Introduction: Coronavirus disease 2019 (COVID-19) is a highly contagious infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Following its emergence in December 2019, the disease rapidly spread worldwide, prompting the World Health Organization (WHO) to declare it a global pandemic on 11 March 2020. COVID-19 vaccines were developed to reduce disease severity and mortality; however, their effectiveness depends on public knowledge, trust, and acceptance. This study assessed the knowledge, attitudes, and acceptance of COVID-19 vaccines among school-going adolescents and youths in the Kitwe and Ndola districts of Zambia. Materials and Methods: A descriptive cross-sectional study was conducted among 754 adolescents and youths (361 from Kitwe and 393 from Ndola) between April and October 2023 using a structured questionnaire. Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 23.0, with findings presented using descriptive statistics. Results: Among the 754 participants, 649 (86.1%) had good knowledge, and 382 (50.7%) demonstrated a positive attitude towards COVID-19 vaccines. Only 159 (21.1%) had received the vaccine, while 595 (78.9%) were unvaccinated. A total of 231 (30.6%) participants expressed willingness to be vaccinated, whereas 69.1% were hesitant or uncertain. Fear of side effects (50.4%) and concerns about vaccine safety (62.4%) were major barriers to vaccination. The majority (84.9%) had never contracted COVID-19. Mass media (51.1%) and social media (21.5%) were the main sources of vaccine information. Conclusion: Despite high levels of knowledge and moderate positive attitudes, vaccine uptake among adolescents and youths remained low. Fear of side effects and misinformation significantly influenced vaccine hesitancy. Targeted educational and behavioural interventions delivered through mass media, social media, and school-based campaigns are essential to enhance vaccine confidence, acceptance, and uptake among young people in Zambia.
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