Student health administrator perspectives on college vaccine policy development and implementation

Immunization policies at colleges and universities differ greatly for many reasons, including prior experience with disease outbreaks and state immunization requirements. Few studies comprehensively explore the range of factors that influence the development of college vaccine policies or facilitators and barriers to their implementation.

To explore the perceptions and decision-making process that influence college vaccine policy development and implementation from the perspective of student health administrators.

This qualitative study used semi-structured interviews with student health administrators (N = 10) from ten U.S. colleges and universities purposefully sampled by school type (public vs. private) and geographic region. A descriptive codebook was developed from the interview guide, and each interview was double-coded using NVivo 11 software (κ = 0.87; inter-observer reliability = 99.4%).

We coded 5785 phrases. Administrators positively viewed their institutions' vaccine requirements, but some expressed concerns about the acceptance of philosophical and religious exemptions. They noted that students were generally ambivalent towards vaccine requirements, and while students recognized the benefits of vaccination, they did not prioritize immunizations. All administrators cited reliance on governmental and professional organizations as well as state regulations for decisions regarding vaccine requirements and recommendations at their institutions. Partnerships with other school departments, pharmaceutical companies, immunization coalitions, and healthcare providers were frequently cited as facilitators of college vaccine programs. Costs of purchasing, storing, and tracking vaccines were identified as major barriers.

We identified key themes that can be evaluated in subsequent studies to identify factors associated with successful implementation of university immunization programs and inform initiatives to increase vaccine acceptance and optimize immunization rates on college and university campuses.