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Annual influenza vaccination of health care students and workers helps protect themselves and patients from influenza, which has a high disease burden during seasonal peaks in Australia. Health care students are an important cohort whose early attitudes and habits towards influenza vaccination may influence future behaviours. We explored the knowledge, attitudes, and behaviours towards influenza vaccination of health care students in two universities from 2018 to 2020 using convergent mixed methodology. We also assessed the impact of two external events – the introduction of mandatory influenza vaccination for select students in 2019, and the COVID-19 pandemic in 2020. We found a significant increase in self-reported vaccination uptake between 2018 (73.5%) and 2020 (89.6%), with the mandate and COVID-19 pandemic being likely drivers of increased uptake. Vaccine mandates are effective but must be supported by easy accessibility, adequately addressing concerns around effectiveness and safety, and promotion of voluntary acceptance and trust.

Background: A 2014 study demonstrated low rates of influenza vaccination among health care worker [HCW] students at the University of Notre Dame [UND], 56% (95% CI 52-60%) overall weighted average, 53%, 57% and 61% for nursing, physiotherapy and medical students, respectively. Since then, annual influenza vaccination and/or documentation of influenza vaccination status has become mandatory for these students. On- campus influenza vaccination became available in 2018. Method: HCW students at UND were invited to participate in online surveys of influenza vaccination uptake in 2018 and 2019. Semi-structured interviews were conducted to collect qualitative data on enablers and barriers to vaccination. Results: A total of 422 students responded to the survey (199 in 2018 and 223 in 2019). The overall weighted vaccination rate of respondents was 91% (95% CI 88-93%) (79%, 90% and 95% for nursing, physiotherapy and medical students, respectively), a significant increase from 2014. Vaccination uptake in medical students increased from 83% (95% CI 76-90%) in 2018 to 99% (95% CI 96-100%) (P < 0.001) after reporting of vaccination status was mandated in 2019. Qualitative data regarding enablers, barriers, knowledge and understanding of influenza and the influenza vaccine, among HCW students and will be presented at the conference. Conclusion: Influenza vaccination uptake among UND HCW students increased significantly following the introduction of mandatory vaccination/reporting of vaccination, and is higher than the 50% observed in HCWs employed by the WA Department of Health. It is hoped that this behaviour will continue after graduation upon entering workplaces where vaccination is not mandated.