May 3rd, 2021

Some Colleges Require COVID-19 Vaccination — Why Don’t They All?

Horse Feathers, 1932. Paramount Pictures.

Each time a college announces that it requires that students be immunized for COVID-19 to attend in-person classes or to live on campus, I do a little cheer. Sometimes it’s accompanied by a happy dance — especially when it’s right in my neighborhood.


Because ever since the pandemic started, carefully done epidemiologic studies consistently show that older teens and young adults have the highest incidence of infection.

This fact might be counterintuitive, since older people bear the disproportionate share of severe disease. As a result, the media quite regularly gets it wrong, by reporting each time when cases surge anew that “this time it’s different — it’s young adults.”

Nope. It’s always been younger adults. They just don’t get as sick. And during the first wave in early 2020, with testing severely limited, we could only test the sickest people — sometimes only those who came to the hospital. Infections in younger people went undiagnosed, since most cases were mild or asymptomatic.

But three key points about COVID-19 in young people should strongly favor mandatory college immunization. First, some young adults get quite sick indeed. Some have lengthy post-COVID symptoms that keep them out of school or work for weeks or months. Some get hospitalized. Some even die, with tragically so many years of life lost.

Second, outbreaks on college campuses can be large, disruptive, and enormously resource-intensive to control. The testing and infection control protocols vary from school to school, but all are costly in both time and dollars.

Finally, young adults with COVID-19 play a key role in perpetuating the epidemic. Mild disease is still contagious, of course, and communities with in-person higher education experienced an increase in COVID-19 incidence, suggesting that infections in students lead to transmissions both on campus and off.

Indeed, vaccinating college students may be a critical strategy in bringing the pandemic under control. Health economist Dr. Zoe McLaren summarized this benefit nicely in this thread:

She kindly referred me to this modeling study, which demonstrated the powerful public health benefits of vaccinating younger adults. Note that the effects would be even bigger than in the study, as the vaccines turned out to be more effective at blocking infection than the authors estimated at the time.

Some might wonder why the rate COVID-19 is so high in teens and young adults. But those who are parents of kids this age, or even better have an accurate memory of their 15-25-year-old self, will not be surprised. When you’re this age, socializing with friends isn’t just a leisure activity — it feels like breathing oxygen, necessary for survival. It’s during this socializing that we develop our identity, affiliations, and friendships, test our independence, and explore the broader world as an almost-adult.

Is it any surprise that this age group would have the hardest time with social distancing? While many of us older types, already paired-off or settled or both, haven’t dined out in months, a college student who starts a new semester in a dormitory or off-campus apartment isn’t likely to sit at home alone all semester, ordering groceries online and avoiding all group dining. And this doesn’t even get into classes, study sessions, sports, concerts, Greek life, or romance.

So what’s blocking the universal requirement for vaccination before on-campus classes or living? After all, don’t most universities require documentation of several immunizations already? Yes. COVID-19 is a far greater threat to personal and public health than many of these other vaccine-preventable illnesses.

One frequently cited obstacle is that these vaccines are not yet fully FDA-approved. True — but this is just a technicality:

Harvard Law professor Glenn Cohen, who teaches health law and bioethics, said there’s no legal reason colleges wouldn’t be allowed to require COVID-19 vaccinations. It makes no difference that the shots haven’t been given full approval, he said, noting that many colleges already require students to take coronavirus tests that are approved under the same FDA emergency authorization.

Already nearly 200 universities have issued a ruling requiring that students get a COVID-19 vaccine. Medical exemptions, of course, are permitted, but based on the safety profile of the vaccines, should be infrequent. (Thanks to Benjy Renton and his invaluable site for that link — he’s been providing terrific coverage of COVID-19 and higher education for months.)

So go for it, colleges and universities. Make the COVID-19 vaccine a requirement for on-campus learning and living, even offer it on-site for those who can’t get it at home. You have my 100% support.

Groucho, Harpo, Chico, and Zeppo agree.

2 Responses to “Some Colleges Require COVID-19 Vaccination — Why Don’t They All?”

  1. francis forte md says:

    I agree with vaccination for students in college . All Americans must do their part in defeating covid .

  2. Patrick says:

    A sensible policy which should be universal – once the vulnerable have been protected then focus on the demographics most likely to spread the virus.

    Are there are real contraindications to vaccination with either of the mRNA vaccines? I’ve been unable to find any listed apart from known allergy to any of the ingredients (which is presumably very rare).

    Lots of people (doctors included) seem to have a concrete ​idea that there are people who ‘can’t be vaccinated’ with Pfizer/Moderna because they are immunosuppressed (or ‘immunosupressed’ with some dubious malady). I presume the root of this is confusion with live virus vaccines, but I keep hearing it repeated by people who should know better.

    On the other hand, our haematologists have been enthusiastically vaccinating their B-cell chemotherapy and BMT patients for months.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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