To our knowledge, this was the first study exploring health professional students’ COVID-19 vaccination uptake in Australia. Our study findings are particularly important because health professional students should serve as role models by participating in health promotion and health education processes and influence attitudes and health behaviour in the general population about the COVID-19 pandemic and vaccination. Indeed, among the participants, 91.6% of the participants received the vaccination, a much higher rate than health professional students in other high-income settings reported in the literature [3, 11, 12].

Doubts about the seriousness of COVID-19 disease and the perceived low risk of developing the disease can be barriers to vaccine acceptance [13] and were closely associated with time completed toward our participant attainment of the degree and age. Consistent with other studies and possibly reflecting an optimism bias [14, 15], approximately 27% of the participants in our study believed that COVID-19 disease was no more serious than seasonal influenza and that they had a lower risk of acquiring COVID-19 infection than the general population. Researchers have interpreted doubts about the seriousness of the COVID-19 disease as ‘pandemic denial’ [13, 16], and believe it links to negative attitudes and perceptions of low risk of acquiring COVID-19 infection. In our study, most participants were from Queensland, a state that had great success in controlling spread and maintaining low rates of mortality from COVID-19 at the time of the survey. Those in our study with 50–75% time progressed towards their degree completion and those of 41–75 years of age (N = 195) were more likely to doubt the seriousness of COVID-19 disease and hold perceptions that they had a lower risk of acquiring COVID-19 infection than the general population. Because young adults (18–29 years) had the lowest hospitalization and death rates among adult age groups [17], we expected younger participants to report lower risk perception of acquiring COVID-19 infection than the older ones. Also, we expected the general attitude of health professional students towards COVID-19 would improve in line with their progress through their courses of study due to increased knowledge. However, this was not the case. Our findings suggest that university administrators should support health professional students to understand their personal risk of COVID-19 infection and their risk of spreading COVID-19 infection to the broader community as part of their course delivery at university.

Attitudes toward vaccine safety and effectiveness may have contributed to vaccine hesitancy [13]; these were closely associated with time toward degree completion. In our study, over 20% of the participants disagreed that the COVID-19 vaccines in Australia were safe, and nearly 30% preferred to wait until they knew more about the long-term vaccine side effects before being vaccinated. This could be related to uncertainty: worries about the speed of vaccine development [5], concerns about unforeseen future effects [18], and distrust in health authorities and governments [13]. We also found that those having completed over 75% of time needed to attain their degrees were more likely to believe that the available vaccines effectively lowered the COVID-19 transmission rates due to the growing mass of vaccinated population. The findings align with previously reported literature that final-year university health students show a more positive attitude toward COVID-19 vaccination than students in earlier years of the program [19]. This fits the assumption that the attitudes of health professional students toward vaccination will improve with professional knowledge and training in their final year of study. We did not find any significant associations between employment outside study, participant age, and attitudes toward COVID-19 vaccination. Other studies have found that students employed as healthcare workers were more likely to get vaccinated [11], and health students under 25 years old held a more positive attitude toward COVID-19 vaccination than those above 25 years [18]. A qualitative study may broaden our understanding of inherent beliefs and reasoning underpinning our health professional students’ attitudes and perceptions of vaccination.

We observed three positive predictors of COVID-19 vaccination uptake including higher-risk perception of acquiring COVID infection than the general population, viewing vaccination as their professional responsibility, and vaccine mandate, with vaccine mandate as the most significant predictor. Notably, in the months prior to data collection the Queensland government mandated COVID-19 vaccination for all health professionals including health professional students. Failure to comply resulted in the termination of employment for health professionals and the withdrawal of placement for health professional students. Thus, the consequence of not following the COVID-19 vaccination mandate was significant, and likely explains why approximately 25% respondents had received vaccination against COVID-19 because of the mandate.

The proportion of students who opposed the COVID-19 vaccine mandate varied but was high worldwide, with nearly 30% of participants opposed to the mandatory COVID-19 vaccination policy in our study (Australia), 51% in Germany [20], and 71.2% in Cyprus (71.2%) [21]. In a cross-sectional survey conducted at a university in the United States, 59.1% of the students indicated that individuals should have the right to choose whether to receive the vaccine [11]. Regardless, the mandates did improve the vaccination rate; however, the hesitancy and the proportion of students opposed to the COVID-19 vaccination should not be overlooked. Future research investigating barriers and facilitators to vaccine update among students is needed to inform vaccine rollout in future pandemics.

Approximately 75% of the participants held views of vaccination as an important professional responsibility, another strong predictor. Consistent with our findings, an Australian qualitative exploration of healthcare workers reported that an expectation of their role was responsibility to receive the vaccine [22]. Similarly, studies found “collective responsibility” [5], “a community responsibility rather than a personal choice” [15], and “responsibility to receive the vaccine to protect other people from COVID-19” [11] as reasons for people to receive the vaccination. All seem equivalent to our health professional students’ view of their responsibility to the profession. Thus, instilling a sense of professional responsibility in healthcare, and education for roles in this field may improve vaccination uptake among health professional students and healthcare workers.

Another strong predictor of vaccination was the perception of a higher risk of acquiring COVID-19 infection than the general population. This is consistent with the fact that risk perception plays a significant role in vaccine uptake, a critical predictor of people’s vaccination behaviour [23]. Nursing students with perceptions of high risk of acquiring COVID-19 infection are more likely to receive vaccination than those with low-risk perception [24]. The Health Belief Model helps us understand how individual risk perception and disease seriousness can influence uptake of a recommended health behaviour [25], possibly through increasing individual knowledge, awareness, and understanding of the COVID-19 disease and its vaccine [24]. An Egyptian study, however, found that the perceived risk of acquiring COVID-19 infection did not significantly predict medical students’ intentions of getting the COVID-19 vaccine [4]. Future research should focus on potential moderating and mediating factors that influence students’ decisions about vaccine uptake while exploring associations between risk perceptions of acquiring COVID-19 infection and their intentions to receive the vaccine.

The three most trusted and used information sources about the COVID-19 pandemic and vaccines in our study were health professionals, government websites, and World Health Organization. Similarly, a cross-sectional study of 2341 students at a diverse, public university in the United States reported government and medical professionals had been the most trusted sources of information [11]. Many students in this study found information about COVID-19 vaccines difficult to understand [11]. Although our participants did not find information difficult to understand, 34.3% (n = 326) stated that information from the government about vaccine safety was unclear. Contrary to our findings on commonly used and trusted sources, social media has been reported as the main source of COVID-19 vaccination information in many studies, including a general population study in Cyprus (31.6%) [21], health students in Vietnam (88.5%) [26], and medical students in Pakistan (92.5%) [27]. Although we need to consider factors such as political distrust, leading to reliance on social media [21, 26, 27], this is concerning as social media gives users an outlet to express thoughts and feelings. Their anti-vaccination and vaccine hesitancy may be easily spread and discourage people from taking important health actions [13]. Governments and health professionals must deliver clear and transparent messages using layperson language, considering preferred means of access and communication for varied populations [28]. This approach may prevent people from preferring social media as a reliable source of information.

Our findings represented self-reported perceptions of student who were willing to participate. Students who did not participate might have different attitudes toward vaccine hesitancy, thus we may have underestimated the true prevalence of vaccine uptake among this cohort. We received responses mainly from Queensland in Australia, limiting the generalization of findings to the whole country and other countries. As most participants were nursing students, findings may not represent all health professional students. The findings are representative of a high-income country only, with stringent border controls and no other countries neighbouring its boundaries. We did not ask the participants if they had received one or two doses of the vaccine at the time of the survey. Our survey tool was not validated, and we did not clarify if ‘acquiring’ meant ‘infection’ in one of our survey questions, which may have biased our responses. Despite these limitations, the sample size was large, and we drew the sample from multiple universities, which gives a realistic picture of the topic in Australia. The study findings provide useful insights for governments, policymakers, and university authorities responsible for developing strategies for future vaccine uptake and pandemic management.