A Key Step Toward Safety This Fall

Colleges should provide free flu shots to all faculty, staff and students and consider making vaccination mandatory for those who want to return to campus, Nancy Kass and Jonathan Links write.

July 23, 2020
 
 
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As colleges and universities map out their plans for bringing students, faculty members and administrators back to campuses in the fall, the same questions are on everyone’s minds: How can we have as normal an academic and student life experience as possible while keeping everyone in our community -- including those who are older or otherwise at higher risk -- sufficiently safe?

All back-to-campus plans include measures for lower density, physical distancing and mandatory face coverings. An additional measure that should be on all campus reopen checklists is urging everyone who returns to have a seasonal flu vaccination.

A flu shot lowers the numbers of fevers and coughs on a campus -- symptoms that now will be met with understandable fear, potential stigma and a cascade of testing and isolation until results come back. More important, it reduces the numbers of individuals who need hospitalization, competing for bed space and the attention of health-care providers during a pandemic. And a flu shot ultimately decreases the chance that when someone does become infected with COVID-19 -- particularly someone already with medical vulnerabilities -- a preventable co-infection may have precipitated their hospitalization or even their death.

Influenza remains a serious illness. The Centers for Disease Control and Prevention estimates that since 2010, influenza has annually caused between nine million and 45 million illnesses, 140,000 to 810,000 hospitalizations, and 12,000 to 61,000 deaths. A flu shot prevents millions of illnesses and flu-related doctor’s visits each year. For example, in 2017-18, the flu vaccination prevented an estimated 6.2 million influenza illnesses, 3.2 million influenza-associated medical visits, 91,000 influenza-associated hospitalizations and 5,700 influenza-associated deaths.

In response to the COVID-19 threat, the United States has embarked on an unprecedented set of stay-at-home measures for the past four months, causing catastrophic hardship for so many people, to ensure that hospitals had the space to take care of those with the disease. Imagine in that context not ensuring that everyone got their flu shot, itself preventing tens of thousands of hospitalizations each year. And if already medically vulnerable persons get influenza -- and then get COVID-19 -- the outcomes for those individuals will be considerably worse.

But we can’t just rely on those most vulnerable stepping forward to get their vaccine; in some years, flu shots are highly effective while in other years only partially effective, and we must rely on herd immunity. This means that everyone who wants to return to a campus must do their part to ensure that there is less flu swirling on those campuses.

So what should colleges and universities do? First, they should provide the flu shot at no cost to all faculty, staff and students.

Second, administering the vaccine should be visible, including at a range of times of day, so that those who pass by can be reminded about the flu vaccine and “get their shot on the spot.” Nurses might be at long tables with balloons and large easel signs in all outdoor quads or patios, for example, as well as in large and well-ventilated indoor lobbies, classrooms and lounges with, again, balloons and large signs in adjoining hallways.

Third, widespread communication campaigns are needed through as many means as possible: email, social media, text reminders, lawn signs and paper fliers. Different people will see different notices, and the reinforcement of why and how are essential.

Fourth, there should be record keeping. It is appropriate for the college to know how the flu vaccine campaign is going to see whether new strategies are needed, and also to be able to announce the percentage coverage by institution, department or dorm as a means to encourage more people to get vaccinated. And little stickers of “I got my flu vaccine: Did you?” to hand out are not a bad idea, either.

Finally, colleges should consider making a flu vaccination mandatory for those who want to return to campus this fall. They have a responsibility to keep those coming to campus safe. This is another mechanism by which to do so.

The measures that colleges and universities are now putting in place are all focused on the same goal: finding ways to allow their missions to be realized this fall, while protecting the people who make those missions happen. Higher education is an essential down payment on so many students’ futures, as well as a home for the scholarship and creative contributions of their faculty. Ensuring a safe environment in which faculty members, administrators and students can continue their studies and their work is the central goal of the thousands of hours being devoted across the country, in thousands and thousands of Zoom meetings, for what restarts and fall planning will look like.

Some of these measures will be hard and will inevitably change, at least to some degree, what residential life or going to class means. Getting a flu shot will not, and, like the best of public health interventions, it is a small step that ultimately increases the freedom for all to pursue why they are really there.

Bio

Nancy Kass is the Phoebe R. Berman Professor of Bioethics at the Johns Hopkins Bloomberg School of Public Health and Berman Institute of Bioethics and vice provost of graduate and professional education at Johns Hopkins. Jonathan Links is professor of environmental health and engineering at the Johns Hopkins Bloomberg School of Public Health, director of the Center for Public Health Preparedness, and vice provost and chief risk and compliance officer at Johns Hopkins.

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