A Cross-Sectional Study to Understand COVID-19 Vaccine Hesitancy Among Nursing Students and Health Workers: Implications for Future Outbreak Preparedness in South Africa

Background: Vaccine hesitancy is a global challenge affecting workplaces and academic institutions. Despite efforts, low vaccination rates persist in South Africa, increasing the risks associated with pathogen exposure. This study assessed the knowledge, attitudes, and perceptions (KAPs) of healthcare workers (HCWs) and students at a Nursing College regarding voluntary and mandatory COVID-19 vaccination. Methods: A quantitative cross-sectional study was conducted using a structured, self-administered electronic questionnaire. All eligible nursing students and staff at the participating Nursing College were invited to participate. Of the 504 eligible individuals, 372 completed the questionnaire, corresponding to a response rate of 73.8%. Data were analyzed using IBM SPSS Statistics version 30.0. Logistic regression and Mann–Whitney U tests were used to assess associations and differences between groups, with statistical significance set at p < 0.05. Results: Most respondents were female (302, 81.0%) and single (252, 67.9%). The age group 26 to 40 was most prominent (144, 38.8%). Only 42.2% of respondents (n = 157) were fully immunized with no boosters. Student nurses dominated (344, 92.5%), with 226 (60.9%) having no COVID-19 infections and 198 (72.0%) voluntarily receiving the vaccine. Occupation (p = 0.030) and age group (p = 0.027) were independently associated with reporting voluntary COVID-19 vaccination. Age was also associated with respondents’ attitudes and perceptions of the COVID-19 vaccine (p < 0.001) as well as their understanding of the vaccine (p = 0.002). Conclusions: Occupation and age group were independently associated with the reported basis on which COVID-19 vaccination was received (voluntary versus mandatory). Targeted communication and educational strategies addressing these factors may improve vaccine acceptance and preparedness for future outbreaks.