In July 2020, the Board of Regents of the University System of Georgia responded to increasing criticism with a science-driven decision to protect the health of students, staff, and faculty: mandating the indoor use of masks throughout its 26 public institutions as part of its Fall 2020 re-opening plans. That decision mattered. A few layers of cloth became an essential part of intervention strategies throughout the 2020-2021 academic year – including physical distancing, online instruction, and, for some institutions, large-scale surveillance testing.
But this summer, we have a new and extraordinarily effective tool in our pandemic-fighting arsenal: vaccines.
Given the safety, efficacy, and widespread availability of COVID-19 vaccines, requiring vaccinations for students, staff, and faculty would help protect those who live, learn, and work on college campuses and in surrounding communities. Already, more than 300 U.S. higher-ed institutions, including Emory University and Atlanta University Center Consortium member institutions, will require vaccines for students (and in some cases, staff and faculty) as part of fall 2021 re-openings.
The COVID-19 pandemic is a public health emergency, with nearly 600,000 documented fatalities in the United States alone. Emergencies require action-taking. Taking decisive steps to increase the number of vaccinated individuals is the safe and ethical way to increase population immunity. The benefits of such a strategy accrue to both individuals and to the community.
All three of the vaccines approved for use in the United States are extremely effective in reducing the incidence of severe cases that can lead to hospitalization and fatalities. The vaccines have worked even better than anticipated: they are also highly effective in preventing asymptomatic infections, helping to stop silent chains of transmission that could endanger those in the community who have not yet been vaccinated.
This combination of individual protection and population immunity should be enough for the vast majority of individuals to decide to get vaccinated at first opportunity. However, if it is hard (or infeasible) to access a vaccination site, then individuals may decide that getting vaccinated is not worth the effort. Access-driven hesitancy can be alleviated, in part, by bringing vaccines directly to the community. That work can and must be done, particularly to address acute differences in the impact of the pandemic on minority communities, further exacerbated by gaps in vaccine access.
But there is another problem in administering vaccines, one that access alone will not resolve.
The reality is that misinformation and politicization has led to a sharp partisan divide with respect to the willingness of individuals to get vaccinated. Gov. Brian Kemp has noted that Georgia is seeing increasing vaccine hesitancy among “white Republicans,” a finding reinforced by a recent AJC poll that found that more than 60% of Republicans who have not yet been vaccinated do not intend to do so. This level of entrenched hesitancy raises a deeper problem: what happens when personal preferences collide with public health?
Imposing vaccination mandates raises ethical and legal questions. Yet, for college campuses, there is strong precedent that vaccination requirements can be imposed given the potentially, rapid spread of infectious diseases in dense live-learn communities. Indeed, the University System of Georgia already has the authority to impose immunization requirements as part of its governing policy documents.
The Board of Regents oversees the University System of Georgia. Its accreditation depends on remaining independent from political interference. Yet, any decision with respect to vaccination requirements should be assessed through the lens of effectiveness – and evaluating the potential effectiveness of action taking requires consideration of political realities.
Some students (and some of their parents), along with some staff and faculty, believe that vaccines should not be mandated. This opposition may be due to strongly held personal reasons. For others, skepticism with respect to vaccination may be fueled by misinformation proliferating on social media sites (no, the “E” in EUA does not stand for experimental, it stands for emergency). Irrespective of root causes, polling results suggest that such resistance is both real and, for some, entrenched. But responding to a public health emergency requires leadership that weighs the balance of personal preferences against the costs of inaction.
A significant fraction of Georgia campus communities may remain unvaccinated by the start of the fall 2021 term in the absence of a mandate. Yet, the virus will still be with us. Many of these unvaccinated individuals will be vulnerable to infection, increasing the chances of clustered outbreaks on campus.
What should the president of a university tell a parent when a dorm or college is shut down due to increasing cases? What should the president of a university say to the community when the amplification of cases amongst individuals unvaccinated by choice (not because of medically approved counter-indications) leads to the hospitalization or death of a student, staff, or faculty member that could have been prevented with a vaccine mandate?
Those who maintain that vaccination should not be mandated neglect the fact that vaccination is not an option for many vulnerable individuals and that the failure to vaccinate at scale places such vulnerable individuals at increased risk of COVID-19.
For over a year, the clarion call of many – including the governor – has been that we must return to normal. Returning to normal in the absence of public health safeguards was never a viable path; institutional failures to tell the truth and act decisively to match public health decisions with socioeconomic relief and nimble policy making has intensified a devastating pandemic.
Of relevance, Pfizer has applied for full FDA approval for their COVID-19 vaccine as of May 7, 2021. We should anticipate that the FDA will grant such approval and that one more objection to the imposition of mandates will have disappeared.
With the widespread availability of safe and effective vaccines, the Board of Regents have the power to do what is right and to do so right now. The Board of Regents should follow the science and impose vaccination requirements as part of on-campus operations, enable suitable exceptions as is done for other vaccines, and ensure that as-yet-unvaccinated individuals can be vaccinated as part of the Fall 2021 return to classes.
Hard decisions rarely have universal approval, yet a vaccination requirement is precisely what is needed to help protect both the people and the operations of higher education institutions across the state.