Make no mistake: The University of Minnesota is committed to ensuring the health and safety of all members of its community and thus wants its students, staff and faculty vaccinated against COVID-19 ("U must lead, not lag, on vaccine campaign," Opinion Exchange, June 17).
Vaccination is the very best way to protect oneself and one's community against the scourge of COVID-19. The question is, how can the university most effectively and quickly achieve its goal? Is it with a policy of "educating, offering and encouraging" or "mandating and excluding"? In other words, carrots or sticks?
Yes, some vaccines are required for students. Since 1989, Minnesota Statute 135A.14 mandates that students in public or private postsecondary educational institutions (i.e., technical schools, colleges and universities) be immunized against measles, rubella, mumps, diphtheria and tetanus. That law establishes a procedure for the Minnesota Department of Health to add a new vaccine requirement to that list, but absent MDH action, there is some doubt over the ability of a state university to do so on its own. No matter whether a COVID mandate is added, however, exemptions are permitted for medical reasons or with a notarized statement asserting a student's conscientious objection to the vaccine(s). The upshot is that when there are vaccine mandates (under a statute or school rule), there will be exceptions. This is true whether the mandate is for students, as with this state statute, or for faculty or staff.
Vaccine verification also presents a challenge. Currently, there is no good way to ensure that those who claim to have been fully vaccinated are so. There is no credible vaccine registry system in place for students from around the world that can provide reliable information on one's vaccine status. Personal attestations and honor systems go only so far. What is more, the university is a public campus, where the coming and going of many contributes to the vibrancy of the community.
Thus, having the university require COVID-19 vaccine may seem like a simple solution, but exemptions, verification and public spaces undermine this approach. The simple solution is complicated by basic epidemiology, social science and the law. A mandate will give a false sense of safety, which only increases risk. This is exactly what we experienced last fall with mandated student COVID-19 testing. A number of universities that mandated routine student testing had campus-related outbreaks because students had a false sense of safety that testing, not reducing risky behavior, protected them. We did not mandate routine testing at the University of Minnesota; rather, we emphasized reducing risky behaviors. Despite being criticized for this approach, we also avoided campus-related outbreaks.
Research on vaccine hesitancy matters. Today, there are three general categories of students, staff and faculty with regard to their willingness to be vaccinated against COVID-19. There are those — the vaccine-affirmative — who have been vaccinated or are in the process of being vaccinated. The second category, the vaccine-hesitant, includes those who are hesitant because of a lack of understanding of COVID risks or vaccine science, or those who have legitimate medical concerns. Finally, the vaccine-hostile reject the medical and epidemiological research on COVID-19, deeply mistrust COVID-19 vaccine research, and/or don't trust scientific authority or the government. A vaccine mandate is not needed for the first group, may or may not marginally increase the rate of the second group, and will surely create great opposition and backlash from the third group, which in their opposition actively undermines vaccination efforts in the vaccine-hesitant group.
Who are in these three groups? Not surprisingly, many members of the university community are already in the first: vaccine-affirmative. Best estimates come from a recent internal survey of 12,500 university members. Some 93% of respondents indicated that they had received one or more doses of vaccine. Undergraduate students have a lower rate of vaccination (87%), but 53% of the unvaccinated students indicated they planned on getting vaccinated, which would bring their rate up 93%. Faculty led the three groups, with 99% vaccinated. Only 2.3% of respondents do not plan on getting vaccinated, and 1% are unsure.
We recognize the shortcomings of these data, especially the fact that the response rate is just 51%. One could assume that the 49% of the sample who didn't respond represent only the hesitant and hostile. But known relationships between the characteristics of members of the university community and other issues associated with vaccination status suggest that these observed yet imperfect estimates are credible.
Research supports our conclusion that the modest percentage of university members who are vaccine-hesitant will respond more positively to education, opportunity and encouragement than to a mandate. Not having backlash from the vaccine-hostile will help in this regard. What is more, we believe that a mandate will disproportionately exclude and prevent certain members of our community from opportunities to learn about the ongoing risk of COVID-19 disease and the safety and effectiveness of the vaccines. Mask mandates have taught public health professionals that this is no time to alienate people we are committed to helping.
Our university has developed an extensive initiative to reach all students, staff and faculty with current, comprehensive, authoritative and culturally sensitive information on the risks of COVID-19 disease and the safety and effectiveness of the vaccines. Vaccinations are free and readily available.
Many colleges are requiring vaccination of students, and some of staff. But most schools in the Big Ten Conference are in agreement with the University of Minnesota's approach. Of the 14 universities in the Big Ten, only three are mandating COVID-19 vaccination for students, staff and faculty (one of these does not require proof of vaccination, only the person's attestation they are vaccinated). One is mandating vaccination for those living in student housing. All four universities allow for exemptions for medical reasons or a person's conscientious objection to the vaccine.
One of us (Michael Osterholm) has spent the past 18 months working tirelessly to support the development, manufacturing and distribution COVID-19 vaccines and advising university leadership. The other (J. Michael Oakes) has participated in many thoughtful and wide-ranging cabinet-level discussions that helped advise university President Joan Gabel on current research. A decision to require unwilling persons to receive a health-related procedure must never be taken lightly. Gabel made a gutsy, science- and equity-based decision to not mandate a COVID-19 vaccine at this time. Her leadership on this very difficult, high-profile decision befits a president of a leading American research university.
We believe those advocating for the U to mandate COVID-19 vaccination have the best of intentions. And we acknowledge that there may be situations in which mandates are best. But if the COVID-19 pandemic has taught us nothing else about increasing public participation in efforts to enhance safety and control transmission, it has taught us that trust and partnership are essential. Now is the time for carrots, not sticks.
Michael Osterholm is regents professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. J. Michael Oakes is a professor of epidemiology and the interim vice president for research at the U.