Original Article

Awareness, Coverage, and Barriers to COVID-19 Vaccination among Undergraduate Students in Nigeria

Fortune B. Effiong¹, Ibrahim A. Hassan², Dimeji A. Olawuyi³, Chiemela P. Ogbonna⁴, Jeremiah B. Araoye⁵, Esther E. Bassey⁶, Kenneth E. Enwerem⁷, Yusuff A. Adebisi⁸

doi: http://dx.doi.org/10.5195/ijms.2023.1908

Volume 11, Number 4: 262-270
Received 27 11 2022; Rev-request 13 02 2023; Rev-request 05 06 2023; Rev-recd 23 02 2023; Rev-recd 14 06 2023; Accepted 02 12 2023

ABSTRACT

Background:

With the resumption of physical learning activities across Nigeria's higher education institutions, tertiary-level students, a priority group in the deployment of the COVID-19 vaccines according to the WHO SAGE, face circumstances that necessitate widespread vaccination coverage among them. This study aimed to assess Nigerian undergraduate students' knowledge, coverage, and barriers to COVID-19 vaccination.

Method:

A cross-sectional survey of Nigerian undergraduates was conducted in October 2021, using an online questionnaire and a combined simple random and snowballing sampling technique. The questionnaire included sections on respondents' demographic characteristics, COVID-19 vaccine awareness, coverage, barriers, and recommendations. A total of 326 respondents electronically completed and returned the informed consent form along with the questionnaire. The data obtained were analyzed using the statistical package for the social sciences (SPSS) version 25.

Results:

The overall awareness of COVID-19 vaccines among the sampled students was high; with 62.3%, 20.9%, and 16.9% having good, average, and poor levels of knowledge respectively. However, a majority of the respondents (81.3%) had not received the vaccines. The most prominent barrier to vaccination was misinformation about vaccine safety (23.6%). Opening vaccination centers on campuses (18.6%), demonstrating vaccine effectiveness and safety (18.7%), and organizing awareness campaigns (17.2%) were the most frequently recommended actions.

Conclusion:

Most respondents were aware of the availability and potential benefits of COVID-19 vaccines; however, coverage remained extremely low. Our findings emphasize the importance of addressing vaccination barriers by public health stakeholders to achieve optimal COVID-19 vaccine coverage.

Introduction

The Chinese government reported to the World Health Organization (WHO) on December 31, 2019, an outbreak of viral pneumonia of unknown cause in Wuhan, Hubei Province, China.¹ The disease was dubbed COVID-19 after it was discovered to be caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2; formerly known as 2019-nCoV).² As more COVID-19 cases were reported outside of China, the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC) on January 30, 2020.³ The WHO declared the coronavirus outbreak a global pandemic on March 11, 2020, emphasizing the importance of enforcing mitigation measures by stakeholders in various countries.⁴

Accordingly, Nigeria responded quickly after the first few cases in the country were recorded. The Nigerian government restricted flights from 13 countries where COVID-19 was confirmed endemic, established a Presidential Task Force to enforce safety measures, began contact tracing, prohibited large social gatherings, placed several states on lockdown, approved stimulus packages for households and businesses, and ordered school closures.⁵ As a result, all academic institutions in the country were closed to reduce community transmission, with no provision for a viable alternative. While some tertiary institutions in Nigeria implemented online learning models to ensure education continuity, most institutions were completely shut down throughout the lockdown due to insufficient e-learning infrastructure to implement virtual learning. Tertiary institutions resumed physical activities in January 2021 to mitigate the devastating effects of school closure on Nigerian students.^6,7

However, due to overcrowding and inadequate health infrastructure in the majority of Nigerian tertiary institutions, the resumption of physical activities raised concerns about the increased risk of COVID-19 spread in the institutions, potentially worsening the national COVID-19 burden.⁷ As a result, a safe, nationally implemented vaccination program would most likely be the long-term solution to COVID-19. As evident in previous vaccination campaigns, vaccines have the potential to break the chain of transmission and stabilize the incidence of an infectious disease.⁸ Evidence suggests that densely populated settings like school campuses are at high risk of COVID-19 spread.⁹ As such, tertiary university students who interact in such settings are considered a priority group for the national vaccination program, according to the WHO SAGE value framework for the allocation and prioritization of the COVID-19 vaccination.³

In comparison to other parts of the world, Nigeria has had very low coverage of COVID-19 vaccination.¹⁰ Since the start of Nigeria's vaccination program on March 5, 2021, about 133 million vaccine doses have been administered. Only 45.5% of citizens had received at least one dose of the vaccine and only 39.4% were fully vaccinated as of November 5, 2023.¹¹ By implication, Nigeria missed the national COVID-19 vaccination coverage goal of 70% by mid-2022 recommended by the WHO.¹² Vaccine uptake and coverage are constantly hampered by factors such as fear, hesitancy, conspiracy theories, disgust, and distrust in the government.¹⁰ However, vaccination programs can only be successful if the vaccines are widely accepted by the citizens. It is worthy of note that there is a significant difference in the levels of knowledge, perception, willingness, and acceptance of the COVID-19 vaccines among citizens worldwide. This has been attributed to multiple factors including differences in socioeconomic, educational, health, age, gender, religious and personal belief statuses across the countries.¹³ As a result, to improve vaccination coverage and uptake rates in Nigeria, a context-specific approach at various societal levels is required.

It is important to understand the factors influencing vaccination intention and behavior of the people in Nigeria, particularly among undergraduate students, who are an important part of the large youthful populace.^3,14 Some studies have assessed the level and factors influencing vaccine acceptance or hesitancy among tertiary students in specific Nigerian institutions and disciplines, identifying similar predictors of acceptance as the general population.^14,15 However, it remains unclear how the willingness to vaccinate or its predictors translate to actual vaccination uptake among the students since the roll-out. More so, to design an efficient vaccination program, more data is required on the coverage rate of the COVID-19 vaccine as well as the student-reported barriers to vaccination uptake across diverse institutional settings and disciplines. Therefore, this study assessed the COVID-19 vaccination awareness, coverage, and barriers among students in Nigerian tertiary institutions in different regions across the country. It also investigated the students' agreement with previously reported recommendations on ways of increasing vaccination uptake. This will serve as a means of informing policies to enhance the country's COVID-19 vaccination program and reduce virus spread.

Methods

Study Design

This cross-sectional study employed an open self-administered online survey conducted via Google Forms from October 20^th to December 19^th, 2021. A combined simple random and snowballing sampling technique was used to recruit the respondents for the study. Undergraduate students in tertiary institutions in Nigeria were invited by sharing the survey's hyperlink via electronic mail and social networking platforms (Telegram, Facebook, Twitter, and WhatsApp), where the students interact. In turn, respondents were also requested to share the survey invitations on their social media pages and groups. To increase response rates, recurring reminders were sent via similar channels. The Google Form used was set up to only accept one response per respondent using their unique email address. To improve questionnaire completion, key survey questions were also designated as ‘required.’ The guidelines for Strengthening the Reporting of Ob‘ervationa’ Studies in Epidemiology (STROBE) were followed in conducting and reporting the findings of this study.¹⁶

Study Setting and Populations

Undergraduate students at Nigerian tertiary institutions were the target audience for this study. The survey was administered electronically and participants were contacted online. Eligible participants were Nigerian undergraduates above 18 years of age; with active studentship status; who were enrolled in an active academic session and had partially or completely resumed physical learning methods at their institutions; and who had a functional email account and internet access. Undergraduate students who did not meet the above eligibility criteria could not participate in the study.

Survey Questions and Outcomes Measure

The questionnaire for the study was developed using the WHO Strategic Advisory Group of Experts (SAGE) on Immunization's validated scale for assessing vaccination coverage¹⁷ and hesitancy,¹⁸ literature review, and relevant discussions with experts. Independent survey experts reviewed and validated the final survey tool. A pilot study of 48 undergraduate students was conducted to determine the tool's face validity. The pilot study's sample was excluded from the main study.

The research survey tool was divided into three sections. Following the consent form, the first section collected respondents' demographic data: age, place of residence, location of institution, level of study and mode of instruction at school at the time of the survey. The second section assessed respondents' knowledge of COVID-19 and COVID-19 vaccines, as well as their vaccination status at the time of the survey. The vaccination status assessment involved the number of doses of the available vaccines received, the vaccination schedule, and facility used. These first two sections were made up of closed-ended questions with the response options designed as categorical variables. The final section investigated the perceived or experienced barriers to COVID-19 vaccination by respondents, as well as recommendations for improving vaccination coverage among Nigerian undergraduate students. The response options in this section, also framed into categorical variables, were derived from a list of commonly reported barriers and recommendations in the literature,^19-21 while the respondents were allowed to include unmentioned ones.

Sample Size

The minimum sample size for this study was calculated using the formula described by Kadam and Bhalerao²²: n= Z² ×S²/m² Where n is the sample size; Z is z-value for a 95% confidence level (1.960); S is the population standard deviation (0.5); and m is the margin of error of 5%. The minimum sample size was determined to be 385.

Data Preparation and Analysis

The survey responses were downloaded into a Google spreadsheet and then imported into IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, NY, USA.) for data analysis. The categorical variables were presented as frequencies, percentages, and histograms, as appropriate.

The level of knowledge (awareness) about COVID-19 and its vaccines among the respondents was assessed by scoring and summing the respondents' responses to the questions asked with this objective. Four questions (Table 1) were asked and each appropriate answer was given a score of 1. Those who scored 1 out of 4 or less were categorized as having “poor” knowledge, 2 out of 4 as “average” knowledge, and 3 out of 4 and 4 out of 4 (i.e. above average) as “good” knowledge (See Result). Two questions were used to assess vaccination coverage – ‘Have you received any of the COVID-19 vaccines?’ and ‘number of doses taken so far’ with options for respondents to choose from. The proportion of the respondents that had received at least a dose of the vaccines at time of the survey was calculated. Chi-square test was used to determine the association between knowledge level and vaccination coverage among the respondents. A p-value of <0.05 was considered statistically significant. Descriptive statistics were conducted on the reported barriers and recommendations for improved vaccine uptake among the respondents.

Results

Socio-Demographic Data of the Respondents

A total of 326 responses were obtained and analyzed. Most of the respondents were between the ages of 18 and 29 (97.2%) with more male respondents (54.3%) compared to females (45.7%). The represented institutions were mostly from the south-western part of the country (43.9%) followed by the south-south (22.1%) and south-east (17.8%). 89.3% of the respondents resided in the urban parts of the country while the remaining 10.7% lived in rural areas. The educational level of the respondents ranged from 100 level to 600 level with 500 level students accounting for 33.7% of the total respondents, closely followed by 200 level students (29.8%). At the time of the survey, the majority (59.3%) of respondents had fully resumed physical learning methods, 38.7% were in programs running both physical and virtual lectures simultaneously, while 2.1% were having solely virtual lectures (Table 2).

Respondents' Knowledge of COVID-19 and the COVID-19 Vaccine

Four questions (Table 1) were asked of the respondents to assess their knowledge of COVID-19 and the COVID-19 vaccine. Knowledge of COVID-19 and COVID-19 vaccines, according to literature, entailed understanding the likelihood of COVID-19 spreading on and off campuses, the availability of COVID-19 vaccines in Nigeria, and the ability of the vaccines to protect against COVID-19. These indicators correspond to data provided by health authorities both locally and globally. 62.3% of the respondents had good knowledge while 20.9% and 16.9% had average and poor knowledge, respectively.

Assessment of the COVID-19 vaccination coverage among the respondents

COVID-19 vaccination coverage level of the respondents was determined by the number of respondents that have received at least one dose of the vaccine at the time of the survey. Only 61 respondents (18.7%) had received at least one dose of the vaccine. Of these, 46 (75.4%) were fully vaccinated while the remaining 15 (24.6%) respondents had an incomplete vaccination status. 42.6% of those that had received the vaccine got their shots within the premises of their institutions while 45.8% claimed to have gotten the vaccine outside of their institution premises (Table 3). Correlation between the knowledge of COVID-19 and COVID-19 vaccine and vaccine coverage was carried out to determine if the level of awareness of the respondents had any significant influence on the level of vaccine uptake. Interestingly, we found that 91.8% (56/61) of the vaccinated respondents had ‘good’ knowledge of COVID-19/COVID-19 vaccines while 6.6% and 1.6% had ‘average’ and ‘poor’ knowledge respectively. Among the unvaccinated students, while 55.4% (147/265) of them had ‘good’ level of knowledge, 24.1% of them had ‘average’ knowledge, and 20.4% had ‘poor’ knowledge of COVID-19/COVID-19 vaccines at the time of the survey. A Chi-square test result indicated a significant association (χ²=28.189 P-value<0.001) between the knowledge of COVID-19/COVID-19 vaccines and vaccine coverage (Figure 1).

Figure 1

Association Between Vaccination Coverage and Awareness (Knowledge Grading) about COVID-19 and COVID-19 Vaccines Among Respondents.

Legend: Chart reflecting the associations between vaccination coverage (uptake of the COVID-19 vaccines) and awareness (knowledge grading) of COVID-19 and COVID-19 vaccine among respondents. Having a good level of knowledge is associated with a higher chance of getting vaccinated. However, other factors may influence actual vaccination coverage in the population. Χ² = 28.189, p < 0.001, n = 326.

Responses on barriers to COVID-19 vaccination

Rumors about the safety of the vaccine (23.6%), difficulty in accessing vaccination centers (16.1%) and lack of trust in the government or country of vaccine import (15.2%) were the most prominent barriers to vaccination considered by the respondents (Figure 2a).

Figure 2a

Barriers To Vaccination and Recommendations to Improve the Uptake of the COVID-19 Vaccines Among the Respondents.

Recommendations for improving vaccine uptake

Showing proof of vaccine safety (18.7%), opening of vaccination centers on campus (18.6%), and creating awareness on vaccine benefits (17.2%) were the actions mostly recommended by the students to improve their level of vaccine uptake (Figure 2b).

Figure 2b

Recommendations for Improving Vaccination Uptake Among Tertiary Students

Legend: a) Safety concerns and inaccessibility top the list of barriers to COVID-19 vaccination among respondents. b) Tested recommendations to improve COVID-19 vaccination uptake among tertiary-level students in Nigeria

Discussion

The extent to which an individual perceives the risk of an infectious disease and comprehends the potential benefits of vaccination influences their attitude toward vaccination.^23-25 Findings from our study indicate an association between the knowledge of COVID-19 vaccines and vaccination coverage i.e. individuals who demonstrate a high level of knowledge of COVID-19/COVID-19 vaccines are more likely to take the vaccines than those with poor knowledge. This suggests that understanding the risk of COVID-19 spread and the benefits of vaccination can increase the willingness to be vaccinated. Several studies have supported this assertion. A study in Jordan, for example, found that 76% of respondents had a good understanding of the vaccine, with 72.4% having a favorable attitude toward it and 71.3% intending to use it.²³ Also, a community-based survey in Ethiopia found that people with a good understanding of the vaccine were more likely to accept the COVID-19 vaccine.²⁶ Furthermore, in Bangladesh, vaccine acceptability among the 605 adults included in a study was found to be significantly related to their knowledge of the COVID-19 vaccine, with up to 60% of the respondents willing to be vaccinated and those with good understanding of COVID-19/COVID-19 vaccines showed 22.23 times higher odds of accepting the COVID-19 vaccine compare to people with lower knowledge.²⁷ A study in Malaysia, however, contradicts these findings. The web-based cross-sectional study, which assessed the knowledge, perception, and acceptance of the COVID-19 vaccine among 1,406 Malaysians, found that even though 62% had little or no knowledge of the vaccine, 65% were still willing to take it.²⁸ This could be due to the population's perception of the infection's risk.

According to our findings, the majority of undergraduates (83.2%) are aware of the availability of the COVID-19 vaccines at the designated vaccination centers and potential benefits of the COVID-19 vaccine. However, coverage remains very low (18.7%). This suggests that willingness to take the vaccine does not always translate into actual vaccination. Although increased knowledge can increase the willingness to get vaccinated, other identified vaccination barriers must be overcome to improve vaccine coverage. The fear of vaccine side effects emerged as the most significant barrier in this study. Similarly, according to the Ipsos survey, the top three barriers were “worry about side effects,” “doubt about vaccine effectiveness,” and “perception of not being sufficiently at risk from COVID-19”.²⁹ Furthermore, a survey conducted by Africa CDC in 15 African countries revealed that the reasons for not accepting COVID-19 vaccines were primarily based on trust in vaccines and perceptions of their safety and efficacy.⁸ Access to vaccination centers is another significant barrier to COVID-19 vaccination among these students (16.1%). Access to vaccination centers can be challenging, leading to low vaccine uptake and vaccine hesitancy.²⁴ Low vaccine uptake is especially problematic in low and middle-income countries, where factors such as a lack of resources, poor roads for transporting vaccines, insufficient cold-chain and storage, and limited funds for surveillance all play a role.^29-32 A study of COVID-19 vaccination disparities among low-, middle-, and high-income countries found that the national economic level of low and middle-income countries, as well as other socioeconomic factors, have a negative impact on vaccination levels and access to vaccination in these countries.³¹ Findings from our study further identified belief in natural immunity, lack of knowledge about vaccine availability, vaccine affordability, rumors about vaccine safety, regulations, vaccine unavailability, regular absence of vaccinators, distrust in the government, and vaccinators' poor attitude as potential barriers to COVID-19 vaccination. These reported barriers are consistent with studies in China,³³ Zambia,²² Malaysia,³⁴ and six Southeast Asian countries,³⁵ in addition to Nigerian studies.^8,21

To overcome vaccine hesitancy caused by the fear of vaccine side effects, our respondents suggested that stakeholders demonstrate proof of vaccine safety, such as displaying scientific evidence of successful vaccinations. The students also suggested that various awareness campaigns should be developed to increase the knowledge of the vaccine's benefits while emphasizing the pandemic's perceived risk. This can be achieved via targeted educational interventions and/or media promotions: e.g. as described by Lessard and colleagues, which may include convening symposia with the students, where the benefits and safety concerns about the vaccines can be addressed by trusted healthcare professionals; and through the use of broadcast and outdoor media tools like flyers, billboards, wallscapes etc. sited strategically in the institutions.³⁶ Furthermore, establishing vaccine advocacy groups on campuses was popular among the respondents and we predict this to be suitable and effective in promoting COVID-19 vaccine acceptance among the students. Starting a new student club or leveraging existing public health-leaning clubs on campus to disseminate sound information about COVID-19 vaccines and encourage vaccine uptake may be an efficient way to implement this. Studies have underscored the critical role students can play in response to the pandemic outbreak, from awareness creation to contact tracing, screening, and vaccine promotion.^37-39 Additionally, in Nigeria, student-led advocacies and peer educator initiatives have been shown to promote positive beliefs and attitude toward disease prevention and vaccination among students.^40,41

To address the challenges with COVID-19 vaccine accessibility among undergraduate students, the students proposed that vaccination centers should be established on campus. Availability of on-campus vaccination centers can ameliorate the difficulty in accessing vaccination centers. Existing health centers or clinics in the institutions can be used for this purpose, although necessary infrastructure such as cold chain storage facilities and trained personnel must be provided. Scheduled visits to campus using mobile vaccination teams may also work where permanent maintenance of cold chain and other infrastructure on-campus is not feasible due to cost.⁴² Administering vaccines first to principal officers was recommended, which is expected to boost the confidence of the students in the safety of the vaccine. Providing vaccines at no cost to the student was also suggested as a means of increasing vaccine uptake. Willingness to pay for the COVID-19 vaccines has been generally low in the Nigerian populace, with some early surveys citing as much as three-quarter of respondents preferring the vaccines to be offered for free.^43,44 Along this line, the government of Nigeria through the primary health care program have made the COVID-19 vaccines available free of charge for all citizens; the policy could have encouraged earlier receivers of the vaccines, including some of our vaccinated study respondents. Furthermore, demanding proof of vaccination as a ticket to important activities, such as examinations and convocations, was also recommended. Notably, this is the least popular recommendation among our respondents and it likely reflects the bigger controversy about the acceptance and justification of the mandatory vaccination policies in the public. Vaccine mandates can be an effective means to improve vaccination coverage among students, for example, Couture and colleagues (2023) demonstrated in one American college that mandating vaccination on campus increased the likelihood of taking the COVID-19 vaccine among the students.⁴⁵ Smith and Emanuel (2023) had further argued that vaccine mandate policies serve greater public health good and the policies are not necessarily coercive, discriminatory nor infringing on civil liberties as claimed by opponents.⁴⁶ They maintained that the policies are not uncommon e.g. among health workers, and are justifiable given the exceptions for medical and religious objections, communal benefits similar to tax and speed limit laws, and individual free will to disengage from circumstances or settings where vaccine mandates apply.⁴⁶ However, the WHO in its 2022 policy brief on mandatory vaccination has cautioned policymakers to balance vaccine mandate considerations with other values such as necessity for a defined objective, evidence of efficacy and safety, accessibility, public trust, and ethical procedures to prevent negative societal outcomes.⁴⁷ Overall, policies and strategies that encourage voluntary participation in vaccination such as educational and accessibility measures should be prioritized over intrusive means like a mandate, especially in complex settings like a tertiary institution.⁴⁷

Limitations

The main strength of our study is in capturing the Nigerian tertiary students' perceived barriers to vaccine uptake and their recommendations for improving the prevalent low vaccine uptake. Our study allows students to suggest how health policies should be implemented and improved. Furthermore, our findings showed that increased vaccination knowledge does not always translate into increased coverage. Vaccination barriers must be overcome for coverage to increase.

The main limitation of our study is the small sample size. This may limit the generalizability of our result, which might to totally represent the opinions of the entire undergraduate population in Nigeria and may warrant confirming the findings and recommendations in subsequent studies among a larger cohort of Nigerian undergraduates. However, we believe that the inclusion of our study participants from across the different regions of the country may enhance the representativeness and applicability of our findings. Also, we acknowledge that the reality of the COVID-19 pandemic in Nigeria may have changed over the periods between data collection and final publication. While this may determine the urgency with which the recommendations given should be applied, we are convinced that the recommendations can contribute to future pandemic preparedness or response among the study population.

Conclusion

This study found a link between good knowledge of COVID-19 and its vaccines and the uptake of the COVID-19 vaccines among Nigerian undergraduate students. However, safety concerns about the vaccines and inaccessibility of vaccination centers are barriers strong enough to cause vaccine hesitancy and low vaccine uptake among students. Thus, to improve vaccine uptake, the safety of the vaccines needs to be demonstrated to the students by health authorities. Additionally, student-centered campaigns and initiatives should be launched to promote the benefits of vaccination and raise the awareness of the risks of the pandemic and vaccine hesitancy. Importantly, vaccines should be provided at no cost, and vaccination centers should be opened on campuses to improve accessibility. Future vaccination programs and related health interventions should consider target population peculiarities for effective implementation.

Summary – Accelerating Translation

This study titled “Awareness, Coverage, and Barriers to COVID-19 Vaccination among Undergraduate Students in Nigeria” is an observational study aimed at generating the necessary data required to design an effective COVID-19 vaccination program for undergraduate students in Nigeria.

The COVID-19 pandemic is still at force in Nigeria with reports of new variants of the virus. Since December 2021, the Nigerian Center for Disease Control and Prevention (NCDC) has been monitoring various emerging sub-lineages and variants of the virus in the country. Also, the COVID-19 vaccines have been rolled out since the second quarter of 2021 but uptake and coverage are still far below the needed threshold. About a third of the 207 million Nigerians are currently fully vaccinated. The resumption of physical learning activities in various tertiary institutions presents a need to prevent fatal outbreaks at the institutions. Studies have shown that places with a large number of inhabitants, such as school campuses, are potential hotbeds for COVID-19 virus spread. The WHO has also recognized this and has specified that tertiary students should be prioritized in vaccine allocation. Hence, the study is focused on this sector of the Nigerian population.

Hesitation towards getting vaccinated is a global problem that is prevalent in Nigeria, particularly among the large youthful populations, which includes tertiary students. This study investigated the knowledge (awareness), coverage (how much utilized), and barriers to the uptake of vaccines among tertiary students in the country. We conducted an online survey, where electronic questionnaires were administered to willing undergraduate students (respondents) in Nigeria and the data obtained were analyzed.

From the results of our study, we observed that a large proportion of our respondents were well aware of the availability and benefits of the COVID-19 vaccine. Yet, approximately 4 of every 5 respondents had not received a dose of the vaccine. The main reasons cited by the respondents were the fear of side effects and unavailability of vaccination centers on their campuses. To this end, most of the respondents agreed that providing proof of vaccine safety, opening vaccination centers on campus, and promoting the vaccine through tertiary students are viable ways to improve the acceptability and uptake of the COVID-19 vaccine among tertiary institutions students.

Acknowledgments

We appreciate all invited reviewers for their invaluable insight, which have significantly enhanced the quality of this work.

Conflict of Interest Statement & Funding

The Authors have no funding, financial relationships or conflicts of interest to disclose.

Author Contributions

Conceptualization: FBE, IAH. Formal analysis: FBE. Writing-original draft: FBE, IAH, DAO, CPO, JBA, EEB. Review/Editing: KEE, YAA].

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Fortune B. Effiong, 1 BMLS. Department of Clinical Chemistry and Immunology, Faculty of Medical Laboratory Science, University of Calabar, Nigeria; Directorate of Research, TORASIF, Nigeria; African Community for Systematic Reviews and Meta-analyses (ACSRM), Rwanda.

Ibrahim A. Hassan, 2 BPharm. Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria; Directorate of Research, TORASIF, Nigeria.

Dimeji A. Olawuyi, 3 Fourth-year Medical Student. Department of Medicine and Surgery, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria; Directorate of Research, TORASIF, Nigeria.

Chiemela P. Ogbonna, 4 BMLS. Department of Medical Laboratory Sciences, Abia State University, Uturu, Nigeria.; Directorate of Research, TORASIF, Nigeria.

Jeremiah B. Araoye, 5 BPharm. Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria.

Esther E. Bassey, 6 BSc. Faculty of Basic Medical Sciences, University of Uyo, Uyo, Nigeria.; Directorate of Research, TORASIF.

Kenneth E. Enwerem, 7 MD. Omega Cares Foundation, Jos, Nigeria.

Yusuff A. Adebisi, 8 BPharm. Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.; Global Health Focus (GHF), UK.

About the Author: Fortune Benjamin Effiong is a Medical Laboratory Scientist from the University of Calabar, Calabar, Nigeria. He is the director for research at The Outstanding Researchers and Scientific Innovators Forum (TORASIF), Nigeria.

Correspondence: Ibrahim Adebayo Hassan. Address: [Institution of affiliation address]. Email: hadebayoibraheeem@gmail.com

Editor: Francisco J. Bonilla-Escobar; Student Editors: Marina Shatskikh & Mohamed Hoosen Suleman; Proofreader: Laeeqa Manji; Layout Editor: Ana Maria Morales; Process: Peer-reviewed

Cite as Effiong FB, Hassan IA, Olawuyi DA, Ogbonna CP, Araoye JB, Bassey EE, et al. Awareness, Coverage, and Barriers to COVID-19 Vaccination among Undergraduate Students in Nigeria. Int J Med Stud. 2023 Oct-Dec;11(4):262-70.

Copyright © 2023 Fortune B. Effiong, Ibrahim A. Hassan, Dimeji A. Olawuyi, Chiemela P. Ogbonna, Jeremiah B. Araoye, Esther E. Bassey, Kenneth E. Enwerem, Yusuff A. Adebisi

This work is licensed under a Creative Commons Attribution 4.0 International License.

International Journal of Medical Students, VOLUME 11, NUMBER 4, December 2023