Informed but Unvaccinated: A Cross-Sectional Study Among University Students in Ghana

During the COVID-19 pandemic, vaccination hesitancy (VH) posed an equally unexpected and significant obstacle to the effectiveness of public health interventions. VH has not only the potential to stir up public unrest, but it may also impede the success of entire immunization programs and thus prevent the attainment of herd immunity. This cross-sectional, quantitative, and descriptive study examined VH and vaccination behavior (VB) among 3486 university students in Ghana, using a standardized self-administered questionnaire based on the 5Cs model among other relevant variables. The findings confirm a significant VH and a VB influenced by both sociodemographic factors, such as gender (OR: 1.45; [CI: 1.26–1.67]), study program (OR: 0.55; [CI: 0.47–0.64]), and ethnicity (OR: 1.31; [CI: 1.12–1.52]) and also four of the 5Cs, i.e., Confidence (OR:1.56; [CI: 1.45–1.68]), Constraints (OR: 0.83; [CI: 0.78–0.87]), Calculation (OR:0.85; [CI: 0.78–0.92]), and Collective Responsibility (OR:1.27; [CI: 1.16–1.38]), yet not Complacency, nor religion. Notably, VH was further shaped by previous vaccine experience, information sources, vaccine attributes, stance on vaccine passport, and conspiracy beliefs, with misinformation from unofficial sources playing a key role. The multiple regression models explained 11% to 34% of the variance in the 5Cs, indicating varying degrees of explanatory power for each factor influencing VB and eventually also VH. This study highlights the urgent need for targeted public health interventions, such as integrating vaccine education into university orientation programs, streamlining vaccination processes, and leveraging influencers for trust-building campaigns.