveness and safety of the vaccine than low accepters. Multivariable logistic regression showed older individuals (70–89 vs.18–49: OR:2.57, 95% CI:1.33–4.86), those with greater perceived severity of COVID-19 infection (very serious vs. not at all serious: OR:2.55, 95% CI:1.76–3.70), practicing more risk mitigation behaviors (per one standard deviation OR:1.75, 95% CI:1.57–1.95), and history of receiving the flu shot versus not (OR:6.56, 95% CI:5.25–8.20) had higher odds of vaccine acceptance. Individuals living with more than one other person (vs. alone: OR: 0.53, 95% CI: 0.35, 0.79) and those who were more socioeconomically disadvantaged (per 10 percentile points: OR: 0.89, 95 %CI: 0.85, 0.93) had lower odds of reporting vaccine acceptance.ConclusionMost patients with cancer have or would receive the COVID-19 vaccine. Those who are less likely to accept the vaccine have more concerns regarding effectiveness and side effects, are younger, more socioeconomically disadvantaged, and have lower perceptions of COVID-19 severity.     

Conditionality of COVID-19 vaccine acceptance in European countries

The COVID-19 vaccine rollout has offered a powerful preventive measure to help control SARS-CoV-2 transmission. Nevertheless, long-standing public hesitation around vaccines heightened concerns that vaccine coverage would not achieve desired public health impacts, particularly in light of more contagious variants. This cross-sectional survey was conducted online just before the European vaccine rollout in December 2020 among 7000 respondents (aged 18–65) in Belgium, France, Germany, Italy, Spain, Sweden, and Ukraine. The survey included open text boxes for fuller explanation of responses. Overall, 56.9% of respondents would accept a COVID-19 vaccine, 19.0% would not, and 24.1% did not know or preferred not to say. By country, between 44% (France) and 66% (Italy) of respondents would accept a COVID-19 vaccine. Respondents expressed conditionality in open responses, voicing concerns about vaccine safety and mistrust of authorities. We highlight lessons learned about the dynamism of vaccine conditionality and persistence of safety concerns.     

COVID-19 vaccination intention and activation among health care system employees: A mixed methods study

BackgroundAchieving high COVID-19 vaccination rates among employees is necessary to prevent outbreaks in health care settings. The goal of the study was to produce actionable and timely evidence about factors underlying the intention and decisions to obtain the COVID-19 vaccine by employees.MethodsThe study was conducted from December 2020 – May 2021 with employees from a VA health care system in Southeastern US. The study used a convergent mixed methods design comprising two main activities: a cross-sectional survey conducted prior to COVID-19 vaccine distribution, and semi-structured interviews conducted 4–6 months after vaccine distribution. Data were collected about participant characteristics, vaccination intention prior to distribution, vaccination decision post-distribution, determinants of vaccination intention and decision, activating factors, sources of information and intervention needs. Data from the survey and interviews were analyzed separately and integrated narratively in the discussion.ResultsPrior to vaccine distribution, 77% of employees wanted to be vaccinated. Post vaccine distribution, we identified 5 distinct decision-making groups: 1) vaccine believers who actively sought vaccination and included those sometimes described as “immunization advocates”, 2) go along to get along (GATGA) individuals who got vaccinated but did not actively seek it, 3) cautious acceptors who got the COVID-19 vaccine after some delay, 4) fence sitters who remained uncertain about getting vaccinated, and 5) vaccine refusers who actively rejected the COVID-19 vaccine. Participants identifying with Black or multiple races were more likely to express hesitancy in their vaccination intention.ConclusionThe findings of our study highlight distinct decision-making profiles associated with COVID-19 vaccination among employees of a VA health care system, and provide tailored recommendations to reduce vaccine hesitancy in this population.     

Racial differences in anticipated COVID-19 vaccine acceptance among religious populations in the US

Given high COVID-19 infection and mortality rates among racial minorities in the US and their higher rates of religiosity, it is important to examine how the intersection of race and religion influences perceptions of COVID-19 vaccinations. Data for this study come from online surveys conducted in twelve congregations between October and December 2020 (N = 1,609). Based on logistic regression analyses, this study demonstrates a severe disparity of 24 percentage points (95% confidence interval 0.14–0.33) in anticipated COVID-19 vaccine acceptance between African Americans and White Americans, even when controlling for trust in COVID-19 information from scientists and levels of worrying about COVID-19 as well as religiosity and demographic factors. Religiosity is negatively associated with COVID-19 vaccine acceptance across racial groups. The findings suggest that the intersection of race and religion should be considered when designing immunization programs, for instance by fostering collaborations and dialogue with faith leaders of racial minority congregations.     

Preferences for a COVID-19 vaccine in Australia

In absence of a COVID-19 vaccine, testing, contact tracing and social restrictions are among the most powerful strategies adopted around the world to slow down the spread of the pandemic. Citizens of most countries are suffering major physical, psychological and economic distress. At this stage, a safe and effective COVID-19 vaccine is the most sustainable option to manage the current pandemic. However, vaccine hesitancy by even a small subset of the population can undermine the success of this strategy.The objective of this research is to investigate the vaccine characteristics that matter the most to Australian citizens and to explore the potential uptake of a COVID-19 vaccine in Australia. Through a stated preference experiment, preferences towards a COVID-19 vaccine of 2136 residents of the Australian states and territories were collected and analysed via a latent class model.Results show that preferences for mild adverse cases, mode of administration, location of administration, price and effectiveness are heterogeneous. Conversely, preferences for immediacy and severe reactions are homogeneous, with respondents preferring a shorter period until vaccine is available and lower instances of severe side effects. The expected uptake of the vaccine is estimated under three different scenarios, with the value of 86% obtained for an average scenario. By calculating individual preferences, the willingness to pay is estimated for immediacy, effectiveness, mild and severe side effects.     

Priming with social benefit information of vaccination to increase acceptance of COVID-19 vaccines

Vaccine hesitancy can be heightened due to increasing negative reports about vaccines. Emphasizing the social benefits of vaccination may shift individual attention from individual to social benefit of vaccination and hence promote prosocial vaccination. In six rounds of a population-based survey conducted over one major community epidemic of coronavirus disease 2019 (COVID-19) in Hong Kong from June to November 2020, we manipulated the question asking about acceptance of a COVID-19 vaccine with or without emphasizing the social benefit of vaccination against COVID-19 (prosocial priming) and monitored the changes of vaccine confidence by news media sentiment on vaccines. Population-weighted percentages of accepting COVID-19 vaccines by priming condition and vaccine confidence were compared across survey rounds. Logit regression models assessed the main effect of prosocial priming and the modification effects of vaccine confidence and perceived personal risk from COVID-19 on acceptance of COVID-19 vaccines. We found that prosocial priming significantly increased acceptance of COVID-19 vaccines across all survey rounds except for Round 3 when incidence of COVID-19 reached a peak. Vaccine confidence significantly declined in Round 6 when news media sentiment on vaccines became predominantly negative. The effect of prosocial priming on promoting vaccine acceptance was significantly greater in participants with low vaccine confidence and those perceiving the severity of COVID-19 to be mild/very mild. Our study suggests that packaging vaccination against COVID-19 as a prosocial behaviour can help overcome low vaccine confidence and promote prosocial vaccination particularly when disease incidence temporarily declines and the public perceive low severity of COVID-19.     

Real-world uptake of COVID-19 vaccination among individuals expressing vaccine hesitancy: A registry-linkage study

Introduction Uptake of COVID-19 vaccination remains suboptimal in the United States and other settings. Though early reports indicated that a strong majority of people were interested in receiving the COVID-19 vaccine, the association between vaccine intention and uptake is not yet fully understood. Our objective was to describe predictors of vaccine uptake, and estimate the sensitivity, specificity, and predictive values of self-reported COVID-19 vaccine status compared to a comprehensive statewide COVID-19 vaccine registry.Methods A cohort of California residents that received a molecular test for SARS-CoV-2 infection during 24 February-5 December 2021 were enrolled in a telephone-administered survey. Survey participants were matched with records in a statewide immunization registry. Cox proportional hazards model were used to compare time to vaccination among those unvaccinated at survey enrollment by self-reported COVID-19 vaccination intention.ResultsAmong 864 participants who were unvaccinated at the time of interview, 272 (31%) had documentation of receipt of COVID-19 vaccination at a later date; including 194/423 (45.9%) who had initially reported being willing to receive vaccination, 41/185 (22.2%) who reported being unsure about vaccination, and 37/278 (13.3%) who reported unwillingness to receive vaccination. Adjusted hazard ratios (aHRs) for registry-confirmed COVID-19 vaccination were 0.49 (95% confidence interval: 0.32–0.76) and 0.21 (0.12–0.36) for participants expressing uncertainty and unwillingness to receive vaccination, respectively, as compared with participants who reported being willing to receive vaccination. Time to vaccination was shorter among participants from higher-income households (aHR = 3.30 [2.02–5.39]) and who reported co-morbidities or immunocompromising conditions (aHR = 1.54 [1.01–2.36]). Sensitivity of self-reported COVID-19 vaccination status was 82% (80–85%) overall, and 98% (97–99%) among those referencing vaccination records; specificity was 87% (86–89%).ConclusionWillingness to receive COVID-19 vaccination was an imperfect predictor of real-world vaccine uptake. Improved messaging about COVID-19 vaccination regardless of previous SARS-CoV-2 infection status may help improve uptake.     

COVID-19 vaccination attitudes,values and intentions among United States adults prior to emergency use authorization

IntroductionSafe and effective vaccines against Coronavirus Disease 2019 (COVID-19) provide the best opportunity to control the pandemic. Having safe and efficacious vaccines available is only half the equation; people must also take them. We describe a study to identify COVID-19 vaccine attitudes, values and intentions immediately preceding authorization of COVID-19 vaccines in the US.MethodsA national panel survey was conducted to measure intent to receive COVID-19 vaccines as well as disease and vaccine attitudes, values and trust in local, state and federal public health authorities.ResultsGreater than 80% of respondents reported confidence they could adhere to COVID recommendations such as mask wearing, social distancing and hand washing. The majority of respondents (70%) reported believing that current drugs were somewhat or very good at treating COVID-19 infection.Vaccine intent fell into three groups: Intenders (50%), Wait and Learn (40%), and Unlikelys (10%). Intent to get vaccinated was substantially lower among African American (32%), and higher among men (56%), those over 60 years of age (61%), those with a Bachelor’s degree or higher (63%), and Democrats (63%). The Wait and Learn group, compared to the Intenders, were less likely to report being diagnosed with a high risk condition for COVID-19, receiving an influenza vaccine in the past 12 months, discussing COVID-19 vaccine with their healthcare provider, perceiving COVID-19 as severe, considering a COVID-19 vaccine important to stop the spread of infection, and wering a mask usually or almost always.ConclusionOnly half of US adults intend to accept COVID-19 vaccines; most others (40%) are uncertain. Levels of immunity associated with community protection will not be achieved without reaching those who are currently uncertain. Characterizing COVID-19 vaccine attitudes and intentions and ascertaining values and trust in local, state, and federal public health authorities that impact vaccine decision-making are essential.     

COVID-19 vaccine hesitancy scale and its association with actual COVID-19 vaccine uptake in Israel

BackgroundThe public's willingness to get vaccinated continues to be a source of concern. In this study we assessed the psychometric properties of the COVID-19 vaccine hesitancy scale (C19-VHS) as well as the association between the scale and self-reported past COVID-19 vaccination, approximately two weeks after the national vaccine distribution plan was launched in Israel.MethodsParticipants were recruited via an online survey distributed through social media platforms and mailing lists. A total of 650 individuals completed the C19-VHS, the general vaccine hesitancy scale, and the fear of COVID-19 scale, and reported on demographic and pandemic-related characteristics. Principal component and Cronbach’s alpha analyses were performed to assess the factor structure and reliability of the scale. Logistic regressions were employed to assess the scale’s convergent and discriminative validity.ResultsTwo factors pertaining to “lack of confidence” (Factor 1) and “risk perception” (Factor 2) emerged. Cronbach’s alpha indicated good reliability of Factor 1 (0.93), with lower reliability of Factor 2 (0.72). Younger age was associated with higher risk perception, with women showing less confidence and perceiving greater risks. Lower hesitancy significantly predicted actual COVID-19 vaccine uptake after adjusting for demographic and pandemic-related factors (OR = 1.16, 95%CI 1.11–1.21, p <.001). Older age, being a woman, and receiving the flu vaccine in the past year were also predictive of COVID-19 vaccine uptake.DiscussionThe C19-VHS measure shows robust psychometric properties and is associated with actual vaccine uptake. Future studies assessing COVID-19 vaccination attitudes may utilize this scale to assess current COVID-19 vaccine hesitancy in different contexts and cultures.     

COVID-19 vaccine perceptions and hesitancy amongst parents of school-aged children during the pediatric vaccine rollout

BackgroundThe United States has the highest number of total cases and deaths due to coronavirus disease 2019 (COVID-19) worldwide (Johns Hopkins COVID Dashboard, 2021). Despite COVID-19 vaccine availability, uptake in the United States has been slow and vaccine hesitancy has been a significant barrier to achieving widespread vaccine uptake. Understanding determinants of vaccine acceptance is essential to implement successful population health interventions to increase COVID-19 vaccination.MethodsWe developed an anonymous cross-sectional parent survey to assess factors associated with parent and child COVID-19 vaccine acceptance and hesitancy during the initial pediatric vaccine rollout amongst adolescents 16 years +. The survey was sent via email to 25,308 parents registered to the Alachua County Public School System in May 2021 and remained active until July 2021.FindingsThere were a total of 2,620 survey responses. Overall, 31.5 % of parents with children ages 16 years + reported their child had received the COVID-19 vaccine, 65.2 % reported their (eligible) child had not received the vaccine, and 3.3 % reported their child was scheduled for the vaccine. A majority of parents (60.9 %) reported they planned to vaccinate all of their children once the COVID-19 vaccine was available for their children’s age. COVID-19 vaccine uptake in adolescents ages 16 + reported by Hispanic and White parents was two times higher than that reported by Black parents. Parent COVID-19 and influenza vaccine uptake were associated with increased child COVID-19 vaccination. The most commonly reported reasons why parents chose not to have their child vaccinated against COVID-19 were concerns about long–term negative side effects (75.7 %) and a negative reaction (56.5 %). Medical providers were reported as the most trusted source of information.ConclusionOur study provides insight into determinants of vaccine acceptance, vaccine hesitancy, and trusted sources of information that may be helpful to develop targeted interventions to increase youth COVID-19 vaccination.     

Prevalence and factors of influenza vaccination during the COVID-19 pandemic among university students in China

BackgroundPrevious outbreaks of emerging infectious diseases (e.g., SARS) had increased the uptake of influenza vaccination (IV). It is uncertain whether such was also true for COVID-19. This study hence investigated prevalence of IV behavior/intention prior to and during the COVID-19 pandemic and associated cognitive factors.MethodsA self-administered, online, and anonymous cross-sectional survey was conducted among 6,922 university students of five provinces in China during November 1–28, 2020 (response rate: 72.3%).ResultsOf all the participants, 35.1% self-reported behavioral intention of IV (next 12 months), while 62.9% reported an increased intention of IV due to COVID-19. However, only 4.7% and 2.9% had taken up IV during the 12-month period prior to the outbreak (1/2019–12/2019) and during the COVID-19 outbreak (1–11/2020), respectively. Adjusted for the background factors, the multivariable logistic regression analysis showed that in general the COVID-19 related perceptions (perceived susceptibility, perceived severity, and perceived chance of having another wave of COVID-19 outbreak) were significantly and positively associated the IV behavior (during the COVID-19 outbreak) and intention of IV uptake in the next 12 months.ConclusionsThe COVID-19 pandemic may have influenced actual behavior and intention of IV uptake among university students during the pandemic. Efforts are warranted to reduce the intention-behavior gap of IV uptake; modification of perceived susceptibility and perceived severity regarding COVID-19 may help. Future longitudinal and intervention studies are needed to confirm the findings of this study and explore other factors affecting IV uptake during the COVID-19 period.