What Florida's push to roll back vaccines means for college students

Florida colleges and universities may soon be the only ones in the country without vaccine mandates.

State Surgeon General Joseph Ladapo announced a plan in early September to revoke all state vaccine requirements, a move that drew backlash from many medical professionals and Tampa Bay K-12 school leaders. State lawmakers would need to approve a complete rollback of vaccine requirements, but the Florida Department of Health can eliminate four not mandated by state law, which could take up to 80 days.

K-12 schools aren’t alone in managing the fallout. College campuses also face risks if vaccine mandates were to be withdrawn, medical experts said.

People are in close contact with one another on campuses, said Michael Teng, an associate professor at USF Health’s Morsani College of Medicine. Students live with one another and go to crowded athletic events and lecture halls, he said, which all increases the risk of a disease spreading.

“There’s really a pretty high chance that you’re going to get some sort of concentration of an outbreak within the college campus,” Teng said.

What’s required now

The Florida Board of Governors, which oversees the state’s public universities, requires that all students submit documentation of the meningococcal and hepatitis B vaccines. If they choose not to be vaccinated, students must sign a statement saying they are aware of the fatal nature of the disease and choose not to be vaccinated.

Florida law also currently requires the measles, mumps and rubella (or MMR) vaccine, so many colleges require documentation of that immunization, too.

Some Florida universities require more than those three vaccines. The University of Florida, for example, requires students enrolling in the College of Public Health and Health Professions to submit documentation of a tetanus, diphtheria and pertussis (or Tdap) vaccine, two varicella vaccines and a tuberculosis test.

Meningitis is one of the most worrisome vaccine-preventable diseases when it comes to college students, said Jill Roberts, a professor at USF’s College of Public Health who specializes in epidemiology. The disease, prevented by the meningococcal vaccine, is the infection and swelling of the brain and spinal cord membranes. It can be deadly within 24 hours, Roberts said.

Disrupting the shot schedule

Some diseases with the potential to disrupt college life are tied to vaccines that students typically get much sooner.

The Centers for Disease Control and Prevention recommends adolescents get the first dose of the meningococcal vaccine between 11 and 12 years old, and a booster at 16. Meningitis is still spread rapidly within college students, and there have been several outbreaks on campuses over the last few decades. Parties have been specifically linked to the spread of meningitis because students share drinks and cups, Roberts said.

Measles, mumps, and rubella also are causes for concern, Roberts said. Campuses became breeding grounds for measles and mumps in the 1990s because of close contact and crowded situations. Teng said these outbreaks prompted the Centers for Disease Control to authorize giving children a second dose at between 4 and 6 years old.

“We expect more measles cases and things like mumps and rubella, if you decrease the vaccination rate,” Teng said. “We do know pretty well that measles virus vaccine coverage needs to be above 90% to really decrease transmission and protect the population.”

Many students also have their first sexual experiences at college, Teng said, which can be another way of transmitting illnesses.

Students might come into contact with the vaccine-preventable human papillomavirus, or HPV, if they’re sexually active. It can cause genital warts, as well as cervical and oral cancers, Roberts said. The CDC recommends adolescents get the HPV vaccine at 11 years old, but Roberts said parents often try to delay until their kids are older.

Teng said people are great at keeping up to date with their vaccines, if they’re mandatory.

“But if it’s no longer required, people think, ‘Well, why? It’s time out of my day. I’ve got to make an appointment,’” he said. “And you can see that with the flu vaccine. Uptake of the flu vaccine is very low because it’s never required.”

The number of people getting their second dose of the meningococcal vaccine in high school especially will likely decrease without a vaccine mandate, Teng said. He said parents are more likely to take young children to the pediatrician on a regular schedule, but by high school, their kids might only go when they’re sick.

Students finishing up high school and entering college in the next few years do have a better awareness about how diseases spread, Teng said.

“They’ve grown up with COVID, so that it’s one of those things that they’ve experienced,” Teng said.

Controlling an outbreak

Student health centers, and nearby hospitals, would need to be better prepared for a disease outbreak, Teng said.

An outbreak of even 100 people with measles would cost millions of dollars, Roberts said, including the price of contract tracing and hospitalization.

”It’s more than a health center could handle,” Teng said.

Thanks to COVID, universities and colleges do have better procedures to quarantine or isolate students if there were to be an outbreak of a contagious respiratory disease, Teng said. There are more options for students to attend remote classes as to not disrupt learning, he said. Some classes like labs, though, often don’t have online options.

Student experiences and opportunities outside of the classroom could also be affected. If studying abroad, students typically need to meet the vaccine requirements of their host countries and host universities.

They may also be unable to intern at university-affiliated hospitals or attend medical schools if they’re unvaccinated. Those facilities and programs often have more robust vaccine requirements, Roberts said.

She said it’s in a hospital’s best interest for the majority of their employees to be vaccinated to maintain their accreditation status, and for the safety of their patients.

“If they’re missing a series that takes years to do, they’re out of luck,” she said. “If they’re not fully vaccinated for hepatitis B, for example, many healthcare facilities won’t let them in.”

Disease outbreaks can affect more than students. Teng worries about aging professors who might be more vulnerable to infections. Some of them may have only gotten one measles, mumps and rubella vaccination in their lifetime, he said, because that’s all that was required.

Specialized health centers located on campuses are also at risk, Roberts said. A measles outbreak would devastate a campus like the Moffitt Cancer Center at USF, she said.

Many Florida universities will likely strongly recommend vaccines, Roberts said, even if they can’t require them.

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