Study questionnaire.

<div><p>Background</p><p>The COVID-19 pandemic impacted the world in every aspect. Higher institutions were greatly affected because the outbreak disrupted the teaching and learning structure. Vaccines decrease the rate of infection and transmission of the virus, but the presence of some myths has led to hesitancy towards the vaccine.</p><p>Objective</p><p>The purpose of the survey was to assess the knowledge, perception, and acceptance of the COVID-19 vaccine among undergraduate students in Enugu State, Nigeria.</p><p>Methods</p><p>This was a cross-sectional study carried out among undergraduate students at the University of Nigeria Nsukka (UNN), the Institute of Management and Technology (IMT), and Enugu State University of Technology Enugu state (ESUT), Nigeria between March and November 2023. These institutions were chosen based on their large student populations, diverse academic offerings, and significant geographical coverage within the state. Data collection was done using a 26-item validated self-administered questionnaire. Statistical Product and Service Solutions (SPSS) version 25 with appropriate descriptive (frequency and percentage) and inferential statistics (Chi-square) were used to analyze the data.</p><p>Results</p><p>1,143 completed questionnaires were obtained. The modal age range was 18–24 years accounting for 814 (71.2%) of the participants. A total of 577 (50.5%) participants demonstrated a good level of knowledge while 685 (59.9%) showed a positive perception of the COVID-19 vaccine. Gender (p = 0.010) and institution (p < 0.001) were associated with their perception of the COVID-19 vaccine. In addition, knowledge and perception of the COVID-19 vaccine were significantly associated with its acceptance at p = 0.038 and < 0.001, respectively.</p><p>Conclusion</p><p>This study reveals that COVID-19 vaccine acceptance among university students in Enugu State, Nigeria, remains low despite moderate knowledge and generally positive attitudes, with perceptions playing a more significant role than knowledge. The findings highlight the need for educational interventions that not only provide accurate information but also actively address misconceptions. To improve vaccine uptake, public health campaigns should focus on shifting perceptions through culturally sensitive, institution-specific strategies.</p></div>