Abstract
<title>Abstract</title> <p>Background Vaccine hesitancy remains a significant public health challenge globally, and vaccine literacy is increasingly recognized as a key determinant of vaccine acceptance. Data on vaccine literacy and acceptance among university students in Palestine are scarce, and no study has directly compared these outcomes across health and non-health disciplines in this setting. This study aimed to assess vaccine literacy, knowledge, and acceptance among Palestinian university students and identify associated factors with vaccine acceptance. Methods A cross-sectional study was conducted at multiple universities across the West Bank, Palestine, during the 2025–2026 academic year. A total of 633 university students completed a structured, self-administered questionnaire distributed via Google Forms. The instrument comprised four sections assessing sociodemographic characteristics, vaccination history and information sources, vaccine knowledge (10 binary items), and vaccine literacy and acceptance using validated five-point Likert scales. Non-parametric group comparisons were performed using the Mann–Whitney U test and Chi-square test. Spearman correlation and multivariable linear regression were used to identify predictors of vaccine acceptance. Results The median age of participants was 19 years (IQR: 18–21), and 72.4% were female. Median scores were moderate across all domains: vaccine knowledge 5.0/10 (IQR: 3.0–6.0), vaccine literacy 3.50/5 (IQR: 3.0–3.88), and vaccine acceptance 3.11/5 (IQR: 2.78–3.56). While 67.8% of students reported receiving recommended vaccines in the past five years, seasonal influenza vaccination was critically low at 9.5%. Health-related students scored significantly higher than non-health students in knowledge, literacy, acceptance, vaccine uptake, and trust in official sources (all p ≤ 0.010). Female students demonstrated higher knowledge (p = 0.021) and literacy scores (p < 0.001), while male sex was independently associated with higher acceptance in multivariable analysis (β = 0.086, p = 0.013). Trust in official information sources was the strongest independent predictor of vaccine acceptance (β = 0.332, p < 0.001), followed by vaccine knowledge (β = 0.239, p < 0.001), health faculty enrollment (β = 0.139, p < 0.001), age (β = 0.093, p = 0.006), and vaccine literacy (β = 0.079, p = 0.025). The regression model explained 32.9% of the variance in acceptance (adjusted R² = 0.329). Key misconceptions identified included beliefs that multiple vaccines weaken the immune system (correctly refuted by only 25.1%) and that no vaccine can be given during pregnancy (correctly refuted by only 21.6%). Conclusion Palestinian university students demonstrate moderate vaccine literacy and acceptance, with health-related students outperforming their non-health peers across all measures. Trust in official sources is the dominant predictor of vaccine acceptance, underscoring the need for trust-centered communication strategies alongside educational interventions. The critically low influenza vaccination rate and persistent vaccine misconceptions highlight actionable targets for university-based and national public health programs. Integrating vaccine literacy content across all academic disciplines and establishing structured on-campus vaccination programs are recommended as scalable, high-impact strategies.</p>