U must lead, not lag, on vaccine campaign

In an e-mail to the University of Minnesota community sent on June 14, President Joan Gabel announced that the U will not require students, faculty and staff to be vaccinated against COVID-19 prior to the start of the fall semester. As members of the U community, we are disappointed by this decision.

The U is the flagship educational institution in the state. It boasts the largest medical school, with a faculty of world-class clinicians, educators and researchers; it also serves as a scientific and economic engine to the state. As such, the U should be expected to be a leader in the fight against COVID-19 by supporting science-based policies that create the safest and least-disruptive environment possible.

The U is also a community, comprising thousands of people from across the state, country and world, of all different ages and in all states of health. Its commitment to the community should be the same: to follow the science to create the safest environment possible, especially for its most vulnerable members.

We have outstanding tools to protect our community: Three FDA-authorized vaccines (all currently under emergency use authorization, but full FDA approval is likely in the coming weeks). The safety and efficacy of the vaccines is outstanding. Yes, rare side effects occur, as with all vaccines. But no serious analysis of the risks/benefits of vaccination vs. the risk of COVID-19 itself can dispute the fact that vaccination is far safer than the risks of COVID-19, regardless of age.

The U.S. Centers for Disease Control and Prevention (CDC) and multiple major medical societies are in unison in advocating for vaccinating anyone who is eligible.

The risk of ongoing COVID-19 is real. As vaccination lags in parts of the U.S. and worldwide, pockets of vulnerability persist, just as new strains such as the Delta variant are proving to be more transmissible and are becoming more common.

While most U students are likely to be at low risk of severe illness or death from COVID-19, some have weakened immune systems and may be more vulnerable, and at this point we have the tools to prevent nearly all deaths from COVID-19. Non-fatal COVID-19 complications are not trivial: time spent in quarantine, costs of hospitalization, disruption to the community and guilt regarding spreading the illness to vulnerable populations.

The rationale laid out in the e-mail from President Gabel was flawed in several ways. First, it stated that "Public health experts note that a 100% vaccination rate is not possible in any situation and the most effective strategy is access and information." In response, we would note that while achieving 100% vaccination is indeed difficult, vaccine mandates for different diseases can significantly impact vaccination rates. We need look no further than measles vaccination: the U requires vaccination for entry with limited exemptions. As a result, the vaccination rate exceeds 90%.

Second, only county-level vaccination data is provided while citing Minnesota Department of Health guidance, not the more granular ZIP code level data that is being used to improve equitable vaccination for communities hardest hit by the pandemic. The Twin Cities, Crookston and Duluth campuses all exist within or adjacent to ZIP codes that are at highest risk by the Social Vulnerability Index. These communities have not only borne a disproportionate burden of the pandemic but are at increased risk for future outbreaks. Vaccination rates in these ZIP codes remain notably below the averages cited at the county level.

A CDC report from October 2020 examined the impact of young adults' transmission of COVID-19 in the surrounding communities and the main conclusion was that: "Strict adherence to community mitigation strategies and personal preventive behaviors by younger adults is needed to help reduce infection and subsequent transmission to persons at higher risk for severe illness."

The U has a responsibility to make public health decisions that account for the communities it exists in, not just for those actively enrolled in or employed by the institution. Therefore, the citation of a U survey that found 84% of respondents were fully vaccinated and 96% had received one dose is insufficient justification given the lack of community input. There was also no mention about what type of response this survey had, and whether the respondents might be expected to be different in their vaccination status from the non-responders.

Lastly, we note an insufficient response to the concern of those in the U community who remain at high risk for complications from COVID-19, including those in our disability community. The e-mail simply instructs such individuals to "work through their campus disability resources or human resources teams to address those concerns."

The Chronicle of Higher Education currently lists 506 schools that will require COVID-19 vaccination, including Midwest Big Ten peers University of Michigan and Indiana University and the entire Ivy League. A school that strives to lead on science, public health and community engagement should not be watching from the sidelines as we try to end the worst pandemic in 100 years.

We urge the leadership of the U to reconsider, and mandate COVID-19 vaccination for students, faculty and staff. As Dr. Thomas Frieden, the former director of the CDC recently wrote: "The higher vaccination coverage a community has, the less risk they face of continued COVID clusters and outbreaks."

The U has a simple method to increase vaccination coverage. It should use it.

Dimitri Drekonja is associate professor of medicine; Nathan Chomilo is adjunct assistant professor of pediatrics; and Michael Aylward is associate professor of medicine and pediatrics — University of Minnesota Medical School. This statement was also submitted on behalf of 203 members of the University of Minnesota Community who have indicated their support for this message.