Colleges, universities grapple with making vaccines mandatory for students

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Toronto’s Seneca College is finding itself in an elite group of the world’s top post-secondary institutions — Berkley, MIT, Harvard — with its new coronavirus rule: Only those fully inoculated against COVID will be invited back to campus this fall.

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While a smattering of other Canadian colleges and universities, most in Ontario, are requiring that students living in residence be immunized, Seneca is making vaccinations against COVID-19 a condition for students and employees to come on campus for the September term, and not just those moving into dorm rooms.

Exemptions for medical reasons will be respected, with the appropriate documentation. The policy doesn’t apply to fully online learning.

“Everything that we’re doing as a country is trying to beat this virus. We know the way we can do that is to get vaccinated and stop the spread,” Seneca president David Agnew said. “It was just the right thing to do to continue to protect the health and safety of our community.”

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They’re certainly in good company.

“There are now well over 500 colleges and universities in the United States that are requiring vaccinations to come on campus in the fall, including the entire New York and California public systems,” Agnew said.

As for Canada, “I think we’re the first,” he said of Seneca.

The policy has been generally well accepted, Agnew said, a sentiment supported by Seneca Student Federation president Ritik Sharma. “We’ve received good feedback from our students as well — they have been very much into it, and getting the vaccine at Seneca,” Sharma said. “They are very much liking this policy.”

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No pushback? “Nothing major,” Agnew reported.

“We’re a big community. We have a variety of perspectives. But no, in fact, we’ve probably heard more from outside the community than inside,” including from people in the U.S. with no apparent connection to the college, Agnew said. “There is obviously an active community that doesn’t like vaccinations, and isn’t afraid to say so.”

The ultimate path out of COVID hinges on mass vaccine buy-in, University of Manitoba researchers recently wrote. But Canada appears to be hitting a complacency wall, with the lowest uptake being among the university-age demographic, the 18- to 29-year-olds. Some warn that anything that hints of a de facto vaccine mandate risks trampling individual liberty and autonomy, while others argue that it’s astonishing more universities in Canada are not requiring vaccination for on-campus attendance.

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There are no mandatory vaccines in Canada. The current COVID-19 vaccines have been granted emergency use authorization, not full approval, which might make any policy legally shaky. Offer vaccines, urge them and hope people take them, bioethicist Arthur Caplan has said, but people are free to say no. According to a World Health Organization policy brief on the ethical considerations and caveats of mandatory COVID vaccination, “policy-makers should consider specifically whether vaccines authorized for emergency or conditional use meet an evidentiary threshold for safety sufficient for a mandate.”

There are some 5,300 colleges and universities in the U.S., meaning only about 10 per cent have some form of vaccine requirements, though the numbers continue to grow. It’s a bit of a red-state, blue-state story, said University of Alberta’s Timothy Caulfield. In the U.S., the discourse is more polarized, the anti-vaccine community more vocal, said Caulfield, Canada Research Chair in health law and policy at the university. “But here in Canada, where you do have soft support, you would think universities would feel more comfortable adopting it.”

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COVID vaccines haven’t yet been authorized for children under 12, and no province has indicated it plans to make COVID vaccinations mandatory for those 12 and older to return to in-class learning.

However, in a “call for arms,” Ontario’s new chief medical officer this week pleaded for the young to get their shots and plug gaps in vaccine uptake. “They are the most social, they’re the most able to propagate the virus back into the communities,” Dr. Kieran Moore said of high-schoolers and the college-aged.

Ontario Education Minister Stephen Lecce will announce a plan to deliver a “more normal, full-time, in-person learning experience,” the minister’s spokesperson, Caitlin Clark, said in an email. With over half of people 18 and older having both doses, and nearly 60 per cent of youth 12 to 17 with a single dose, “this gives us an incredible sense of confidence that the communities our schools are within will be safer,” Clark said.

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But some health officials are warning that high vaccination rates among the university crowd will be critical. COVID is less severe among the young, but the hyper-contagious Delta variant and higher contact rates among them pose unique risks. Add in congregate living situations (residences) and shared common spaces that make it challenging to isolate or quarantine should someone become infected. High two-dose vaccination coverage — ideally more than 90 per cent — of the student population “will be necessary to prevent local outbreaks in the upcoming academic year,” Dr. Lawrence Loh, medical officer of health for Peel Region, wrote in June to University of Toronto officials.

It’s not clear whether campus vaccine “mandates” would improve things, or just embolden the hesitant.

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U of T students living in dorms this fall will be required to be vaccinated. Those moving into residence at Western University will be required to receive at least a first dose. McGill University has no plans to mandate vaccines, confident it will reach a high level of protection voluntarily. While the University of British Columbia “strongly encourages members of the community to get the vaccine,” it won’t be making COVID shots mandatory for students, faculty or staff, because of equity, privacy, human rights and other concerns. The University of Alberta, where 80 per cent of classes will be delivered in person in the fall, also has no plans to request proof of immunization to work or learn on campus, though it “strongly encourages all U of A community members to get vaccinated as soon as they become eligible.”

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Would they merely ‘encourage’ their students to install smoke alarms in their residences?

Health law professor Amir Attaran

“How very effete and unprincipled,” University of Ottawa health law professor Amir Attaran wrote in an email. “Would they merely ‘encourage’ their students to install smoke alarms in their residences? I think not.”

Canadian universities either don’t appreciate the effectiveness, safety or necessity of vaccines, he said, or lack the courage to mandate their use. “There are no legal barriers to requiring vaccination as a condition for attendance.” Some schools already do this: Ontario requires children and teens to be immunized against designated childhood diseases, unless they have a valid exemption.

The universities, for their part, say that while they emphatically support the value of vaccines, a softer approach — incentives like raffles, tuition waivers and #Back2gether vaccination campaigns — is preferable.

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As of June 26, 63.7 per cent of the university-age demographic — youth ages 18 to 29 — in Canada had received one dose of a COVID vaccine, compared to 80 per cent of 50- to 59-year-olds. Ontario vaccination numbers released Thursday show 67 per cent of the 18 to 29 age group has received at least one dose; 32 per cent have been double dosed.

Caulfield suspects it comes down to complacency rather than a more vaccine-hesitant stance. “I think that you have these young, healthy individuals that think it’s not important for them to get vaccinated,” he said. “Perhaps there is hope that carrots are going to win out. But it’s crunch time, and I think we need to think more seriously about sticks. If we’re going to get to herd immunity, this population is relevant.”

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If we’re going to get to herd immunity, this population is relevant

Timothy Caulfield, University of Alberta

University of Manitoba researchers who explored the willingness of older teens and young adults to take a COVID vaccine found the most common reasons for those who said “no,” “maybe” or “I don’t know” were concerns around safety (development was rushed or protocols skipped, some feared), not enough information about the vaccines, and concerns about effectiveness. With vaccination rates appearing to plateau, epidemiologist Raywat Deonandan is more sympathetic to Seneca’s vaccine rule than he would have been months ago. “The cost, of course, is that you create some discontentment in society. Maybe you lose some goodwill. But we’re at a time crunch here. And if that’s what’s needed to get more vaccination, so be it.”

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There could be a human rights issue, and accommodations need to be made. Seneca has “tons” of programs available online, but Agnew acknowledged there are some things you just have to do in person. Seneca has one of Canada’s premier aviation schools. “You can’t train to be a pilot without flying a plane.”

A vaccination policy undermines the idea that vaccination is a choice, said Cara Zwibel, director of the fundamental freedoms program at the Canadian Civil Liberties Association. “If we create enough things that you can’t do without being vaccinated then de facto we end up with a mandatory vaccination regime, which is not where we think we should be.

“What is it that we are trying to achieve by doing this,” she asked. “Is this about making people feel safer? Is it about liability? Is it about a school being able to say, ‘Well, we took every precaution we could, so if you get sick, we couldn’t possibly be to blame.’”

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Online and in-person learning aren’t equivalent options, she said. They aren’t the same kinds of experiences. “I’m not so sure that there isn’t some coercive element here.”

The risk of COVID-19 transmission in a residence can be significant, said Queen’s University infectious diseases specialist Dr. Gerald Evans. Like any household, secondary attack rates are high. Some undergraduate first-year courses at Queen’s have 200 or 300 students. There are large auditoriums to accommodate them, “but if there’s a scattered number of people who are infected in that group, there is tremendous risk to everyone else who is in the auditorium, particularly those in close proximity to the infected person,” Evans said.

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He doesn’t see a downside to heavy vaccination of the university-age crowd. He’s sensitive to the concerns about myocarditis, the rare cases of heart muscle inflammation that have been linked to the mRNA vaccines, Pfizer and Moderna. However, “it’s transient, it’s low, and it seems to be readily reversible.”

It’s not clear how Seneca plans to enforce its policy, which is now being finalized with the advice of legal and public health experts. Of the roughly 30,000 students expected this fall, about one third will have some part of their program on campus, the rest will continue online or some hybrid of the two. Agnew said they’re taking it a term at a time, as campus gradually reopens more and while they wait guidance from the province in terms of masking and distancing and health checks for the fall semester.

“I think all of us in post-secondary — all of us in a lot of worlds —  are kind of making assumptions about what the world will look like in September,” he said.