From the community | Stanford must do more to encourage COVID-19 vaccination

Stanford, please do the bare minimum: Enthusiastically endorse the booster. Devote resources to ensuring community members get it.

Oct. 18, 2022, 6:36 p.m.

Over the first year of the pandemic, Stanford demonstrated its commitment to COVID-19 response—and especially, to COVID-19 vaccination campaigns—in a number of ways. In 2020, Stanford Medicine conducted vaccine trials against COVID-19. In 2021, Stanford was early to require the primary series of the COVID-19 vaccine, a mandate which was met with high compliance.

But throughout the second and third year of the pandemic, which in America were nearly as fatal as the first, the University has stripped those protections away: first dispensing with mandatory testing for faculty and students, then dedicated quarantine facilities for students living on campus. And this fall, Stanford has done little, very late, to inform its community that a new booster, with the potential to save nearly 100,000 lives in the next six months if enough people get it, is now available and that most community members are eligible to receive it.

The CDC’s Advisory Committee on Immunization Practices moved to recommend a bivalent booster targeted at BA.4 and BA.5, the currently circulating Omicron subvariants, on September 1, 2022. But it wasn’t until yesterday that Stanford sent its first University-wide communication dedicated to promoting uptake of the booster—and only in one that simultaneously removed the classroom mask mandate.

Before that email, Stanford greeted this development with almost-total silence–making only one very cursory mention of the shot buried in the middle of a Stanford Report email sent on October 4. The information was not included in a number of communications in which one might expect to find it: not in a university-wide welcome message from President Marc Tessier-Levigne, not in any of the university life newsletters through the month of September, including in those promoting flu vaccine clinics, and not even in the “Important COVID-19 and Monkeypox Update” sent to undergraduate and graduate students on September 7, six days after the bivalent booster was recommended by CDC. Nor have Stanford’s many subdivisions put in much effort toward promoting vaccine uptake: at the start of quarter, I had a dozen friends, across Stanford divisions and departments, comb through their inboxes for mentions of the bivalent booster. The only one we found was sent by Stanford Medical School.

This is a shame, because the booster is great. Laboratory studies reviewed by CDC indicate that the new booster induces immune responses four times stronger against circulating variants than did the previous version (which was tailored to older strains of the virus). And almost all Stanford community members are eligible to get it: Anyone whose last COVID-19 vaccine was more than two months ago is.

Availability of the vaccine has been patchy, but with some persistence, you can get appointments for the shot at the Walgreens in Vaden Health Center, most local pharmacies, or Stanford Health Care. Getting the shot is free, it takes fifteen minutes, and it is one of the most impactful things you can do to prevent yourself from getting – or spreading – COVID-19.

While we are lucky to have low transmission on campus right now, the country is nonetheless in a precarious moment of the pandemic. About 400 Americans are dying per day of COVID-19, making the disease the third leading cause of death in the United States, behind only heart disease and cancer. Health officials and epidemiologists are predicting yet another wave in the fall and winter, with early indications of an uptick already materializing in some parts of the country.

Meanwhile, county governments and institutions have removed most non-pharmaceutical interventions, from surveillance testing to mask mandates, with no signs that they will reinstate them in the event of rises in hospitalization or death counts.

You might think that, given these conditions, the federal government would blast news of the booster from the rooftops and launch a full-scale campaign to get as many people vaccinated as possible. Unfortunately, that is not what is happening. Federal support of vaccine outreach and promotion has halted because the Biden administration failed to push funding for COVID-19 response through Congress.

Preliminary data indicates that, one month into the campaign for a bivalent vaccine that 72% of Americans have said they would get, less than 4% of Americans had actually received a shot. This lack of uptake continues a trend of America’s booster campaign lagging far behind other countries with comparable supplies of boosters— leading to disproportionately high and preventable death tolls.

As much as this national failure to run a robust booster campaign restricts what Stanford can accomplish, it also places a special obligation on Stanford to endorse the booster in order to promote collective public health.

First of all, based on polling conducted by the Kaiser Family Foundation, one in five eligible adults have heard nothing about the new booster shot and over half are unsure whether they are eligible—or even believe they are not eligible. Stanford has a very important role to play in ensuring that its community members actually hear about the new shot.

Second, universities form an essential part of the civic fabric of America; they are “semi-public” institutions that can disseminate reliable information during confusing times and set the tenor of public conversation. When many universities moved to require the COVID-19 vaccine last year–or even just recommend them–they placed an expectation of its widespread availability on the US government and sent a clear message about the safety, effectiveness and importance of vaccines to the American public.

These interventions are not just symbolic: They make real differences to the health of the communities in which universities are situated. In fall of 2021, according to a working paper by the National Bureau of Economic Research, university vaccine mandates reduced case counts by over 300 per 100,000 people in their home counties and saved an estimated 8,000 lives nationwide.

In fact, Stanford’s long silence on the COVID-19 booster may have been routine within the United States as a whole, but it is unusual among its peer universities, the majority of which have recognized this important role of universities in promoting collective public health and taken prompt steps to promote the new vaccine. By the beginning of October, 9 of the top 50 universities had moved to mandate students receive the bivalent booster, including the entire University of California system. 29 had sent out dedicated messages addressed to their entire university community or posted prominent website notices encouraging uptake of the shot. And at least 8 already had systems in place to track information about how many of their students have received the bivalent booster, which Stanford still does not. 

Stanford’s failure to enthusiastically and promptly endorse the shot is all the more striking in light of the role that many of its affiliates, like Jay Bhattacharya, Michael Levitt, and John Ioannidis – as well as employees of the Hoover Institute, like Scott Atlas – have played in poisoning the public conversation about COVID-19 vaccination in general and about this booster in particular. (Bhattacharya, specifically, has advocated against the CDC’s recommendation of the new shot — and universities requiring it — on the grounds of a misleading, fear-mongering claim that the vaccines do not have “any human safety data” associated with them.) In failing to communicate about the importance of the bivalent booster for so long, Stanford abrogated its responsibility to distance itself from  claims like Bhattacharya’s.

It is not too late for Stanford to improve its approach to the bivalent vaccine campaign. Now that Stanford has finally announced its recommendation of the booster, in the coming weeks, it should, at the very least, send frequent, repeated reminders to students, faculty, and staff to receive it across university communications. It should create a system to track how many of us have received it. It should hold drop-in clinics for the booster, similar to those it runs for flu shots. And it should thoroughly update all its COVID-19 materials – including its out-of-date COVID-19 Vaccinations Page, which makes no mention of the bivalent booster – with recommendations to receive the booster and information about how to receive it.

Moreover, COVID-19 vaccination is likely to become a yearly routine, and this year’s lack of a timely and enthusiastic campaign should not set the template for future years. COVID-19 vaccination campaigns must join yearly flu vaccine campaigns as a University public health priority, rather than an afterthought. 

When University President Marc Tessier-Levigne wrote an email to the community on the first day of quarter, he heralded the start of a year where “our ‘new normal’ feels much more normal.” But as the death count continues to mount, as the inequalities marking COVID outcomes grow still more chasmic, and as the informal network of social supports that allowed people to scrape by the past few years crumbles to nothing, the abandonment of basic public health commitments by institutions with the responsibility to uphold them does not feel normal. It feels morally and politically grotesque. If there is anything normal about it, it’s not a normal worth preserving.

So Stanford, please do the bare minimum: Enthusiastically endorse the booster. Devote resources to ensuring community members get it. Keep track of how many of us have gotten it. The university can do much more than this to promote public health justice. To achieve anything close to a “normal” worth aspiring toward, it cannot do less.

Kara Schechtman is a master’s student in the Symbolic Systems program.

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