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

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.