Clear communication needed with college students regarding COVID-19 vaccine procedures and cost

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, widespread restrictions and bans on social and business gatherings, travel, and leisure activities in groups have been implemented. Furthermore, in-person teaching was halted in colleges and schools, leading students, staff, and faculty to transition to online learning environments.

After the rollout of several different types of COVID-19 vaccines that offer protection against symptomatic and critical disease, many academic institutions are looking at reopening again or have already begun classes on campus. This necessitates vaccine coverage of students in order to protect them and those in contact with them. A new study published on the preprint server medRxiv* explores the acceptability and usage of COVID-19 vaccines among the student community.

Study: Measuring College Student Attitudes Toward COVID-19 Vaccinations. Image Credit: Tom Wang /


The phase of online learning was a cumbersome period, especially when large universities were involved. Expensive new technologies and infrastructure had to be deployed to cover large numbers of students online to offer students an acceptable quality of online education.

The fact that students were no longer on campus also removed them from dormitories and campus activities, thus preventing students from participating in social interactions with each other in person and precluding their involvement in student organizations. These effects, however, have been shown to increase the retention rate of learning, as well as enhance the rate of graduation.

As a result, many institutions that offer higher education are looking at ways to reopen safely in the coming semesters. Besides benefiting the students themselves, institutions are hopeful that reopening their campuses will return the campuses to their normal states. Many thousands of workers who have lost their jobs or been furloughed will also be able to find employment again in their old positions, both in the United States and globally.

Vaccines against COVID-19 became available in December 2020, beginning with the messenger ribonucleic acid (mRNA) vaccines from Pfizer and Moderna. With their clinical trial data indicating high efficacy and safety, these vaccines quickly received emergency use authorization from the U.S. Food and Drugs Administration (FDA) and were initially prioritized for some high-risk populations.

Later expansion of the eligibility criteria for COVID-19 vaccines still covered only essential healthcare workers. However, to date, colleges with a sizeable on-campus population are confronted with whether student vaccination is a feasible and acceptable recommendation for college students. The current study also looks at whether students would rather leave their courses rather than comply with mandatory vaccination mid-semester and whether students know that COVID-19 vaccines are entirely free.

Study findings

The current study shows that of the approximately 1,200 students studying for higher education who were enrolled, most are willing to be vaccinated when it becomes mandatory under college rules.

Almost 70% of these students were first-generation students, and about 20% had disabilities of some kind. Nearly half of the participants were undergoing only online instruction; however, most other students were receiving hybrid classes.

Only 6% of the participants in the current study were receiving in-person instruction as their sole medium of learning at the time of the survey. Almost one in three were undergoing part-time instruction.

About two-thirds of students were not fiercely opposed to being vaccinated. That is, just over a tenth was somewhat agreeable to it, while just under a third and slightly under a quarter said they were quite agreeable and moderately agreeable to the procedure, respectively.

Conversely, a tenth of the study participants indicated that they were quite averse to the idea, and a quarter was more or less opposed. Overall, approximately 80% said they would get vaccinated before college campuses reopened if required.

If vaccinations were made mandatory midway through the semester, a third of the participants said they would rather not attend classes than stay on campus. Females were generally a little less comfortable with the vaccine and were more likely to indicate that they would rather withdraw from in-person instruction if vaccines became mandatory. This was also the case with students aged 25 years and over.

Among Black students, vaccines were slightly less acceptable, and mid-semester requirements particularly unwelcome, though they did not have greater unwillingness to comply with mandatory vaccinations. White and other non-Black students showed similar levels of compliance.

Surprisingly, many students at this level did not know that the COVID-19 vaccines are free. About one in seven were prepared to pay up to $99 dollars for the vaccine. Over a tenth thought, it would cost between $100-$199, and 4% thought it would be still more expensive. This indicates the need to communicate vaccine costs clearly to the student community and inform them about the procedure to get a shot.

First-generation students were more compliant; however, the proportion of those who said they would prefer to withdraw if vaccine mandates were issued was similar for first- and second-generation students. Full-time students were more compliant than part-time ones, as were those taking four-year courses.

Disabled students would prefer to withdraw rather than take mid-semester vaccination, as would students who thought they needed to pay for the vaccine. However, both of these groups were similar to other groups in terms of their comfort with the vaccine or willingness to take the vaccine. No other differences were observed based on the type of class currently being taken.


Many higher education institutional policies have concentrated on the need for vaccines and how to make them widely available to the students, staff, and faculty in order to contain the viral transmission, especially in the face of emerging novel variants. Vaccine supply shortages, coupled with vaccine hesitancy, have created chaos in many states and counties, with federal, state, and county officials often in competition rather than coordination in their vaccination efforts.

While higher centers of learning are useful as hubs of vaccine distribution, they also present a potential route for the dissemination of the virus in the community once students return. Student vaccination appears to many policymakers to be a promising approach to keep campuses safe while simultaneously help increase vaccination coverage.

The current study enquired about student willingness to take the vaccine in various situations, so as to shape policies on campus safety.

Our findings showed that students supported vaccinations before returning to campus, and universities are well positioned to provide guidance on the importance of vaccines on affecting community safety and a return to normal operations.”

The incentives for such vaccinations could be the prospect of free interactions within the campus, without social distancing or mask use. Universities should also frame their messages to focus on disseminating correct information, combating vaccine misinformation, clarifying costs and insurance coverage, and setting out norms for vaccine eligibility.

Such policies must be communicated clearly to students at higher risk for vaccine hesitancy to ensure that all students understand that vaccines are free and available, besides being useful for their health and the health of their community.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information

Journal reference:
Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.


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The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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