Assessing Mechanisms for Delivery of COVID-19 Vaccines to University Students

Lead Research Organisation: University of Leicester
Department Name: Genetics

Abstract

Achieving a high level of vaccine coverage and immunity among university students is urgent and critical for the long-term control of COVID-19 infections. Mixed methodologies will be used to survey university students' attitudes to COVID-19 vaccination as part of a strategy to develop informed recommendations on university involvement in vaccine programmes. Multiple studies indicate that students are high-risk spreaders of COVID-19 with students' arrival on campus in the autumn of 2020 likely to have contributed to the second wave of the pandemic in the UK. With universities being a major industry, effective delivery of vaccines to students is essential for the inter-twined goals of economic recovery and breaking COVID-19 transmission cycles.

University student cohorts are ethnically, economically and geographically diverse with international students being a major, economically-important sub-set of the student population. Delivery of effective student-centred COVID-19 vaccine campaigns will require a clear understanding of how these different student groups perceive the vaccines and whether differing experiences during the pandemic will negatively or positively impact on decisions relating to vaccine uptake. The University of Leicester (UoL) provides an ideal case study. One reason is because UoL is located in one of the cities worst affected by COVID-19. But more importantly, UoL has an exceptionally diverse student population with ~50% having BAME backgrounds and boasts a vibrant international student community.

We aim to deliver a vaccine-focussed questionnaire to a large-proportion of the current UoL student cohort whilst making sure of representative coverage of a range of home and international students. We will then conduct 40-80 follow-up semi-structured interviews with specific sub-groups. One set of survey questions will focus on knowledge of the effectiveness and accessibility of COVID-19 vaccines and, as comparators, vaccines that are critical for protection against meningitis, measles and mumps. Another set of questions will focus on vaccine complacency and hesitancy. As a younger age group, students may be less inclined to take up vaccines because of perceptions of a lower risk of falling seriously ill with COVID-19. Moreover, as digital natives, students are comparatively more likely to be exposed to disinformation about COVID-19 vaccines circulating on social media, such as the myth that vaccination leads to female infertility. A final question set and the interviews will examine pandemic experiences. These aspects will focus on COVID-19-related discrimination based on race and ethnicity or prejudice encountered purely on the basis of being a student in a university town, along with the detrimental impact of prolonged lockdowns on wellbeing and individual freedom. There will also be interview questions about students' exposure to media coverage of the pandemic. These factors may all shape students' evaluation of COVID-19 vaccination as a way of returning to 'normal', pre-pandemic life.

As an inherently mobile and transient population, university students may be among the hard-to-reach groups for COVID-19 vaccination programmes. In consultation with Public Health England and other stakeholders, we will utilise evidence from our questionnaires and interviews to develop COVID-19 vaccine-delivery recommendations that will be applicable across the entire university sector. The applicability of our ideas will be further explored in a follow-on ESRC application for a multi-partner, multi-institutional project to evaluate COVID-19 vaccine uptake and delivery mechanisms among different student groups and a range of institutions (i.e. universities of differing sizes, types and parts of the country). This application will also address the important long-term goal of developing effective policies on vaccine delivery to undergraduate students that are achievable by all higher educational institutions.
 
Description Our research proposal aimed to contribute to development of student-centred vaccine policies and delivery of effective vaccine campaigns for COVID-19 and other infectious diseases within the university sector. Our hypothesis was that students would respond positively to such campaigns if provided with appropriate information and vaccines are readily accessible. We sought to understand these issues through questionnaires and interviews with undergraduate students at the University of Leicester. We also organised two workshops with participants from a range of stakeholders to discuss the findings of our research and current policies relating to delivery of vaccines to students.

Key achievement 1. New data sets. Questionnaire data was obtained from 827 students in June 2021 and comprised 29 questions covering demographics, vaccines, COVID-19 disease and harassment. Interview data was obtained from 34 students and covers vaccine hesitancy, disease and harassment experiences.

Key achievement 2. Improved knowledge on general determinants of vaccine hesitancy. COVID-19 vaccine hesitancy was found to higher among individuals who were concerned about the side-effects of these vaccines and for students living at home. Students were in general not concerned about hospitalisation, however concerns about spreading the disease to others were higher among students who were willing to be vaccinated. We also found that hesitant students perceived vaccines to be riskier and not as valuable as natural immunity (measured through a VAX score).

Key achievement 3. Influence of ethnicity and nationality on vaccine uptake. COVID-19 vaccine hesitancy among students was found to be associated with black ethnicity but not with other ethnic groups. A small number of responses indicated that this may be influenced by perception that these vaccines have not been adequately tested on all ethnic groups. Vaccine uptake was however not significantly lower among international students.

Key achievement 4. Informed data on student-centred vaccine campaigns. Significant numbers of students were found to be unsure about or to have not had two critical childhood vaccines - MMR and MenACWY - that protect against measles, mumps, rubella and certain types of meningitis. Uptake of these vaccine was significantly lower among international students. High levels of students were in favour of on campus vaccine campaigns with international students particularly favouring these campaigns. These campaigns were particularly favoured by students living in private residences or halls of residence.

These key achievements relate to our four original objectives meaning that we have fully met the goals of our research proposal. These achievements have led us to recommend that universities pursue on campus vaccination campaigns for COVID-19 and other vaccines. We have also recommended that updates to the NHSapp enable students to check their childhood vaccinations and hence to make informed decisions on taking up missed vaccines as adults. Finally our achievements indicate that we need to consider targeting information to students to address specific concerns in order to reduce hesitancy and increase vaccine uptake.
Exploitation Route Our findings are of interest to academics interested in vaccine hesitancy, to student groups, university welfare, public health and charities interested in vaccine delivery to students and to governmental advisors interested in vaccine policies. Each of these groupings may utilise and take forward our findings. Academics will be able to utilise our questionnaire for generating new comparable datasets. Academics will also be able to utilise our data outputs for comparative analyses with data generated for other population groups or students in other countries. Groups interested in vaccine delivery will be able to interrogate our findings to improve delivery of vaccines by students through improving information around vaccines with targeted approaches for different groups or addressing areas of concern. These groups may also utilise our data on student attitudes to vaccine delivery and our recommendations to implement on campus vaccine delivery to improve uptake of COVID-19, MMR and MenACWY vaccines among student populations. Policy makers may also consider our outputs in designing national vaccine delivery programmes and specifically to improve utilisation of electronic vaccine records through the NHSapp to increase individuals awareness of their vaccination status.
Sectors Healthcare

 
Description We are in the early stages of generating and assessing the impact of our research. Our questionnaire generated information on student perceptions of delivery of vaccines on the University of Leicester campus including the ways in which the students became aware of a pop-up vaccine campaign that was run just prior to our survey. We passed this information on to the University of Leicester Student Support services so they could evaluate the effectiveness of their advertising and the value of running the pop-up vaccine campaigns. We have also provided information on vaccine uptake and on campus vaccines campaigns from our survey to Universities UK, Public Health England and MeningitisNOW in order for them to assess policies in this area. This is a developing area and an area where scenarios have changed rapidly making it difficult to assess whether our information has impacted policy or procedures. Vaccine delivery on campus is however an important and under-researched aspect of university well-being policy and our research will help to nucleate studies of these issues as a novel research area.
First Year Of Impact 2021
Sector Healthcare
Impact Types Policy & public services

 
Title Assessing Mechanisms for Delivery of COVID-19 Vaccines to University Students, 2021. Data collection. 
Description population group is crucial for combating these diseases. Targeting of COVID-19-specific vaccines to students is highly likely to be necessary for breaking cycles of COVID-19 transmission. Universities have played key roles in disseminating information on infectious diseases and the use of vaccines as protective measures. Maintenance of this information flow throughout the pandemic has helped universities with protecting their young adult populations against COVID-19. Universities are also substantial economic engines with home and international students being crucial funding sources. Our primary aim is to understand students' knowledge of and attitudes to COVID-19 vaccines. Our secondary aim is to develop bespoke data-informed recommendations for universities on delivery of these vaccines to students. These goals are urgent and imperative as student-focussed vaccine campaigns will have significant roles in combatting COVID-19 in both the short and long-term. Universities have played key roles in disseminating information on infectious diseases and the use of vaccines as protective measures. Maintenance of this information flow throughout the pandemic has helped universities with protecting their young adult populations against COVID-19. Universities are also substantial economic engines with home and international students being crucial funding sources. The dataset from a survey of University of Leicester undergraduate students in June 2021 is made available. The dataset contains 827 cases (questionnaires) and 78 variables. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
Impact Publication on medRxiv. 
URL https://reshare.ukdataservice.ac.uk/855372/
 
Description UniCoVac position paper: Considerations for University Campus-Based Programmes for COVID-19 and other infectious disease vaccines 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact This position paper outlined the requirements for setting up vaccine programmes for university students on campus. The article utilised information from our study to develop these recommendations and was reviewed by our collaborators from Public Health England. We have include a link to this article in our published research paper and provide the link to participants in our workshops.
Year(s) Of Engagement Activity 2021
URL https://journals.le.ac.uk/ojs1/index.php/lias/article/view/3849
 
Description Workshop 1. UniCoVac Workshop on Attitudes of University Students to COVID-19 and Other Infectious Disease Vaccines 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Workshop attended by 22 individuals. Eight external individuals from Public Health England, Universities UK, PHE Universities Settings Panel, Oxford Vaccine Group, University College London and MeningitisNOW. Seven internal individuals represented Student Wellbeing, Law School, Dept Media, Communications and Sociology, Genetics and Genome Biology and UK-REACH. The purpose was to disseminate and discuss the implications of the findings of our study on the student uptake, knowledge and attitudes to COVID-19, MMR and meningitis vaccines.
Year(s) Of Engagement Activity 2021
 
Description Workshop 2. Effects of Pandemic Experiences and Media on Vaccine Hesitancy and Well-Being Among University Students. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Undergraduate students
Results and Impact Our ESRC-funded study (UniCoVac) included a questionnaire with a range of demographic questions, questions on vaccine hesitancy and sources of information and questions about harassment arising during the pandemic. The University of Leicester has both an ethnically diverse student cohort and a large number of international students whose attitudes to vaccines and experiences during the pandemic were varied and hence this was a valuable study population. The questionnaire was followed up by a series of interviews where vaccine hesitancy and pandemic experiences, such as harassment, were discussed in more detail. This second workshop focussed on these issues vaccine hesitancy among students and student experiences during the pandemic. The workshop included presentations from other on-going studies alongside talks on the data both from our questionnaire and initial round of interviews. These presentations were complemented by small group discussion on the following issues: demographic effects and vaccine hesitancy; tackling vaccine hesitancy among specific groups; hate crime and the student pandemic experience; and pandemic support strategies. The workshop finished with discussion about recommendations for providing information, vaccine delivery and support during pandemics.
Year(s) Of Engagement Activity 2021