Factors Influencing COVID-19 Booster Vaccine Attitudes Among University Students: A Cross-Sectional Study

Background of the study

The COVID-19 pandemic, first reported in December 2019 in Wuhan, China, was officially declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organisation (WHO) on 30 January 2020 (Guo et al., 2020; WHO, 2022a). It rapidly spread to more than 200 countries, resulting in significant mortality (Hashim et al., 2021; WHO, 2022b). As of May 29, 2022, confirmed cases had exceeded 525 million globally, with over six million deaths (WHO, 2022c). In Malaysia, a wave of infections emerged in September 2020, with daily cases surpassing 4,000 by January 2021 (MOH, 2022a). By May 2022, Malaysia had recorded 35,660 COVID-19 deaths, equating to a 0.8% fatality rate out of 4,502,579 confirmed cases (MOH, 2022a). Recent Ministry of Health reports indicate a 50.4% decline in confirmed COVID-19 cases in 2024 compared to 2023, from 202,962 to 100,666 cases, alongside a marked drop in fatalities from 441 to 57 (Bernama, 2025). While Bernama highlights booster vaccination as a major contributor to this trend, these data should be interpreted in conjunction with peer-reviewed evidence linking booster uptake to reduced transmission and mortality (Abrescia et al., 2024; Wan et al., 2023).

Recent analyses have highlighted that, despite declining infection rates, booster vaccine uptake among individuals aged 18–30 remains disproportionately low in Malaysia and across Southeast Asia (Choi et al., 2025; Khoo et al., 2024; Marzo et al., 2022; Wong et al., 2022). University students, in particular, report concerns over vaccine safety, perceived necessity, and mistrust of information sources, which significantly reduce willingness to receive boosters (Min Htike et al., 2025; Jongmekwamsuk et al., 2024; Rangelova et al., 2024). These findings emphasise the importance of understanding behavioural and psychosocial determinants of booster acceptance within this group, as their mobility and dense social interactions place them at elevated risk of both acquiring and transmitting infections (Yu et al., 2024; Liu et al., 2024).

To curb the resurgence, various preventive measures were promoted, including the use of masks, physical distancing, and hand hygiene (Abrescia et al., 2024; Barattucci et al., 2022; WHO, 2022d). Concurrently, global vaccine development efforts accelerated (WHO, 2022e; CDC, 2022). Although vaccines substantially reduce severe disease and death (Lundstrom, 2024; Mor et al., 2021; Haas et al., 2021), studies confirm that immunity wanes over time (Walsh et al., 2024; Levine-Tiefenbrun et al., 2021; Falsey et al., 2021) and that vaccines may be less effective against highly transmissible variants (Chenchula et al., 2024; Plans-Rubio, 2023; Hayawi et al., 2021; Abu-Raddad et al., 2021; Lopez Bernal et al., 2021), necessitating regular booster doses (Milne et al., 2021). Malaysia responded to the Omicron wave by authorising booster administration (Bernama, 2022), aiming to reduce hospital burdens and avoid stricter restrictions. The WHO further recommends annual boosters for high-risk groups and biennial doses for the general population (Guarascio, 2022). In Malaysia, vaccines from Pfizer, AstraZeneca, and Sinovac received conditional approval for use as boosters once 80% of adults had completed the primary series (Latiff, 2022). At the same time, 85.6% of Malaysians received at least one dose, and 82.8% completed two doses; however, only 49.3% obtained boosters (MOH, 2022a; 2022b).

Numerous studies highlight that vaccine acceptance stems from a complex decision-making process influenced by perceived benefits and risks, trust, religiosity, and information exposure (Tavolacci et al., 2021; Machida et al., 2021; Rzymski et al., 2021). Public acceptance varies globally, with fear of infection, trust in leaders, and perceived efficacy as key factors (Detoc et al., 2020; Dror et al., 2020; Kreps et al., 2020; Al-Mohaithef & Padhi, 2020). Booster-specific studies report acceptance rates ranging from 55.3% in Saudi Arabia (Alhasan et al., 2021) to over 80% in China and among U.S. healthcare workers (Lin et al., 2020; Pal et al., 2021). Despite such international data, Malaysian studies remain sparse, focusing mainly on general vaccine hesitancy (Khoo et al., 2024; Barello et al., 2020) and adult populations (Rajakumar et al., 2023) rather than university students, who represent a socially dynamic group with higher transmission potential (Han et al., 2020; Lu et al., 2021).

Research on student populations is mainly limited to medical and dental cohorts (Arthur et al., 2023; Jaber et al., 2023; Lucia et al., 2021; Saied et al., 2021) or healthcare workers (Pal et al., 2021; Klugar et al., 2021). Broader young adult cohorts remain understudied, despite evidence suggesting that university students may act as potential superspreaders (Han et al., 2020; Zheng et al., 2020; Figliozzi et al., 2020; Guilamo-Ramos et al., 2021). Recent reviews (Wan et al., 2023; Kaighobadi et al., 2023) highlight the importance of examining diverse non-health disciplines to inform tailored outreach strategies.

Accordingly, this study aims to assess university students’ acceptance of the COVID-19 booster vaccine through positive attitudes and identify the significant psychosocial and behavioural predictors influencing their positive attitudes towards COVID-19 booster vaccination, including perceived benefits, perceived risks, religiosity, information-seeking behaviour, trust in key stakeholders, and government support. Using Universiti Kebangsaan Malaysia’s data as a case study, the findings will contribute to understanding vaccine-related behaviours among young adults and provide evidence-based recommendations for policymakers, healthcare providers, and higher education institutions to improve booster uptake.

Data collection

The data for this study was obtained through a questionnaire distributed online from January 1, 2022, to January 31, 2022, involving university students in Malaysia (see Table 1). Respondents were approached through a convenience sampling strategy, with the questionnaire distributed through the UKM Folio application and online platforms via email and WhatsApp. This approach enabled lecturers to connect with students online, focusing on those enrolled in the compulsory Philosophy and Contemporary Issues (Falsafah dan Isu-isu Semasa) course for Semester 1, 2021/2022, which involved 2,408 students across all faculties at Universiti Kebangsaan Malaysia. A total of 627 valid responses were collected, yielding a 26.04% response rate. Online surveys are widely recognised as an efficient and cost-effective method for collecting large-scale data, mainly when targeting university students who are highly engaged with digital platforms (Evans & Mathur, 2018). Given that Malaysian university students predominantly utilise digital communication channels, such as institutional e-learning portals and online platforms (Kassim et al., 2022; Al-Rahmi et al., 2018), deploying the questionnaire through UKM Folio ensured both accessibility and maximised the response rate. This strategy aligns with recent studies that indicate that self-administered digital surveys can yield high response accuracy among digitally literate populations (Dodemaide et al., 2020; Rada, 2019; Rada & Domínguez-Álvarez, 2014). Ethical approval was not required for this study based on the Guidelines for Ethical Review of Clinical Research or Research Involving Human Subjects (MOH, 2006). Respondent participation was entirely voluntary, and non-participation was an option. The protection of respondents' profile data was maintained. The datasets generated and analysed during the current study are available in the Mendeley Data repository, https://doi.org/10.17632/7g5dkwz9ys.2 (Arham, 2026).

Study design, location, participant engagement, and sample size

Study design and location

This study undertakes a comprehensive examination of the attitudes of Malaysian university students towards COVID-19 booster vaccinations, employing a rigorously designed quantitative cross-sectional survey methodology. A self-administered online questionnaire was used to gauge the perspectives of students effectively. This instrument was disseminated via UKM Folio, the official digital learning platform of Universiti Kebangsaan Malaysia, and through an online platform, with the link provided to the selected respondents via email and WhatsApp. By leveraging this institutional e-learning system and online channels, the study ensured structured and reliable access for participants, adhering to the best practices in health behaviour research (Wilkerson et al., 2014; Evans & Mathur, 2018).

Universiti Kebangsaan Malaysia's location in Selangor, Malaysia's most populous and economically dynamic state, provided an ideal context for this research endeavour. The choice of Selangor was not merely a convenience but a strategic decision. The state experienced a disproportionate impact from the pandemic, consistently recording the nation's highest COVID-19 cases and hospitalisations (MOH, 2022c). Consequently, extensive vaccination campaigns were implemented, including initiatives promoting booster doses, rendering it a pertinent locale for investigating vaccine-related attitudes. This state's enhanced public health engagement created a rich backdrop for examining how young adults responded to vaccination efforts.

Selangor is distinguished as Malaysia's most urbanised and developed state, attracting students from diverse backgrounds who seek to further their education at its numerous universities. Among these institutions is Universiti Kebangsaan Malaysia, a prestigious national research university that reflects Malaysia's rich mosaic of ethnicities, socio-economic statuses, and geographical diversity. Although this study focuses exclusively on Universiti Kebangsaan Malaysia students, the findings are interpreted as specific to this cohort rather than being generalizable to all Malaysian youth. However, the data provides insights relevant to similar urban, multi-ethnic university populations.

The focus on Universiti Kebangsaan Malaysia was both practical and strategic. As Malaysia's leading research university, Universiti Kebangsaan Malaysia is a hub for students from varied faculties and regions. Its compulsory Philosophy and Contemporary Issues course ensured participation from students with diverse academic and social backgrounds, enriching the study’s representativeness within the institution. Concentrating on a single institution also enhanced internal validity, as contextual factors such as university vaccination policies, healthcare access, and institutional communication channels could be more consistently examined.

Existing research suggests that institutional culture and engagement can significantly affect students' vaccine acceptance and health behaviours (Kecojevic et al., 2021). Universiti Kebangsaan Malaysia’s active role in pandemic response, including booster awareness campaigns, provides a robust setting to explore how institutional dynamics shape student attitudes toward vaccination.

Participant engagement

The emphasis on young adults, particularly those enrolled in university, is significant. This demographic plays a critical role in addressing the challenges posed by the pandemic. Young adults are frequently characterised by high mobility, social engagement, and influence within their peer networks (Bish & Michie, 2010). Although they face a lower risk of severe outcomes related to COVID-19, vaccine hesitancy within this group presents a significant challenge (Ganem et al., 2023). Contributing factors to their reluctance include a perceived lower risk, misinformation, and peer influence (Qiao et al., 2021). Therefore, it is imperative to explore their perspectives to develop effective health communication strategies that align with their specific concerns and motivations (Wan et al., 2023).

Understanding vaccine attitudes among young adults is increasingly essential in the contemporary landscape, particularly given their impact on public health initiatives. Consequently, this study selected UKM Folio as the primary platform for administering the survey. This decision allowed a dynamic and invested student population to engage, thereby minimising non-response bias and leveraging an official academic channel. This approach adheres to best practices observed in university-based health behaviour research, wherein digital platforms are instrumental in reaching respondents (Evans & Mathur, 2018).

The study employed a convenience sampling approach rather than random sampling due to logistical constraints and the need to focus on a specific, high-relevance population of undergraduate and postgraduate students at Universiti Kebangsaan Malaysia, who constitute the majority of young adults in an urban context. While this limits the generalisability of findings beyond this cohort, focusing on this group is justified as they are socially active, frequently engaged in group activities, and therefore play a pivotal role in vaccine-related public health interventions (Lu et al., 2021).

An online, self-administered questionnaire was employed as it is cost-effective, efficient for large-scale student populations, and supports anonymity, which encourages honest responses (Creswell, 2021; Ball, 2019; Couper, 2001). This method is widely recognised as suitable for post-pandemic health behaviour research, particularly when targeting digitally literate respondents. As the scope is deliberately limited to one institution, findings are interpreted strictly within the Universiti Kebangsaan Malaysia student population, while still offering functional implications for similar urban, multi-ethnic university cohorts across Malaysia.

This focus was driven by the recognised need to understand young adults' perceptions regarding vaccines, a demographic identified as pivotal in public health interventions due to their mobility and exposure to risk (Lazarus et al., 2021). Although generalizability is often most effectively achieved through simple random sampling, targeted sampling is widely accepted in behavioural and social science research, especially when examining specific subpopulations (Hurlburt, 1979; Imai, 1998). Additionally, previous studies have identified university students as potential superspreaders, attributable to their sociable lifestyles and densely populated living conditions (Lu et al., 2021). Thus, concentrating our investigation on this demographic enhances the relevance and applicability of our study.

Sample size

This study determined a sample size of 627 respondents, adhering to structural equation modelling (SEM) principles, which recommend a minimum of 10 to 15 participants per estimated parameter to ensure robust path analysis (Hair et al., 2019a; 2019b). The structural equation modelling (SEM) principles of Partial Least Squares Structural Equation Modeling (PLS-SEM) further validate our sample size, as this method is exceptionally proficient in managing complex models involving latent constructs, even with moderate sample sizes (Sarstedt et al., 2021). PLS-SEM has become increasingly popular in health behaviour research, especially in examining vaccine attitudes and decision-making processes (Qiao et al., 2021).

Addressing potential sampling bias

While online surveys can present challenges, such as potentially excluding individuals with limited internet access, we implemented various outreach strategies to mitigate this issue. By making the questionnaire available through institutional e-learning portals, we enhanced the likelihood of obtaining a more representative sample. Research shows that distributing surveys across multiple platforms effectively minimises biases associated with the digital divide (Lehdonvirta et al., 2021).

However, as this study employed a convenience sample drawn exclusively from Universiti Kebangsaan Malaysia students, a group predominantly comprising young adults in Selangor, the external validity remains limited. Participation was restricted to students with stable internet access and a willingness to engage with health-related topics, which may have skewed responses toward those who are more health-conscious or informed. Consequently, the findings should be interpreted as reflective of patterns among similar urban, multi-ethnic university populations rather than generalisable to all Malaysian youth.

Nevertheless, online, self-administered questionnaires remain widely endorsed in contemporary health behaviour research due to their cost-effectiveness, efficiency, and ability to facilitate anonymous responses, which can encourage more honest reporting (Creswell, 2021; Ball, 2019; Couper, 2001). Weaving these methodological considerations into this study not only upholds validity and reliability in examining vaccine booster attitudes among Universiti Kebangsaan Malaysia students but also proactively addresses the typical limitations of online survey methods through strategic design and robust statistical analysis.

Demographic characteristics of respondents

The present study engaged 627 university students, yielding a diverse sample characterised by various demographic dimensions, including gender, ethnicity, geographic origin, and history of prior COVID-19 infection. Table 1 illustrates a comprehensive demographic breakdown of the participants.

The gender composition of the sample revealed a predominance of female respondents, accounting for 70.2%, while male participants constituted 29.8%. This skewed distribution is consistent with patterns observed in health-related survey research, as noted by Babbie (2020) and Calixte et al. (2020). Regarding ethnic representation, the sample comprised 78.0% Malay, 11.6% Chinese, 6.2% Indian, and 4.2% from other ethnic groups. This ethnic distribution broadly corresponds to the demographic composition of the Malaysian population; however, it exhibits a slight overrepresentation of the Malay demographic, which may be attributable to the specific institutional context of Universiti Kebangsaan Malaysia, where a significant majority of the student body consists of ethnic Malays.

Geographically, the study population encompassed all Malaysian states, with respondents for the Philosophy and Contemporary Issues course at Universiti Kebangsaan Malaysia coming from diverse regions across the country. The highest proportions of students participating in the online survey via UKM Folio were from Selangor (30.8%), Johor (11.0%), and Perak (10.2%), indicating a geographically diverse cohort. Furthermore, 68.4% of respondents were residents of urban locales, in contrast to 31.6% from rural settings, offering a unique opportunity to investigate potential disparities in vaccine perceptions based on urban-rural distinctions.

Concerning prior COVID-19 exposure, 81.3% of participants reported having completed their primary vaccination series (received two doses of the COVID-19 vaccine). In comparison, 17.1% had finished their booster vaccination, and 1.1% were awaiting primary vaccination doses or were not registered for the COVID-19 vaccine. Notably, 26.3% indicated a history of COVID-19 infection, whereas 73.7% reported no prior infection, a factor that may significantly influence their risk perception and decisions regarding vaccine uptake.

Recognising that vaccine acceptance can be shaped by levels of awareness, the survey also evaluated students' knowledge regarding various booster vaccine types. The awareness level for mRNA-based booster vaccines, such as Pfizer, was 61.4%. In contrast, only 53.7% of individuals were knowledgeable about viral vector-based boosters, such as AstraZeneca, and only 47.0% had awareness of viral vector-based boosters, including Sinovac. Alarmingly, 27.1% of students expressed uncertainty regarding mRNA-based booster vaccines, with 32.7% and 36.7% unsure about their awareness of AstraZeneca and Sinovac booster vaccines, respectively. This indicates a significant gap in vaccine knowledge that could adversely affect their decision-making processes.

These demographic insights establish a fundamental understanding of the study population and lay the groundwork for subsequent analyses exploring the factors that influence booster vaccine acceptance, which will be elaborated upon in later sections of this study.

Research instruments

A self-administered questionnaire based on a validated study was distributed. The questionnaire included six independent variables (perceived benefits, perceived risks, trust in key players, knowledge, information seeking behaviour, and religiosity) to determine the respondents' attitudes toward COVID-19 booster vaccines. The questionnaire was prepared in the Malay language. The questionnaire was divided into two sections: Section A contained demographic questions, and Section B contained questions about predictive factors influencing the respondent’s intention to receive a COVID-19 booster vaccination, as listed in Appendix A. All questions were scored on a seven-point Likert scale ranging from one (strongly disagree) to seven (strongly agree).

Data analysis

The hypothesised relationships were evaluated using structural equation modelling based on the parameter estimation of partial least squares (PLS-SEM) with the aid of SmartPLS software (Sarstedt and Cheah, 2019). This method is advantageous when explaining complex behaviour by reasoning about the interaction of multiple factors (Ringle et al., 2015). First, the validity and reliability of the measurement model were evaluated. The structural model was then tested to ensure the hypotheses were correct, including the model fit test (Henseler et al., 2016; Hair et al., 2017a; 2017b). In addition, the relevance of the path coefficient and load was determined using a bootstrapping approach with 5,000 replicate samples. A normality test was also performed to ensure the data met the normality criterion (Ali et al., 2016, 2018; Hair et al., 2017a; 2017b; Ramayah et al., 2017; Henseler et al., 2016; Ringle et al., 2015).

Descriptive analysis

The results presented in Table 2 indicate that Malaysian university students engaged in relatively moderate information-seeking behaviour about the booster vaccine (mean score of 4.87). Interestingly, they perceived a high level of support from the government for the booster vaccine (mean score of 5.52) and have high trust in key players (mean score of 5.79) as well as religious acceptance associated with the booster vaccine (mean score of 5.90). They also indicated a moderate risk related to the booster vaccine (mean score of 3.57). Finally, they acknowledged that the booster vaccine offered extensive benefits and revealed highly positive attitudes towards the booster vaccine (mean score = 5.57).

Common method bias (CMB)

Harman's one-factor test examined the data set for potential common method biases (Podsakoff et al., 2003). The first (and most significant) factor accounted for 43.26%, and none of the general factors accounted for more than 50% of the variance, indicating that common method bias was not a serious problem in the data set (Babin et al., 2016; Harman, 1976). Second, the full collinearity (FC) test showed that the variance inflation factor (VIF) values were between 1.21 and 3.06 (below 3.33; see Table 2) (Kock and Lynn, 2012). This suggests that CMB is unlikely to be a serious issue in this study ( Table 3).

Measurement model

This study used a confirmatory composite analysis (CCA) procedure, as suggested by Hair et al. (2020). To evaluate the measurement model. First, the reflective measurements were assessed regarding their reliability and convergent validity. As presented in Table 3, all metrics for internal consistency reliability (CA, rho_A, and CR) were above the critical value of 0.7. Thus, the reliability of the measurements was acceptable (Hair et al., 2019a; 2019b). Furthermore, all the constructs had average variance extracted (AVE) values above 0.5 (Hair et al., 2019a; 2019b), establishing the convergent validity of all the measurements. Finally, the discriminant validity was assessed using the heterotrait-monotrait ratio of correlations (HTMT). As exhibited in Table 4, all the HTMT values were lower than the conservative threshold value of 0.85 (Henseler et al., 2015). This established discriminant validity among all the constructs used in this study.

Structural model

Table 5 shows that all the VIF values were well below the threshold of 3.33 – 1.189 to 2.90; thus, it can be concluded that this model did not pose a multicollinearity issue (Hair et al., 2019a). Next, Table 5 also shows the hypotheses for each path tested via a bootstrapping technique with 5,000 sub-samples (Streukens and Leroi-Werelds, 2016). The output for the entire dataset shows that most of the suggested hypotheses were statistically significant, except for government support on perceived risks (H2b: β = 0.087; t-value = 1.644) on attitude (H2c: β = 0.037; t-value = 0.881) and trust in key players on attitude (H3c: β = 0.047; t-value 1.061) (See Figure 2). The result also shows the coefficient determinations (R²) of 0.655 for perceived benefits, 0.220 for religious acceptance, and 0.727 for attitude. Finally, a blinding procedure assessed the model's predictive relevance (Q²). The Q² values for the endogenous variable were more significant than zero and ranged from 0.177 to 0.625, indicating that the model possessed acceptance of predictive quality (Hair et al., 2019a).

Figure 2. Structural model analysis.

Model fit

The standardised root mean square residual (SRMR) and normed fit index (NFI) are the fit measures used in this study to demonstrate model fit in PLS-SEM (Hair et al., 2017a, 2017b; 2019a, 2019b). Table 6 shows an SRMR value of 0.052, which is less than the threshold value of 0.08 and hence can be regarded as a good fit and suitable for PLS path models (Hu and Bentler, 1999). The NFI value is 0.883, considered a good match because it is close to 1 (Bentler and Bonett, 1980).

Limitations and implications

Study limitations and future research directions

This study acknowledges several limitations critical to enhancing the robustness of future research endeavours. Firstly, it employed an online questionnaire survey disseminated through UKM Folio, email, and WhatsApp platforms. This approach may have introduced selection bias by predominantly capturing responses from digitally literate and academically engaged students. Consequently, perspectives from those less connected to online platforms or from marginalised backgrounds may not be adequately represented. Moreover, as the sample was restricted to students from a single public university in Selangor, which is a highly urbanised and economically developed state with greater vaccine access and awareness compared to rural or less developed regions, the findings cannot be generalised to all Malaysian youth. Instead, the results should be interpreted as reflective of patterns among urban, multi-ethnic university populations, rather than as representative of students in other states or those with limited digital access. Future studies should address these gaps by incorporating hybrid data collection methods, such as in-person surveys and focus groups, to capture a broader and more diverse student demographic.

Secondly, the research was confined to participants in Selangor, a state characterised by urbanisation and development within Malaysia. This limitation raises concerns regarding the generalizability of the findings to vaccine attitudes among students from rural or less developed regions. Existing literature suggests that geographical disparities can significantly influence vaccine perceptions, with urban students typically exhibiting higher acceptance levels due to improved healthcare access and exposure to information (Kaighobadi et al., 2023). Therefore, subsequent studies should aim to expand data collection to encompass multiple universities across various Malaysian states, particularly those characterised by lower vaccination rates, to yield a more comprehensive national perspective.

Additionally, this study exclusively targeted university students, thereby limiting the applicability of the findings to other significant populations, such as healthcare professionals, educators, and the general public. Prior research indicates that vaccine attitudes may differ based on professional background, age, and exposure to health-related risks (Callow & Callow, 2021; Tunc & Cevirme, 2023). Accordingly, future research endeavours should facilitate comparisons of vaccine perceptions across diverse occupational groups, focusing on frontline workers involved in public health initiatives. Future research should not only include these diverse groups but also compare students across states and employ longitudinal designs to capture how attitudes shift in response to new variants, emerging policies, and changing risk perceptions.

Lastly, while this study investigated factors influencing vaccine attitudes, it did not delve into longitudinal behavioural trends, failing to capture the potential evolution of attitudes toward booster vaccinations. Given that vaccine hesitancy may fluctuate in response to new variants, emerging scientific data, and changes in public policy, future studies should employ a longitudinal research design to track these behavioural shifts over extended periods. By addressing these identified limitations, future research endeavours can enhance the applicability of findings, improve data accuracy, and provide more actionable insights to inform national vaccination strategies.

Practical implications for policymakers, healthcare providers, and universities

The findings of this study present significant implications for designing and implementing targeted interventions to enhance booster vaccine uptake among university students. The results indicate that perceived benefits are the most substantial predictor of vaccine acceptance. Consequently, public health campaigns should prioritise the effective communication of the protective advantages associated with booster vaccines in ways that resonate with young adult populations. Given that a substantial number of university students perceive themselves as being at low risk of experiencing severe COVID-19 outcomes, it becomes essential to emphasise the community-level benefits of vaccination, which include fostering herd immunity, preventing the emergence of new variants, and mitigating the risk of long-term health complications. By framing booster doses as an expression of social responsibility, policymakers may foster a heightened collective commitment to vaccination endeavours.

Additionally, the influence of religious beliefs on students’ attitudes toward the COVID-19 booster vaccine warrants particular attention. Collaborations with religious leaders and faith-based organisations can enhance vaccine confidence among this demographic (Kisa & Kisa, 2024). In Malaysia, where religious convictions significantly shape public sentiment, positioning vaccination as a moral obligation to protect oneself and the community can be an effective strategy (Arham et al., 2022a). Other countries, such as Indonesia and Saudi Arabia, have successfully integrated religious endorsements into their vaccination campaigns, illustrating the potential efficacy of faith-based messaging. Engaging religious scholars to provide clear guidance on vaccine permissibility and incorporating religious narratives into public health communication strategies can enhance vaccine acceptance among university students.

The role of healthcare providers is equally critical in fostering trust and addressing vaccine hesitancy (Pal et al., 2021; Lee et al., 2022a). The study’s findings reveal a notable credibility gap between students and health authorities, suggesting that trust in reputable figures did not substantially influence student attitudes. To bridge this gap, healthcare providers should consider implementing direct engagement strategies, including peer-led discussions, expert Q&A sessions, and social media campaigns that present evidence-based narratives to counter misinformation. Research indicates that students are more inclined to trust vaccine information from medical professionals when it is conveyed in an interactive and personalised format rather than through generic governmental messaging. Furthermore, universities should facilitate one-on-one counselling sessions that allow students to voice their concerns regarding vaccine safety, effectiveness, and potential side effects in a supportive and confidential environment.

In light of the escalating influence of digital platforms on vaccine-related decision-making, universities and health institutions must collaborate in developing interactive, fact-checked digital platforms. These platforms should provide students access to verified information, expert opinions, and updates related to vaccination (Lee et al., 2022b). Moreover, engaging student influencers, campus ambassadors, and health professionals through social media can cultivate positive attitudes toward booster vaccination. Incorporating vaccine education modules into university curricula, particularly within health-related disciplines, can enhance students' scientific literacy, enabling them to evaluate vaccine information critically.

Ultimately, the accessibility of booster vaccines remains a crucial factor in determining uptake. To promote higher participation rates, universities should incorporate vaccine administration into campus life by establishing on-site vaccination booths, mobile vaccination units, and convenient appointment scheduling options. Ensuring booster doses are available at multiple campus locations and during high-attendance events such as orientation weeks or university fairs can bolster uptake. Additionally, institutions might consider offering incentives, such as academic credits, campus privileges, or discounts on student fees, to encourage participation.

By implementing these strategies, policymakers, healthcare providers, and universities can work together to enhance booster vaccine acceptance and improve public health outcomes among university students. Integrating clear communication strategies, religious and community engagement, evidence-based education, and increased accessibility can foster a pro-vaccine environment and facilitate a robust public health response to COVID-19 and future pandemics.