Designing COVID-19 vaccine mandates in colleges and universities: a roadmap to the 10 key questions

COVID-19 transmission among students, faculty, and staff at US institutions of higher education (IHEs) is a pressing concern, especially with the dominance of the highly contagious Delta variant and emergence of the Omicron variant. From the start of the pandemic to May 26, 2021, >700,000 cases were linked to US colleges and universities. To protect their populations and surrounding communities, IHE administrators are increasingly considering COVID-19 vaccine requirements. Roughly one-quarter of the nearly 4,000 college and university campuses across the US have announced COVID-19 vaccine mandates for students or employees. However, deciding to require vaccination is only the first of multiple decisions, as IHEs face complex issues of how to design and refine their mandates, including whether to require boosters. Mandates vary significantly in stringency, implementation, impact on members of the college or university community, and net benefit to the institution. This essay examines 10 key questions that an IHE must face in designing or refining a COVID-19 vaccination mandate. Showing that these 10 questions were carefully considered may be crucial if the institution's mandate is challenged. Ultimately, how an IHE designs its mandate may make the difference between meaningful risk mitigation that advances institutional goals and benefits students, faculty, and staff versus a public health failure that erodes trust, raises equity concerns, threatens to undermine preexisting vaccination requirements, and divides the campus.