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As the number of colleges requiring COVID vaccines continues to grow, many institutions mandating the immunizations for students fit a certain profile: more often private than public, selective, located in a Democratic-leaning state.

There are exceptions, of course. But the pattern is unmistakable. Just 15 of 181 colleges with COVID-19 vaccine requirements included in a list maintained by The Chronicle of Higher Education are located in states that voted for Trump in 2020. Of those 15, just one, Cleveland State University, in Ohio, is a public university.

Public and private institutions in the same state are taking different approaches on vaccine requirements. After Duke and Wake Forest Universities, selective private institutions in North Carolina, announced they would require vaccines for all students this fall, the News & Record reported that the University of North Carolina would not.

Similarly, Grinnell College, a private liberal arts college in Iowa, will require the vaccine for students next year, but the chair of the Iowa Board of Regents said that the state’s public universities will not.

Public universities in different states are also making different decisions. The University of Massachusetts campuses at Amherst, Boston and Lowell, along with nine other Massachusetts public universities, are all requiring vaccines for students this fall. The Colorado State University system is also mandating them, as is Washington State University.

Meanwhile, the University of Tennessee Board of Trustees voted this month not to include COVID-19 vaccines on its list of required immunizations for students. The board chair, John Compton, stressed personal freedom but strongly encouraged students and employees to consider getting a vaccine, according to a press release.

“Our No. 1 job is campus safety, and vaccines seem to be our best defense against COVID-19,” he said.

The American College Health Association on Thursday recommended colleges put in place COVID-19 vaccination requirements.

"The American College Health Association (ACHA) recognizes that comprehensive COVID-19 vaccination is the most effective way for institutions of higher education (IHEs) to return to a safe, robust on-campus experience for students in fall semester 2021," the association said. "Therefore, where state law and available resources allow, ACHA recommends COVID-19 vaccination requirements for all on-campus college and university students for fall semester 2021, in accordance with the IHE's normal exemption practices, including exemptions for medical contraindications."

In a handful of states, colleges are constrained by executive orders or legislation from requiring COVID-19 vaccines even if they want to, at least not without including broad exemptions that would risk making a mandate meaningless. Republican governors of at least five states -- Arizona, Idaho, Florida, Montana and Texas -- have issued executive orders barring government entities from requiring proof of COVID vaccination for access to buildings or services, though the potential applicability of these orders to colleges varies across those states. Arizona’s, for example, includes a carve-out saying that nothing in the order would prevent a school or university from requesting a student’s vaccine records “pursuant to state law.” An executive order from Texas governor Greg Abbott, on the other hand, is especially broad and affects both public colleges and any private college that receives state funding.

Utah’s governor signed a law in March that prohibits public universities from requiring vaccines unless they allow for exemptions for medical reasons and religious and personal beliefs.

“I think that can be reasonably interpreted to essentially give a person an ability to say, ‘I don’t want to get a vaccination’ to be exempt from a requirement,” said Geoffrey T. Landward, deputy commissioner and general counsel for the Utah System of Higher Education.

Landward said Utah colleges still have the option of requiring vaccinations.

"It's just a question of how effective would a requirement be with the exemptions that we have to have in place under this law," he said.

He added that some colleges are considering ways to incentivize, but not require, COVID-19 vaccination.

"The goal here is to get as many students vaccinated as possible," he said.

Chris Marsicano, an assistant professor of education practice at Davidson College in North Carolina, and director of the Davidson-based College Crisis Initiative, which researches colleges' responses to the pandemic, said he expects to see more colleges incentivizing vaccines. But he also expects a “flood” of colleges announcing requirements if and when any of the COVID-19 vaccines receive full approval from the Federal Drug Administration. Right now the vaccines are authorized for emergency use, creating a legal gray area for colleges.

The California State University and University of California systems have both said they plan to require the COVID vaccine this fall, but they made those requirements contingent on at least one of the available vaccines receiving full FDA approval.

“I see the blue state/red state divide, but I don’t think by the end of all of this there’s going to be this divide as much,” Marsicano said. “What we’re seeing is early adopters, and what’s driving the early adopters is less blue state/red state but eliteness and the desire to be the standard bearer. The wrinkle in all of this is we’re beginning to see some state legislatures introduce bills that would prohibit colleges from mandating vaccines. If those were to pass, then that’ll be the big red state/blue state divide.”

In Michigan, which has a Democratic governor and a Republican-controlled Legislature, a House version of a spending bill includes language prohibiting the state’s 15 public colleges from requiring COVID vaccines as a condition of enrollment or attendance. Two Michigan universities, the University of Michigan at Ann Arbor and Oakland University, have announced plans to require vaccination for all students living on campus, while the University of Michigan at Dearborn has announced plans to require either a vaccine or weekly proof of a negative COVID test.

Bob Murphy, chief policy officer for the Michigan Association of State Universities, said the language in the House bill, which is not included in a companion Senate bill, is concerning.

"We want to have the campuses be safe and approaching normal operations this fall, with fewer shifts and pivots online, with fewer outbreaks," he said. "Having herd immunity is part of that, and the way to get herd immunity safely is to maximize the number of people that get vaccinated."

Murphy noted that not very institution will take the same path.

“Some universities will leave it to strong guidance, and that will be dependent on local factors, the student population and a host of other concerns that are going to be decided institution by institution.”

He said member universities are reporting that students are clamoring to get vaccinated.

"It’s a question just of being able to get it," he said. "Some institutions don’t feel they have to have a mandate."

State University of New York chancellor Jim Malatras recently told Spectrum News that SUNY students have not widely shown vaccine hesitancy and a mandate is not needed at this time.

“If by the middle of summer, if we feel like our students have not gotten vaccinated enough to come back, we’ll talk about a mandatory vaccination program, but we’ll cross that bridge only if we have to get to it,” he said. “Right now we feel very confident that most of our students are going to get vaccinated.”

At Appalachian State University, which is part of the University of North Carolina system, professors want to see a vaccine requirement. Members of the Faculty Senate approved a resolution earlier this month calling on any controlling body -- whether that be the Legislature, the governor, the Department of Health and Human Services, the UNC system administration or Board of Governors, or the Appalachian State administration -- to impose a vaccine mandate for students returning this fall.

The university says it is strongly encouraging vaccines but says that “as a state government entity, App State cannot unilaterally mandate vaccines for employees or students.”

“I do think that the faculty continues to be very concerned about this,” said Michael C. Behrent, an associate professor of history who just completed his term as Faculty Senate chair. “I think the background to this is the fact that North Carolina opened in person in fall of 2020 at a time when a lot of campuses remained completely online. Some of our sister institutions, Chapel Hill and NC State and East Carolina, opened for a few days and then shut down fast. We stayed open; we did have a student death that did get quite widely reported. None of that was actually mentioned in the discussion, but I think it’s probably the background.”

“I hope in the next couple of months both Appalachian State and the UNC system re-evaluate their position,” said Jeffrey Bortz, a professor of history who sponsored the resolution calling for a vaccine requirement. “They might have more information. I hope they might change their minds.”

Elena Conis, an associate professor at the University of California, Berkeley’s Graduate School of Journalism who writes about the history of U.S. public health and policy, said, “We are in an unusual moment in the history of vaccination, talking of mandates for a vaccine that has yet to be approved by the FDA.”

Conis noted that although vaccine mandates have been used in the U.S. for more than a century, “They have been controversial for just as long. Importantly, we’ve gone through phases of relying to a greater or lesser extent on mandates to encourage widespread vaccination, and in recent decades we’ve relied on them more than ever before in our history. COVID-19 is now clearly accelerating this.”

Leana Wen, a former health commissioner for the city of Baltimore and a visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health, expects more colleges to announce vaccine mandates in the coming weeks and months.

“We’re seeing an increasing number of them,” she said. “My sense is others are in the wait-and-see approach. We will almost certainly see many more start to do this. I think a lot of places do not want to be first, but now we’re seeing that others have gone and have seen very little by way of complaints. Maybe there are some antivaccine parents who have expressed concerns, but my sense is overwhelmingly students are thrilled that they can have a return to pre-pandemic life.”

For those colleges that are concerned about or constrained in imposing a requirement, Wen added that there is a “middle ground of sorts … Entities may not require it but could require health screening so that in a sense the vaccine is the EZ-Pass lane."

For example, she said a college could require symptom screening daily and thrice-weekly testing -- “but if you are vaccinated, you can bypass all of that. I think that is a middle ground where you are not requiring vaccination, but getting the vaccine becomes a convenience factor where you can still bypass the other steps.”

The University of Illinois at Urbana-Champaign announced plans just to that effect Thursday. The university, which has had one of the most rigorous COVID-19 testing requirements of any college, said it plans to use verified proof of full vaccination status as a substitute for regular COVID testing this fall.

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