Implementing vaccine policy that addresses equity should be a University of Minnesota priority

Earlier this week University of Minnesota President Joan Gabel announced that the university would soon require employees to attest to the fact that they have been vaccinated against COVID-19. Further, the president promised that once the FDA approved any COVID vaccine (right now, all are authorized under an emergency use authorization or EUA), COVID vaccination would be added to the list of immunizations required for students. The president’s announcement noted that details on how these changes would be operationalized would be forthcoming.

We applaud Gabel’s decision to change course when presented with a shifting context and additional information and hope more college and university leaders will follow this lead. Now, as the university  develops the roadmap for implementing these promises, we call on our university to develop a clear, comprehensive, equity-focused approach to vaccination. It should be activated immediately and would ask everyone in the university community to participate in some way.

Some have borne a disproportionate brunt of the pain

For all of us, living through the pandemic for the past year and a half has been grueling and punctuated with losses. However, some have borne a disproportionate brunt of the pain: more Black, Hispanic, Native, and lower-income people have contracted COVID, gotten severely ill, and died from it. In our state, COVID cases are rising and once again the most pronounced increase is among Black Minnesotans.

A virus does not understand race or class, so how has it managed to ravage certain communities with greater intensity? One reason is that racism, both past and present, has structured our society to dole out resources selectively and unequally. This results in historically oppressed people having less access to the protections we know can shield us from the pandemic’s harms. For instance, those who face social and/or economic disadvantage are more likely to be employed in jobs where it is difficult to minimize exposure to the virus and simultaneously face a variety of barriers to accessing vaccination. In other cases, institutionalized racism experienced by many patients of color in health care settings perpetuates the medical mistrust sown by centuries of medical exploitation and exclusion of these communities.

A comprehensive and equitable policy approach is more than just a rule saying you must get vaccinated. Effectively implementing an equity-guided policy will require UMN to make vaccines maximally accessible – culturally, socially, logistically, financially. Let’s start immediately with setting up vaccination sites across campus that allow walk-ins, have extended hours and offer a choice of vaccines. People should be allowed paid days off or guaranteed accommodations for missed work or school assignments if they experience side effects from vaccination. This strategy would also entail providing frequent, easily accessible and culturally appropriate information and counseling on vaccination for all.

Meaningful engagement is critical

A vaccine requirement may be alarming to some who were hesitant to seek vaccination due to both historical injustices and wrongs they have personally experienced in their interactions with the health care and university systems. But institutions have a duty to address these wrongs head on. Here, meaningful engagement is critical. Commitment to dialogue with hesitant community members as well as others concerned about safety on campus often happen best through trusted organizations — whether student groups, religious institutions, or staff unions — and the university should share its power and resources with these organizations. They should be funded to design and carry out various aspects of Get the Vax 2.0, like community conversations, vaccination or testing events, distribution of masks and incentive programs. The people who will be most affected by a COVID outbreak or any health concern should not only be at the table but leading conversations about what they need to feel safe.

As it does with all the other vaccines already required of its students, UMN will allow some exemptions, with details to be worked out. Individuals who pursue an exemption from vaccination should be required to assume other protective measures to demonstrate their commitment to community safety, including proper indoor masking (with high quality masks) and regular, verified COVID testing. It is imperative that all members of the university community take preventive measures so that personal actions (or inactions) do not inflict harm.

Time is of the essence

While we understand that full FDA approval might offer some assurance for students, numerous employers and colleges, including many in our region, have already required vaccination under the EUA. Time is of the essence. It is unknown when FDA will grant approval; meanwhile, the fall semester is rapidly approaching, the highly transmittable delta variant is surging, and protections in the broader community have been rescinded (i.e., statewide mask requirements, capacity restrictions in public spaces). Having an equity-guided vaccine policy already activated at the start of the fall semester has important implications beyond our campuses and extending across the region. More than 65,000 students, hailing from locations throughout the state and around the world, are enrolled in the University of Minnesota system. Additionally, nearly 30,000 people work for the university, which is one of Minnesota’s largest employers. COVID transmission at the U will be a determining factor in how well COVID is controlled throughout Minnesota, which includes hard-hit rural areas, this fall and winter.

The University of Minnesota’s leadership in prudent public health policy should intrinsically address the foundational structures built upon centuries of racism that have contributed to inequitable COVID outcomes. This certainly presents challenges and would require a significant commitment of resources, both time and financial, from the university. But we believe an equity-minded approach to vaccine policy has the best shot of increasing our “community immunity” — enhancing safety, and building trust, compared to the status quo.

Though we are 18 months into this pandemic, it is not too late to take proactive steps to repair harm, provide access to protection, and center those whom our systems have historically put at disadvantage. Implementing a vaccine policy that prioritizes equity as a goal will promote the whole community’s safety in the context of a pandemic that has had unjust impacts.

This piece was developed and written collaboratively by Rachel Widome, a social epidemiologist at the U who researches how policy can be leveraged as a tool to promote population health and equitable outcomes, and the following co-authors: Nate Chomilo, a pediatrician and internal medicine physician and adjunct faculty member of the U’s Medical School; Sarah Gollust, a health communications and policy researcher in the U’s School of Public Health who studies the translation of various types of health information (including discourse on vaccines) to the public; Rachel Hardeman, a health equity researcher in the U’s  School of Public Health and the founding director of the Center for Antiracism Research and Health Equity; Carrie Henning-Smith, a health equity researcher at the U’s School of Public Health focusing on disparities that rural and older people face in accessing care and how policy can address these issues; Katy Backes Kozhimannil, a health services researcher at the U’s School of Public Health who focuses her work policy strategies to advance racial, gender, and geographic equity; Jaime Slaughter-Acey, a maternal and child health epidemiologist at the U’s School of Public Health who focuses her research on marginalized/underserved populations; Kumi Smith, an infectious disease epidemiologist who researches STI transmission dynamics and effective population-wide interventions for limited resources settings; and Elizabeth Wrigley-Field, a demographer and mortality researcher in the U’s Department of Sociology. Her recent research has quantified racial inequities in COVID-19 deaths.

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