Determining COVID-19 vaccine acceptance, risk perception and general attitudes toward COVID-19 vaccination are keys to defining prevention strategies, and allowing visualization of the perceived benefits of the investment that research laboratories had in developing COVID-19 vaccines, which is important considering the current global resurgence of various SARS-CoV-2 variants. This study, to the best of our knowledge, is the first study carried out to determine the COVID-19 vaccine acceptance, risk perception and general attitudes toward COVID-19 vaccination among college students and staff in the Southeastern Universities in Nigeria. Thus, in this study, 769 respondents took part in the survey with mean age of 24.37 ± 7.086 years, and participants’ minimum and maximum ages of 16 and 65 years, respectively. The highest respondents were in the age group of 15–25 years (554; 72.0%) followed by those within the age group of 26–36 years (165; 21.5%), while the least number of respondents were within the age group 59–69 years (6; 0.8%). Most of the respondents were Igbos (647; 84.1%), and there were more male 399 (51.9%) than female (47.7%) participants in the survey study, in contrast with the study by Jain et al. , which had more female respondents.
The number of respondents in this study is lower than 3089 gotten in France , 3805 in Lebanon , and 1062 in South Carolina USA , but higher than 330 gotten in China , 440 in the Northwestern Nigeria , 423 in Ethopia , 282 in a Southern USA University , and 655 in India . The disparity in the numbers of respondents may depend partly on ease of respondents’ access to questionnaires, location, culture, and/or the readiness of respondents to respond to the questionnaire. The mean age in this study is lower than 35 years mean age , 36.3 years mean age  and 42.5 years mean age  gotten from other studies. However, the mean age difference in these studies is probably due to the target population studied, where the mean age in this study is corroborated with studies by Qiao et al.  among college students in South Carolina, USA, where they found the mean age of the respondents to be 23.83 years, and 20.3 years gotten in France , showing that colleges students are mostly teens and young adults.
The 25.6% of the respondents who agreed to take the vaccine if made available in this study is quite small compared to 58.0% gotten from a study in France , 36.4% in China , 87% in Lebanon , 40.0% in the Northwestern Nigeria , 57.5% in USA , 73.9% in Greece , 74.47% in Nigeria  and 75.8% in Italy  carried out in various target populations. However, similar to what was obtained in this study, Nzaji et al.  found out that only 27.7% of HCW agreed that they would accept a COVID-19 vaccine if it was made available in the Republic of Congo, thus supporting or suggesting the findings that African countries have lower rate of vaccine acceptance, albeit COVID-19 vaccines. The good number of respondents who said they are not sure if they will accept COVID-19 vaccines in this study, are likely to be convinced to accept the vaccines if some of the factors such as well definition of the vaccine safety is met. Young adults generally tend to feel they are healthier than the older people, and probably feel they have lower risk of contracting COVID-19 as was shown in the study by Jain et al. , where only one-third (33.4%) of the student respondents in India were concerned about contracting the COVID-19 virus.
To further determine the vaccine acceptance among the university students and staff in this survey, the respondents were asked “Is COVID-19 vaccine safe and good to take?”, while 22% said Yes, 54.5% said Not sure, and 23.4% said No. The low vaccine acceptance in this study also depends on the belief by respondents that the timing for current COVID-19 vaccine is inappropriate as 224 (29.1%) said Yes, 290 respondents (37.7%) said No and 253 (32.9%) said they are not sure. Moreover, 75.7% said No that the vaccine should not be made compulsory, suggesting that the respondents do not want them to be compelled to take COVID-19 vaccine. The low percentage of vaccine acceptance in this study may also depend on the perceived risk. Thus, when the respondents were asked “Are you concerned about the side effects of COVID-19 vaccine?” 632 (82.2%) said Yes, while 67 (8.7%) and 70 (9.1%) said No and Not Sure, respectively. Similarly, Tobin et al.  stated that 436 (71.4%) of the respondents in their study stated that one of the reasons for their COVID-19 vaccine refusal is that they were concerned about the side effects.
Furthermore, when the respondents were asked “Do you think COVID-19 vaccine contain a dangerous substance?” 200 (26.0%) said Yes, 173 (22.5%) said No, while 394 (51.2%) said they were not sure. These responses show, however, that there may be high perceived risk of COVID-19 vaccine among the respondents. When compared with the findings in this study, Tobin et al.  revealed that in the general population of Nigeria, perception of risk was very high among 218 (17.8%) respondents, high for 288 (23.5%), low for 340 (27.7%) and no risk for 382 (31.1%) respondents. They however stated that HCW had a significantly higher perception of risk; 56.4% (88/156) of them compared to 39.0% (418/1072) of non-HCW. The big difference between the respondents that are concerned about the side effects (82.2%) and those that think COVID-19 vaccine contain a dangerous substance (26.0%), shows that the respondents are not afraid of being specifically targeted as was the case with poliomyelitis vaccine rejection in some Northern Nigeria states in 2003 , but of a general concern of vaccine side effects, which is common in some populations. Furthermore, the low vaccine acceptance and high risk perception in this may not be unconnected to the findings by Adebisi et al.  in their study to assess public perception of hypothetical COVID-19 vaccine in Nigeria. They revealed that among the 132 respondents that would not take the COVID-19 vaccine, the major reason for non-acceptance of COVID-19 vaccine was unreliability of the clinical trials [49 (37.12%)], followed by the belief that their immune system was sufficient to combat the virus [36 (27.27%)].
The trust of the citizens in national institutions will have a direct relationship with their level of acceptance of information originating from them, which will in turn affect their compliance or otherwise with government directives. Thus, when the respondents in this study were asked what they thought is the most reliable source of information on COVID-19 vaccine, majority of them, 442 (57.5%) said WHO, while as few as 148 (19.2%) said it is Nigeria Center for Disease Control (NCDC) (Table 2). Thus, the high reliance on WHO for information about COVID-19 vaccines may be attributed to the quality and reliability of the information published on weekly, monthly and quarterly bases by NCDC on current issues about COVID-19 vaccines, especially the safety profile and clinical trials and approval. Contrastingly, the study by Jain et al.  among India students revealed that about a little less than two-thirds (64.5%) of the students responded that they have trust in the healthcare system of India, and a little more than half (56.0%) responded that they have confidence in domestic vaccines.
The attitude towards COVID-19 general vaccination in this study showed that greater percentage (49.2%) of the studied population stated that they were unwilling to take COVID-19 vaccine if recommended by the government, and also 349 (45.4%) of the respondent said that they will not advice any of their family members to take the vaccines. However, greater percentage of the studied population 590 (76.7%) said that COVID-19 vaccine do not conflict with their belief. Contrasting to the existing health behavioral theories, although not accessed in this study, which posit that higher perceived susceptibility predicts stronger motivations of taking protective actions, such as vaccine uptake and inconsistent with extant literature on COVID-19 vaccine acceptance. Qiao et al. , found that perceived susceptibility was not significantly associated with COVID-19 vaccine acceptance among college students which may be attributed to the optimistic bias in college students who are not viewing the virus as a serious threat. The low willingness to take COVID-19 vaccine may also be an optimistic bias hinged partly on mistrust in the Nigeria government about the vaccine and also on their unconcern about the entire vaccination program.
We have shown in this study that the attitudes towards general COVID-19 vaccination is positively correlated to COVID-19 acceptance and risk perceptions towards COVID-19 vaccine. This is similar to the results of the study by Qiao et al. , in which COVID-19 vaccine acceptance was positively related with perceived severity of COVID-19 and fear of COVID-19. In this regards, the low acceptance of COVID-19 vaccine among the respondents in this study may not be unconnected with the well known facts that COVID-19 severity has been generally milder in many African countries including Nigeria when compared to most other parts of the world [26–28]. Furthermore, a similar study in another population group by Williams et al.  revealed that the willingness to receive a COVID-19 vaccination was positively associated with the belief that the COVID-19 outbreak is going to continue for a long time, and negatively associated with the belief that the media has over-exaggerated the risks of getting infected with COVID-19 viruses. Contrasting to the findings in this study, there were no significant correlations between intention to vaccinate and the other questions tapping perceptions of COVID-19, or with age. Williams et al.  further stated that higher levels of worry about COVID-19 were positively associated with perceived likelihood of infection, severity, and age. Similar to the findings in this survey, Nzaji et al.  found out that some measured variables on COVID-19 vaccine acceptance among HCW in the Democratic Republic of Congo were significantly associated with COVID-19 vaccine acceptance after stepwise selection including: older age, occupation, belief that isolation and treatment of people who are infected with COVID-19 are effective ways to reduce the spread of the virus.
The multivariable analysis in this study shows that the various faculties of the respondents were negatively associated with the COVID-19 vaccine acceptance, and the gender of the respondents was positively associated with risk perception of COVID-19 vaccine. Contrastingly, Jain et al.  revealed that those who trusted the healthcare system (vs. those who did not trust) and those who had confidence in domestic vaccines (vs. those who did not have confidence) had higher odds of reporting willingness to receive COVID-19 vaccines. Furthermore, the university affiliation of respondents in this study was negatively associated with risk perception, while age, gender and states of respondents were positively associated with risk perception of COVID-19 vaccine, and various faculties of the respondents is negatively associated with risk perception of COVID-19 vaccine. Tobin et al.  reported that among different population groups in Nigeria, respondents who were greater than 25 years were 1.66 times likely to accept a COVID-19 vaccine with acceptability increasing with advancing age. Muslims were 1.57 times likely to accept a vaccine compared with Christians. Also that the females were 0.77 times likely to accept the vaccine compared to males, and self-employed respondents were 0.68 times likely to accept a vaccine compared with those in government service (P = 0.02, 95% CI 0.52–1.03). Additionally, we found that the various faculties (B = -0.024; P = 0.001; 2.2% and B = -0.010; P = 0.0 45; 3.6%), university affiliations (B = -0.020; P = 0.029) and age (B = -0.011; P = 0.023; 3.6%) of the respondents were negatively associated with attitudes towards general COVID-19 vaccination, while the states of the respondents (B = 0.041; P = 0.014; 3.6%) was positively associated with attitudes towards general COVID-19 vaccination. Inasmuch as students are seen as trusted influencers and ambassadors of vaccine promotion , understanding their willingness to take COVID-19 vaccine would be helpful to advancing the effort in increasing the vaccine acceptance among the general population. Although, this study showed a low COVID-19 vaccine rate, strengthening the Nigeria government’s efforts on information dissemination about the COVID-19 vaccines and their safety profile will be helpful and thus may increase COVID-19 vaccine acceptance, especially among college students.
There were some limitations in this study, for example the respondents were predominantly students which limits the generalization of the involvements of both staff members and students. Moreover, there may be bias on the anonymity of the administration of the questionnaire. However, the study has advantage of using both online and manual approach that allowed for easier access to the survey questionnaire, thus covering a wider status of the study population.