Lisa Ipp, MD, on Influenza Vaccination Among College Students

September starts influenza season in many parts of the United States. It is also typically when classes resume on college campuses. Recent research examined college students’ feelings about receiving the influenza vaccination, what factors would motivate them to get vaccinated, and more.

Lead researcher, Lisa Ipp, MD, answered our burning questions about this topic. Dr Ipp is associate director of Adolescent Medicine and associate professor of Clinical Pediatrics at Weill Cornell Medicine in New York, New York.

INFECTIOUS DISEASES CONSULTANT: A 2016 report by the National Foundation for Infectious Diseases (NFID)¹ reported that influenza vaccination rates on college campuses fall short of US public health goals. What are some of the challenges associated with vaccination on college campuses? How can these challenges be overcome by public health officials?

Lisa Ipp: Per the Centers for Disease Control and Prevention (CDC), annual vaccination is the best way to reduce the chances that an individual will get influenza. Yet on US college campuses, flu vaccination rates remain strikingly low, hovering between 8% and 39%, and falling far short of the 70% Healthy People 2020 target recommendation as well as the American College Health Association (ACHA) Healthy Campus 2020 target goal of approximately 50%.

College students are at particularly high risk of getting and spreading the flu because of constant exposure to high-touch areas like common living spaces and classrooms, and through social activities. However, motivating college students to get an annual flu vaccination is difficult and compounded by several factors, including misperception of risk (e.g., healthy students may not worry about getting the flu);  life transitions (e.g., for many, this is the first time managing their own health); varying levels of awareness/attitudes toward the flu vaccine, side effects, and overall effectiveness; lack of knowledge regarding access to the vaccine on campus; busy schedules and competing priorities; and uncertainty about, or limited, insurance coverage. 

Education is critical for increasing vaccination rates, particularly with respect to addressing misconceptions regarding vaccine efficacy and side effects, and equally important is providing information regarding access to the vaccination.

ID CON: What qualities do successfully implemented college vaccination programs have? How can other colleges across the country implement these programs?

LI: Successful college and university flu programs had four main elements in common:

1. Prioritize vaccination clinics – These are the most utilized approach to on-campus prevention. Best practices had multiple high-traffic locations across campus, flexibility in hours conducive to student schedules, one big event or multiple smaller clinics, and free or “no cost” shots during clinics. To help increase immunization rates, several schools offer shots for free to students and faculty. Other schools call it “no cost,” as they use the student’s insurance to cover the cost.
2. Emphasize the importance of staying healthy – Feeling healthy is a main reason students do not get vaccinated, but staying healthy is also the main reason they do (e.g., not missing class or social engagements). Schools also indicate that the most prevalent challenges facing schools are students feeling that they are invincible and will not get sick. 
3. Use a variety of partners and platforms to disseminate information – Successful programs utilize campus partnerships, such as residence life, dining services, student groups and associations, and the athletics department. In addition, they utilize a variety of communication vehicles, including website, social media, newsletters, signs, and parents’ publications/events. Some schools also participate in competitions, utilize mascots and student groups, and offer flu survival kits to promote flu vaccination.
4. Make influenza prevention a year-round endeavor – Early spring is when most schools begin planning for the next flu season. Late summer is when education takes place, September is the start of flu prevention communications, and October is when most of the flu immunization clinics/events are held. 

ID CON: You recently conducted a survey² of college students that found that certain incentives might increase the likelihood of vaccination. Can you tell us more about that survey and its findings?

LI: Our survey was conducted online by The Harris Poll on behalf of the NFID within the United States between October 12 and 31, 2017, among 1005 US college students ages 18 to 24 years who were attending a 2-year or 4-year college or university at the time of the study. Figures for age by gender, race/ethnicity, region, household income, household size, and enrollment status were weighted where necessary to bring them into line with their actual proportions in the population. 

Improving vaccination rates among students appears to hinge on alleviating the cost, offering an incentive, and ensuring easy access. Almost half of college students who do not typically receive the flu vaccine (49%) say the only way they would get a flu vaccine is if there was a tangible incentive offered. About 6 in 10 college students believe that a monetary or other incentive (61%) or access to the vaccine at a low or no cost (61%) would affect college students’ likelihood of getting the flu vaccine “a lot.” Nearly half of students (48%) think access to the vaccine in multiple locations on campus would also affect likelihood “a lot.” When asked what specifically would be most effective to encourage student vaccination, free food (31%) and a big campus event where students can receive the flu vaccine (and get free food, listen to live music, etc.) (26%) topped the list.

ID CON: What is your overall key take-home message for practicing infectious disease and public health specialists?

LI: Our research was very helpful to begin to try to understand why rates of flu vaccination are currently so low amongst college students. The input of both the students and college health stakeholders are critical for understanding how to increase uptake. Students told us that incentives and low/no cost access are very important factors to increasing immunization.  Additionally, increasing education appears to be an essential factor. The school perspective also helped us understand what things work well, and it is important to disseminate this information to inform other schools and the broader community. An organized, planned approach to influenza vaccination, as well as improving education and focusing on the importance of staying healthy during flu season are critical components of a successful program. It was very interesting that a main barrier to flu vaccine is the student’s perception that they are healthy, while a main driver amongst those who receive the vaccine is to stay healthy.   

References:

1. Addressing the challenges of influenza vaccination on US college campuses: a report by the National Foundation for Infectious Diseases [published online May 2016]. National Foundation for Infectious Diseases. http://www.nfid.org/publications/reports/college-flu-summit-report.pdf.
2. New national survey suggests a combination of education, access, and incentives may help increase flu vaccination on college campuses [press release]. Bethesda, MD: National Foundation for Infectious Diseases; December 6, 2017. http://www.nfid.org/newsroom/press-releases/2017-press-releases/college-student-incentive-survey.pdf.