Is Covid-19 “vaccine uptake” in postsecondary education a “problem”? A critical policy inquiry

Abstract

Since the launch of the Covid-19 global vaccination campaign, postsecondary institutions have strongly promoted vaccination, often through mandates, and the academic literature has identified “vaccine uptake” among postsecondary students as a problem deserving monitoring, research, and intervention. However, with the admission that vaccines do not stop viral spread, that older-age and co-morbidities are major determinants of poor outcomes, and that many vaccine side effects disproportionately affect the young, it cannot be assumed that a risk-benefit analysis favors vaccinating postsecondary students. Drawing from critical policy studies, I appraise the literature on Covid-19 vaccine uptake in postsecondary education. I find that this literature reflects the “scientific consensus,” hardly acknowledging contradictory medical evidence, ignoring coercive elements underlying “vaccine acceptance,” and neglecting ethical tensions built into the very design of vaccination policies. I discuss potential explanations for my findings, and their implications for academia’s role in society in the COVID-19 era and beyond.

“It’s time for all Canadian colleges and universities to adopt mandatory vaccination policies. Many schools here and in the United States have already taken this step, yet others [are] concerned that a student or staff member might use Section 7 [of the Charter of Rights and Freedoms] ¹ to challenge a vaccine mandate. Would Canadian courts uphold vaccine mandates in the face of a Section 7 challenge? As legal scholars and educators, we believe the answer is a resounding ‘Yes!’”

Samuel E. Trosow and Julie Lowe, 2021, Western University, Canada

“Freedom [. . .] is a basic aspiration; the whole history of mankind consists of struggles and efforts to create social institutions capable of ensuring a maximum of freedom.”

Antonio Gramsci, 1916-1935, Selected Writings.

Introduction

Covid-19 vaccination policy in postsecondary education has been highly contested, with supporters and critics on both sides of the issue cutting across conventional “right/left/conservative/liberal” ideological lines, especially since mandated vaccination was implemented across many North American institutions (Burke, 2021; Canadian Academics for Covid Ethics, 2022; Forte, 2022; Trosow and Lowe, 2021). Importantly, however, there is little disagreement in the medical and public health communities that when formulating policy, the risk-benefit ratio for the recipient population of proposed interventions should be considered, for prudential and bioethical reasons (World Medical Association, 1964). As for any ratio, computing this one requires a good-faith assessment of both numerator and denominator. In our case, concerning the denominator, that is, anticipated benefits of Covid-19 vaccination, close to 3 years into the crisis it is apparent that children, adolescents, and young adults are at a much lower risk of severe disease, hospitalization, and death than older adults (COVID-19 Forecasting Team, 2022; Pezzullo et al., 2023) and that persons with comorbidities are at significantly higher risk than those without them (CDC, 2022; Wise, 2021). ²

For example, the Infection Fatality Rate (IFR)—the death count from an infectious disease over population infected—turned out to be far lower than originally reported, especially for young people. Analysis of seroprevalence data up to September 2020—that is, pre-vaccination era—found that infection rates were much higher, and IFR much lower, than predicted. The calculated infection fatality rate (IFR) across 51 locations among people younger than 70 years ranged from 0.00% to 0.31% with a corrected median of 0.05%, leading one well respected Stanford epidemiologist to conclude that “infection fatality rates tended to be much lower than estimates made earlier in the pandemic” (Ioannidis, 2020). A more recent analysis of age-stratified seroprevalence data reported even lower IFR estimates among non-elderly populations than previously calculated—a median IFR of 0.0003% at 0–19 years, 0.002% at 20–29 years, and of 0.011% at 30–39 years, 0.035% at 40–49 years, 0.123% at 50–59 years, and 0.506% at 60–69 years (Pezzullo et al., 2023). Notably, the absolute number of fatalities have turned out to be lower than seasonal flu fatalities among the younger age strata (Pezzullo et al., 2023) when compared to the 0.1% IFR for the seasonal flu reported by the WHO in March of 2020 (WHO, 2020).

International evidence also indicates that the risk of outbreaks in educational institutions, where the population is mostly young, has been very low (Ludvigsson et al., 2021), and North American public health agencies only list acute care, congregate living, correctional, and long-term care facilities—incidentally, all settings with very high vaccination rates—as accounting for 100% of their own recorded “outbreaks” (Public Health Agency of Canada, 2022), excluding educational institutions entirely. As to the numerator, that is, risks, it is also apparent that Covid-19 vaccination, chosen as the leading vehicle to control viral spread and reduce poor Covid-19 health outcomes (WHO, 2021), has side effects that are not trivial, since they include severe disability and death (Buchan et al., 2022; Fraiman et al., 2022; Karlstad et al., 2022; Li et al., 2021a; Mansanguan et al., 2022), or adverse effects relevant to men and women of reproductive age—“transient” reduction of sperm motility (Wesselink et al., 2022) and menstrual abnormalities (Muhaidat et al., 2022).

Whatever the case may be, the question arises: what criteria should guide policy under conditions of uncertainty, especially those impacting millions, such as Covid-19 vaccination policies in colleges and universities (hereafter “postsecondary institutions”)? The answer to this question, at least among postsecondary institutions across North America, has been clear: most institutions in the United States and Canada have insisted that Covid-19 vaccines are safe, effective, and have been critical to end the crisis, and how established mandated vaccination to promote vaccine “uptake” as a condition of employment of staff and faculty, or enrollment of students, with rare or no exemptions (Brown, 2022). As a result, in the summer of 2021, students were deregistered for refusing to comply with Covid-19 policies (Gilligan, 2021), and professors were laid-off for similar reasons (Dawson, 2021). Even after mandates were largely suspended in the summer of 2022, many institutions encouraged students, staff, and faculty to remain “up to date” with Covid-19 vaccines as per recommendations from public health authorities (University of Toronto, 2022; York University, 2022).

Be that as it may, the framework of the precautionary principle provides useful guidance to how to formulate policy concerning complex issues. It includes “shifting the burden of proof to the proponents of an activity; exploring a wide range of alternatives to possibly harmful actions; and increasing public participation in decision making”(Kriebel et al., 2001: 871). As applied to Covid-19 vaccination, the burden of proof should lay on its proponents, alternatives to harmful effects should be considered, and public participation should be guaranteed. This is especially critical when the risk-benefit ratio of official Covid-19 policy for a largely young and healthy population is questionable (Bardosh et al., 2022a) and when early treatment and even prophylaxis for high-risk groups with repurposed drugs has been successfully and internationally implemented (Kerr et al., 2022; Kory et al., 2021; McCullough et al., 2021; Risch, 2020).

Interestingly, as noted by Bardosh et al., it is the harm principle that has commonly been invoked to argue that vaccine mandates are ethically justifiable for the greater social good, by assuming that vaccines prevent transmission and therefore reduce harm to others (Bardosh et al., 2022a, 2022b). However, there is mounting evidence that vaccines have had a very limited, and only temporary, impact on reducing SARS-COV-2 transmission and reducing harm to others. Covid-19 vaccines do not provide sterilizing immunity and, as noted by a 2021 article in The Lancet, the risk of transmission among people who are unvaccinated and vaccinated is similar. The Lancet authors found that “fully vaccinated individuals have a peak viral load (25%) similar to unvaccinated cases (23%) and can efficiently transmit infection in household settings, including to fully vaccinated contacts” (Singanayagam et al., 2022: 1), challenging claims that vaccination prevented or greatly reduced transmission. Similarly, another study reported no significant difference in viral load (reported as cycle threshold values) between vaccinated and unvaccinated individuals who were infected with the Delta variant—whether asymptomatic or asymptomatic at the time of testing (Acharya et al., 2022). There is even some evidence of higher cases of infection among highly vaccinated populations. For example, an analysis of COVID cases in 68 countries and 2947 US counties found that COVID cases did not decrease in places with a higher percentage of fully vaccinated, and at a country level the trend showed even a marginal positive association between higher rates of vaccination and higher Covid per one million people (Subramanian and Kumar, 2021). Indeed, evidence that boosting with “updated” (i.e. bivalent) Covid-19 “vaccines” ³ correlates with higher risk of infection is mounting (Shrestha et al., 2022), to the point that already by 2021 even leading public health agencies no longer claimed that Covid-19 vaccines stopped viral spread (CDC Newsroom, 2021). Nevertheless, vaccination of the young has continued to be advanced for the benefit of society and close contacts—particularly elderly and vulnerable family members—by academic institutions even after these issues and debates became mainstream.

I have focused my analysis on postsecondary students because this is a population for whom the “problem” of vaccine uptake requires careful consideration. Notably, as my analysis will show, these considerations have played virtually no role in research on Covid-19 vaccination policy in postsecondary education, to the point that very high vaccination rates—higher than in the general population—have been pursued, and achieved—82% according to the American College Health Association (ACHA, 2022) and nearly 100% in some Canadian universities (University of Western Ontario, 2021)—regardless of risk-benefit ratio considerations. These high rates notwithstanding, the expert literature appears to perceive postsecondary students as having lower than desirable “uptake,” framing uptake and its key driver, “vaccine hesitancy” —defined as delay, reluctance, or refusal to accept vaccines even when available (WHO/Sage, 2014)—as a “problem” to document, appraise, and address with “effective” policies, meaning policies that can achieve the highest possible vaccination rates in perpetuity (See Chamon et al., 2022a; Gao et al., 2022; Geng et al., 2022; Khubchandani et al., 2022). The position is so extreme that even when students, after having received a so-called complete primary series, express reluctance to accept repeated “boosters,” their behaviors are construed as a “problem” (See ACHA, 2022). In fact, according to Bardosh et al mentioned earlier, there may even be a net harm to vaccination, given the low benefit to be accrued by young recipients (Bardosh et al., 2022b). In this context, a critical appraisal of the expert literature whose object of study is this “problem” is warranted.

Drawing from critical policy studies (Bacchi, 2016), I address this gap in the research by problematizing the dominant framing in the expert literature on Covid-19 vaccine uptake in postsecondary education. In the next section, I describe the theoretical and methodological approaches that inform my investigation. I subsequently present my findings and analysis of the data, then move on to discuss this study, its limitations, and potential explanations for my findings in the context of the broader expert literature, social practices, and power dynamics underlying public policy making in times of Covid-19. I conclude by elaborating on implications of my findings for the role of academia in society moving forward. This study is part of a larger project examining medicalization and social control in the Covid-19 era.

Theoretical and methodological considerations

My study was informed by the critical policy tradition, exemplified by Carol Bacchi’s approach, encapsulated in the question “What is the problem represented to be?” (hereafter WPR). While mainstream policy approaches envision policy analysis as a technical task, take at face value dominant representations of “policy problems,” and seek solutions within the boundaries of these representations, the WPR approach proposes instead a genealogy of “policy problems,” identifying the conceptualization of the “problem” by examining assumptions underlying actual policies. Put another way, WPR researchers focus on extant policies to tease out from them the “problems” that these policies are expected to address and resolve, while appraising the power dynamics underlying problem definition, range of “solutions” proposed, and paths not taken (Bacchi, 2016). The WPR form of analysis, which draws heavily from Foucauldian approaches to problematization (Bacchi, 2012), focuses on the social construction of problems—how problems are given “shape and meaning,” and is therefore “problem-questioning” rather than “problem solving” exercise (Bacchi, 2016). In the context of this study, I was interested in understanding the discursive strategies whereby certain cognitive states, psychological inclinations, and behaviors come to be seen as “problematic” and in need of a “policy fix,” and what type of power relations—societal, institutional, interpersonal—may explain these strategies.

To clarify my position with respect to the chosen approach, I agree with WPR researchers that all too often data, especially statistical, biomedical and epidemiological data, are used as “techniques of governing” to legitimize state action and control of human behavior, and therefore WPR researchers often shun these data (Bacchi, 2012). I would like to suggest, however, that data do not speak for themselves and as much as they can be used as “techniques of governing,” they can also be used for, in fact are fundamental to, challenging such techniques through a critical analysis. Therefore, I rely heavily on data on Covid-19 epidemiology, immunology, and pathophysiology to support my analysis. The research question guiding my inquiry was “Why (and for whom) is “vaccination uptake” among postsecondary students a “problem” and what should be done (and by whom) about the problem?”

To address this question, I immersed myself in the literature on “vaccine uptake/hesitancy” and examined policies developed to address this perceived problem, familiarizing myself with policy documents produced by leading agencies (See Government of Canada, 2021; Office of the US Surgeon General, 2021; WHO/Sage, 2014). I also designed several studies, including an umbrella review of the expert literature on Covid-19 vaccine hesitancy and an exploration of postsecondary students’ experience with vaccination policies in the Canadian context, both of which have been reported elsewhere (Chaufan and Hemsing, 2023; Chaufan, 2023). The current study reports findings of my critical policy analysis of articles retrieved from the United States National Library of Medicine.

On November 26, 2022 I conducted a PubMed search with no restrictions of time, place, or study type, using the Medical Subject Headings (MeSH) terms “Covid-19 vaccines,” “students,” and several terms listed under “acceptance” (National Library of Medicine, 2022)—“uptake” is not available as a MeSH term—to identify articles from the expert literature focused on vaccine uptake in postsecondary education. Search terms included “Covid-19 vaccines,” “students,” “and surrogates of “uptake” such as “patient acceptance of healthcare,” “patient satisfaction,” “behavior,” and “vaccination hesitancy” as Medical Subject Headings. I selected articles that addressed exclusively Covid-19 vaccine uptake exclusively among postsecondary students that also addressed “Covid-19 vaccination” as intervention. I conducted the screening and analysis of all included studies, but did not quality appraise the literature, since the purpose was not to systematically review this literature but rather appraise the “problem” as constructed by it. I treated these articles as “social facts,” human productions able to reflect actual power relations and convey meanings (Bowen, 2009). My goal was to explore how the expert literature discursively treated students’ attitudes and behaviors toward Covid-19 vaccination and the extent to which article authors reproduced or challenged the “scientific consensus” on Covid-19 as defined by leading medical journals (Alwan et al., 2020).

Since all articles were identified through PubMed, a search engine hosted by the US National Library of Medicine at the National Institutes of Health, I was confident that my sample would represent positions respected within the academy, offsetting limitations of the sampling process and data selection by a single researcher. After screening articles for eligibility—a focus on vaccine uptake in postsecondary education and publication in refereed journals—I identified the most salient themes trough a recurrent, deductive-inductive approach guided by my research question (Bowen, 2009). In Table 2, I summarize how each study represented the “problem” of vaccine uptake, which was the guiding question motivating my analysis. Because I drew from publicly available documents, the study did not require IRB approval.

Table 2.

Article description, first author country (WHO region) and income level (WB).

ID	first author, year	first author location	Study location	Pop. of interest	Study type	Policy problem yes/no	Why policy problem
1.	Ifechi, 2022	Nigeria	Nigeria	Medical Students	Quantitative (Survey)	Yes	Vaccines most promising to manage crisis and VH could be “great obstacle” Med students are future doctors, trusted figures; if hesitant themselves, may spread vaccine hesitancy
2.	Rodríguez-Blanco, 2022	Spain	Spain	Health Students	Quantitative (Survey)	Yes	Vaccine distribution faces “misinformation” Students are healthcare professionals & trusted leaders of the future; must be educated about vaccines to model with example
3.	Gabrovec, 2022	Slovenia	Slovenia	Medical and Other Health Professions Students	Quantitative (Survey)	Yes	Vaccines most successful public health measure; deployment faces “infodemic.” Health care workers important leaders, high risk of infection. Students future health professionals & trusted leaders, must accept vaccines to convey right message
4.	Jiang, 2022	China	China	College Students General	Quantitative (Survey)	Yes	VH serious threat to managing crisis. Vaccination of youth critical to achieve heard immunity.
5.	Gao, 2022	China	China	College Students General	Quantitative (Survey)	Yes	Third dose critical to reduce severe disease, especially in crowded places like college campuses.
6.	Liu, 2022	China	China	Medical Students	Quantitative (Survey)	Yes	Vaccines critical to reduce unprecedented global burden. Medical students may be misinformed about the importance of vaccination, despite their medical background.
7.	Chen, 2022	China	China	College Students and Teachers	Quantitative (Survey)	Yes	College students at increased risk of contagion; teachers critical role models
8.	Chamon, 2022	France	France	University Students	Mixed (Survey & interview of sub-sample)	Yes	Young adults increasingly at risk of infection & spread. Vaccinating young adults critical to herd immunity. Young adults hesitant about boosters despite high rates achieved by mandates.
9.	Guantier, 2022	France	France	Healthcare Students	Quantitative	Yes	Health workers at high risk of infection. To ensure success of vaccination, authorities need to build trust in vaccines, yet little is known about hesitancy among healthcare students in France
10.	Geng, 2021	China	China	College Students General	Quantitative (Meta-analysis of surveys)	Yes	Vaccines most effective way to stop unprecedented public health challenge. Young adults vulnerable to infection & more likely to transmit virus than older adults. At risk of campus outbreaks. False sense of confidence.
11.	Jaffe, 2022	US	US	College Students General	Quantitative (Survey w. text response option for 1 question)	Yes	Most promising strategy to end public health & social crisis is vaccination. Vaccine hesitancy among college students is concerning due to high risk of spread on college campuses. Knowledge of predictors critical to inform vaccine uptake interventions.
12.	Moro, 2022	Italy	Italy	Medical Students	Quantitative (Survey)	Yes	Vaccine confidence critical to success of vaccination campaign, especially among groups like medical students, future health professionals. Even if med students recognize the need for boosters, uptake among them is low (68%).
13.	Zhang, 2022	China	China	Healthcare Students	Quantitative (Survey)	Yes	Mass vaccination is critical to achieve herd immunity and control pandemic. Healthcare workers and students far higher risk of infection and transmission than general population.
14.	Almalki, 2022	Saudi Arabia	Saudi Arabia	Public Health Students	Quantitative (Survey)	Yes	Transmission among students can increase transmission to families and society. Proximity to border (Yemen, Africa) increases risk of infection from illegal immigrants
15.	Jain, 2021	India	India	College Students General	Quantitative (Survey)	Yes	Vaccines are critical to attain complete protection. College students are messengers of health promoting behaviors to families and communities. However, uptake is low (50%).
16.	Montvidas, 2021	Lithuania	Lithuania	Health Science Students	Quantitative (Survey)	Yes	Non-Pharmaceutical Interventions have negative economic & psycho-social impact. No treatments are available. Vaccines are needed to control the pandemic. Health students are critical to vaccination efforts but vaccine hesitancy among them remains high (from 10–46%).
17.	Fontenot, 2021	US	US	Nursing Students	Quantitative (Survey)	Yes	Nurses are at high risk of infection yet hesitancy among them is widespread (about one third). Nurses are retired and will be replaced by current students, so vaccine confidence among them must be strengthened.
18.	Mayan, 2021	US	US	Medical Students	Quantitative (Survey)	Yes	Vaccines are critical to mitigate pandemic. Medical students will become trusted leaders and must be capable of countering vaccine misinformation.
19.	Yesiltepe, 2021	Turkey	Turkey	Nursing Students	Quantitative (Survey)	Yes	No effective treatment of Covid exists. Best prevention are vaccines. Postmodern perspectives in social media emphasize risks over benefits. Nursing students should believe in vaccines. We need to assess how degree of fear of Covid among them predicts hesitancy.
20.	Mustapha, 2021	Nigeria	Nigeria	Health Science Students	Quantitative (Survey)	Yes	Vaccination is critical to herd immunity. Vaccines widely available yet uptake endangered by misinformation. Health sciences students can be advocates of public health measures, yet vaccine acceptance among them varies.
21.	Li, 2021	China (Hong Kong)	China (Hong Kong)	University Students General	Quantitative (Survey & experiment)	Yes	Vaccines are mandated on campus, yet uptake remains an issue among sub-groups of students. Critical to understand why to increase vaccine uptake.
22.	Hamdan, 2021	US	Lebanon	University Students General	Quantitative (Survey)	Yes	Despite Non- Pharmacological Interventions, cases are increasing. There are no effective treatments. Prevention through vaccines is critical. Gaps in knowledge among students exist.
23.	Khubchandan, 2021	US	No country exclusion	College Students General (excludes healthcare)	Quantitative (Review)	Yes	Rising rates of morbidity and mortality among young adults calls for concerted action to increase vaccine uptake.
24.	Bolatov, 2021	Kazakhstan	Kazakhstan	Medical Students	Quantitative (Survey)	Yes	Vaccines are ungently needed to control pandemic. Especially important among medical students, to achieve herd immunity and as role models. Despite wide availability, uptake remains low (under 10%).
25.	Andrade, 2021	United Arab Emirates	Venezuela	University Students General	Quantitative (Survey)	Yes	Venezuela has been slow to receive vaccines due to Western (US) sanctions. Even when present, hesitancy is widespread, related to conspiracy beliefs, anti-science stance, and religiosity. Important to understand these issues among university students.
26.	Alzubaidi, 2021	United Arab Emirates	United Arab Emirates	University Students General	Quantitative (Survey)	Yes	High vaccination rates are critical to herd immunity. Understanding vaccine acceptability among university students in planning prevention efforts.
27.	Wismans, 2021	Netherlands	Netherlands Belgium Portugal	University Students (General)	Quantitative (Survey)	Yes	Vaccines are critical to herd immunity. Hesitancy greatest challenge to vaccination. Young adults less likely to accept vaccines.
28.	Li, 2021	China	China	Medical Students	Quantitative (Survey)	Yes	Despite significant public health efforts epidemic continues. Herd immunity through vaccines one of most effective interventions. Medical students in clinical training at high risk of infection and operate as role models.
29.	Luo, 2021	China	China	University Students	Quantitative (Survey)	Yes	Vaccination most promising intervention to end pandemic. Social media may expose to misinformation and anti-vaccination sentiments. University students consume social media, and subject to peer influences. We should investigate social media and peer influences to promote uptake and avoid campus closures.
30.	Saied, 2021	Egypt	Egypt	Medical Students	Quantitative (Survey)	Yes	No treatment is available. Vaccines are best strategy to control pandemic. Students are at risk of infection and can transmit to others due to their sense of invulnerability. Only 45.9% of medical students in Egypt intend to accept vaccines.
31.	Barello, 2020	Italy	Italy	University Students	Qualitative (Survey)	Yes	Italy has experienced the highest rates of measles in Europe in recent past. It is important to examine intention to accept Covid vaccines among young adults because they are open-minded, educated, and supposed to respond quickly to public health measures.

Findings and analysis

My search identified 37 articles published in peer-reviewed journals, six of which I eliminated because they either reported on vaccine uptake among elementary (1) or high school (3) students, one (1) because it reported on interventions other than vaccination, and another one (1) because it reported on the nursing profession’s views on the need to vaccinate nursing students, leaving a total of 31 articles for examination (Table 1). All but one among the remaining articles reported original, quantitative survey research (one was conducted along with a survey experiment), one consisted of a review of the literature, and one was a mixed-method study combining a survey and interviews of a small subset of surveyed participants. Most articles were conducted by authors affiliated to academic institutions, or medical institutions within academia (e.g. teaching hospitals) in middle- or high-income countries, on student populations in their own countries, except for two articles, one whose first author, affiliated with a US institution, conducted a literature review with no geographic restrictions, and another one conducted in the Netherlands on students in the Netherlands and two other European countries (Belgium and Portugal). Following the WHO regions, two 1^st authors were affiliated with African institutions (Nigeria), five with North American institutions (USA), four with institutions in the Eastern Mediterranean (two in the United Arab Emirates, one in Egypt and one in Saudi Arabia), two with European institutions (two with institutions in France, two in Italy, and the remainder equally distributed among institutions in Kazakhstan, Lithuania, the Netherlands, Slovenia, Spain and Turkey), one in Southeast Asia (India) and nine with institutions in the Western Pacific (all but one in mainland China and one in Hong Kong) (Table 2).

Table 1.

Article selection references.

Almalki, M. J. (2022). A Cross-Sectional Study of the Satisfaction with, Adherence to, and Perspectives toward COVID-19 Preventive Measures among Public Health Students in Jazan, Saudi Arabia. International Journal of Environmental Research and Public Health, 19(2). https://doi.org/10.3390/ijerph19020802

Alzubaidi, H., Samorinha, C., Saddik, B., Saidawi, W., Abduelkarem, A. R., Abu-Gharbieh, E., & Sherman, S. M. (2021). A mixed-methods study to assess COVID-19 vaccination acceptability among university students in the United Arab Emirates. Human Vaccines & Immunotherapeutics, 17(11), 4074–4082. https://doi.org/10.1080/21645515.2021.1969854

Andrade, G. (2021). Vaccine hesitancy and religiosity in a sample of university students in Venezuela. Human Vaccines & Immunotherapeutics, 17(12), 5162–5167. https://doi.org/10.1080/21645515.2021.1981737

Barello, S., Nania, T., Dellafiore, F., Graffigna, G., & Caruso, R. (2020). “Vaccine hesitancy” among university students in Italy during the COVID-19 pandemic. European Journal of Epidemiology, 35(8), 781–783. https://doi.org/10.1007/s10654-020-00670-z

Bolatov, A. K., Seisembekov, T. Z., Askarova, A. Z., & Pavalkis, D. (2021). Barriers to COVID-19 vaccination among medical students in Kazakhstan: Development, validation, and use of a new COVID-19 Vaccine Hesitancy Scale. Human Vaccines & Immunotherapeutics, 17(12), 4982–4992. https://doi.org/10.1080/21645515.2021.1982280

Bou Hamdan, M., Singh, S., Polavarapu, M., Jordan, T. R., & Melhem, N. M. (2021). COVID-19 vaccine hesitancy among university students in Lebanon. Epidemiology and Infection, 149, e242. https://doi.org/10.1017/S0950268821002314

Chamon, Q., Govindin Ramassamy, K., Rahis, A.-C., Guignot, L., Tzourio, C., & Montagni, I. (2022). Persistence of Vaccine Hesitancy and Acceptance of the EU Covid Certificate Among French Students. Journal of Community Health, 47(4), 666–673. https://doi.org/10.1007/s10900-022-01092-6

Chen, Y., Zhang, M.-X., Lin, X.-Q., Wu, H., Tung, T.-H., & Zhu, J.-S. (2022). COVID-19 vaccine hesitancy between teachers and students in a college, a cross-sectional study in China. Human Vaccines & Immunotherapeutics, 18(5), 2082171. https://doi.org/10.1080/21645515.2022.2082171

Fontenot, H. B., Mattheus, D. B., Lim, E., Michel, A., Ryan, N., Knopf, A., Abuelezam, N. N., Stamp, K., Hekel, B., Branson, S., & Zimet, G. (2021). Undergraduate nursing students’ COVID-19 vaccine intentions: A national survey. PloS One, 16(12), e0261669. https://doi.org/10.1371/journal.pone.0261669

Gabrovec, B., Selak, Š., Crnkovič, N., Šorgo, A., Cesar, K., Fafangel, M., Vrdelja, M., & Trop Skaza, A. (2022). Compliance with Preventive Measures and COVID-19 Vaccination Intention among Medical and Other Healthcare Students. International Journal of Environmental Research and Public Health, 19(18). https://doi.org/10.3390/ijerph191811656

Gao, W., Zhang, Y., & Yin, G. (2022). Identifying conditions for a third dose intention of COVID-19 vaccination in college students: A fuzzy-set qualitative comparative analysis. Frontiers in Public Health, 10, 932243. https://doi.org/10.3389/fpubh.2022.932243

Gautier, S., Luyt, D., Davido, B., Herr, M., Cardot, T., Rousseau, A., Annane, D., Delarocque-Astagneau, E., & Josseran, L. (2022). Cross-sectional study on COVID-19 vaccine hesitancy and determinants in healthcare students: Interdisciplinary trainings on vaccination are needed. BMC Medical Education, 22(1), 299. https://doi.org/10.1186/s12909-022-03343-5

Geng, H., Cao, K., Zhang, J., Wu, K., Wang, G., & Liu, C. (2022). Attitudes of COVID-19 vaccination among college students: A systematic review and meta-analysis of willingness, associated determinants, and reasons for hesitancy. Human Vaccines & Immunotherapeutics, 18(5), 2054260. https://doi.org/10.1080/21645515.2022.2054260

Ifechi, O. C., Chinonye, E. E., & Chidozie, O. (2022). COVID-19 Vaccine Hesitancy among Clinical Medical Students in Enugu, South East Nigeria. Journal of Health Care for the Poor and Underserved, 33(4), 1879–1890. https://doi.org/10.1353/hpu.2022.0143

Jaffe, A. E., Graupensperger, S., Blayney, J. A., Duckworth, J. C., & Stappenbeck, C. A. (2022). The role of perceived social norms in college student vaccine hesitancy: Implications for COVID-19 prevention strategies. Vaccine, 40(12), 1888–1895. https://doi.org/10.1016/j.vaccine.2022.01.038

Jain, L., Vij, J., Satapathy, P., Chakrapani, V., Patro, B., Kar, S. S., Singh, R., Pala, S., Sankhe, L., Modi, B., Bali, S., Rustagi, N., Rajagopal, V., Kiran, T., Goel, K., Aggarwal, A. K., Gupta, M., & Padhi, B. K. (2021). Factors Influencing COVID-19 Vaccination Intentions Among College Students: A Cross-Sectional Study in India. Frontiers in Public Health, 9, 735902. https://doi.org/10.3389/fpubh.2021.735902

Jiang, F., Zhao, Y., Bai, J., Yang, X., Zhang, J., Lin, D., & Li, X. (2022). Perceived health literacy and COVID-19 vaccine acceptance among Chinese college students: A mediation analysis. PloS One, 17(9), e0273285. https://doi.org/10.1371/journal.pone.0273285

Khubchandani, J., Biswas, N., Mustapha, T., Talbert, S., & Dharamsi, S. (2022). COVID-19 vaccination refusal among college students: Global trends and action priorities. Brain, Behavior, and Immunity, 99, 218–222. https://doi.org/10.1016/j.bbi.2021.10.006

Li, M., Zheng, Y., Luo, Y., Ren, J., Jiang, L., Tang, J., Yu, X., Luo, D., Fan, D., & Chen, Y. (2021). Hesitancy toward COVID-19 vaccines among medical students in Southwest China: A cross-sectional study. Human Vaccines & Immunotherapeutics, 17(11), 4021–4027. https://doi.org/10.1080/21645515.2021.1957648

Li, X., Chong, M. Y., Chan, C. Y., Chan, V. W. S., & Tong, X. (2021). COVID-19 vaccine preferences among university students in Hong Kong: A discrete choice experiment. BMC Research Notes, 14(1), 421. https://doi.org/10.1186/s13104-021-05841-z

Liu, H., Zhou, Z., Tao, X., Huang, L., Zhu, E., Yu, L., Du, S., & Zhang, M. (2022). Willingness and Influencing Factors to Receive COVID-19 Vaccination Among Chinese Medical Students. Frontiers in Public Health, 10, 869838. https://doi.org/10.3389/fpubh.2022.869838

Lo Moro, G., Cugudda, E., Bert, F., Raco, I., & Siliquini, R. (2022). Vaccine Hesitancy and Fear of COVID-19 Among Italian Medical Students: A Cross-Sectional Study. Journal of Community Health, 47(3), 475–483. https://doi.org/10.1007/s10900-022-01074-8

Luo, S., Xin, M., Wang, S., Zhao, J., Zhang, G., Li, L., Li, L., & Tak-Fai Lau, J. (2021). Behavioural intention of receiving COVID-19 vaccination, social media exposures and peer discussions in China. Epidemiology and Infection, 149, e158. https://doi.org/10.1017/S0950268821000947

Mayan, D., Nguyen, K., & Keisler, B. (2021). National attitudes of medical students towards mandating the COVID-19 vaccine and its association with knowledge of the vaccine. PloS One, 16(12), e0260898. https://doi.org/10.1371/journal.pone.0260898

Montvidas, J., Basevičiūtė, M., Burokaitė, K., Adomaitienė, V., & Lesinskienė, S. (2021). COVID-19 Vaccine Hesitancy and Psychosocial Effects of the COVID-19 Pandemic among Health-Science Students of Lithuania-A National Cross-Sectional Online Survey. International Journal of Environmental Research and Public Health, 18(24). https://doi.org/10.3390/ijerph182412870

Mustapha, M., Lawal, B. K., Sha’aban, A., Jatau, A. I., Wada, A. S., Bala, A. A., Mustapha, S., Haruna, A., Musa, A., Ahmad, M. H., Iliyasu, S., Muhammad, S., Mohammed, F. Z., Ahmed, A. D., & Zainal, H. (2021). Factors associated with acceptance of COVID-19 vaccine among University health sciences students in Northwest Nigeria. PloS One, 16(11), e0260672. https://doi.org/10.1371/journal.pone.0260672

Rodríguez-Blanco, N., Vicente-Alcalde, N., Cubero-Plazas, L., Sánchez-Más, J., Montagud, E., Moragues, R., Gabaldón-Bravo, E., Hurtado-Sanchez, J. A., & Tuells, J. (2022). Acceptability of the Vaccine against COVID-19 in Spanish Health Sciences Students: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 19(19). https://doi.org/10.3390/ijerph191912244

Saied, S. M., Saied, E. M., Kabbash, I. A., & Abdo, S. A. E.-F. (2021). Vaccine hesitancy: Beliefs and barriers associated with COVID-19 vaccination among Egyptian medical students. Journal of Medical Virology, 93(7), 4280–4291. https://doi.org/10.1002/jmv.26910

Wismans, A., Thurik, R., Baptista, R., Dejardin, M., Janssen, F., & Franken, I. (2021). Psychological characteristics and the mediating role of the 5C Model in explaining students’ COVID-19 vaccination intention. PloS One, 16(8), e0255382. https://doi.org/10.1371/journal.pone.0255382

Yeşiltepe, A., Aslan, S., & Bulbuloglu, S. (2021). Investigation of perceived fear of COVID-19 and vaccine hesitancy in nursing students. Human Vaccines & Immunotherapeutics, 17(12), 5030–5037. https://doi.org/10.1080/21645515.2021.2000817

Zhang, J., Dean, J., Yin, Y., Wang, D., Sun, Y., Zhao, Z., & Wang, J. (2021). Determinants of COVID-19 Vaccine Acceptance and Hesitancy: A Health Care Student-Based Online Survey in Northwest China. Frontiers in Public Health, 9, 777565. https://doi.org/10.3389/fpubh.2021.777565

The most salient finding was the undisputed consensus across sampled articles that Covid 19 vaccine uptake in postsecondary institutions is a “problem” that requires continuing monitoring, research, and policy intervention. This “problem” dominated articles’ introduction and discussion sections, justifying the need for policies to address it. This was the case despite, as referenced earlier, the extremely low personal risk for most postsecondary students—a survival rate of over 99.98% (COVID-19 Forecasting Team, 2022; Pezzullo et al., 2023) or mounting evidence of vaccine adverse effects disproportionately affecting, or of greater concern to, the young, such as subclinical myocarditis (Mansanguan et al., 2022), transient reduction of sperm motility (Wesselink et al., 2022), lack of reproductive toxicity data (UK.Gov, 2022), and increased risk of death (Fraiman et al., 2022), evidence that was not cited, downplayed, or deemed illegitimate.

Having identified vaccine “uptake” and “hesitancy” among postsecondary students as “problems,” the policy “solution” of decreasing hesitancy to improve uptake followed seamlessly: recommendations varied from strengthening vaccination messaging, to tailoring messages to the perceived uniqueness of this demographic group, to recruiting trusted sources to spread the dominant message (Chamon et al., 2022a; Gao et al., 2022; Geng et al., 2022; Khubchandani et al., 2022). Strikingly, none of the proposed “solutions” even entertained the hypothesis that the “policy problem” so construed may be no problem at all, and that the cognitive states, attitudes, and behaviors identified could indicate instead a very healthy degree of skepticism given the available evidence. Nor did any author consider that their findings may also indicate resistance by a student population that over the past years has been subjected to an unprecedented pressure to comply. I now lay out the key themes identified through a critical analysis of the expert literature.

No degree of “vaccine hesitancy” can ever be justified

All articles identified a range of drivers of lower than desirable uptake, including concerns with side effects and ineffectiveness (Saied et al., 2021), “mistrust” in science (Fontenot et al., 2021), conservative ideology (Fontenot et al., 2021), and lack of knowledge about Covid-19 and vaccination (Mayan et al., 2021), presented as leading to varying degrees of “vaccine hesitancy” (Chamon et al., 2022a; Jaffe et al., 2022; Lo Moro et al., 2022a). My most salient observation, however, was that if there were any sound reasons to express reluctance toward Covid-19 vaccination, readers were not told, as students’ reasons that may have helped scholars to make sense of these drivers were largely left unexplored. Put another way, “identified” drivers of uptake/hesitancy consisted ultimately of replies to survey questions alluding to concepts as operationalized by researchers who, as per their stated study goals, and transparent pro-vaccine preferences, were a priori persuaded that low (or lower than expected by investigators) uptake and “hesitancy” are “problems” requiring “policy solutions.” Predictably, in the single case when students’ experiences were examined qualitatively (a small number of surveyed students were also interviewed), and researchers identified that students were concerned with the side effects of vaccination, authors concluded that the “policy solution” was to increase students’ “knowledge” about the “true” severity of Covid-19—implying that students understated its severity—and about the risks of vaccination—once again, implying that students overstated vaccine risks or miscalculated the ratio of risks versus benefits. Solutions proposed or insinuated by the authors would reduce students’ reservations (Chamon et al., 2022a).

“Uptake” indicates “acceptance”

Several articles also revealed ambiguity in the use of terms like “uptake” and “acceptance,” often using both interchangeably (Mustapha et al., 2021; Zhang et al., 2021). This is problematic, as in the fall of 2021, for students across many North American institutions who wished to continue or complete their postsecondary studies, refusing vaccination was very costly, the highest cost being the loss of student status (CBC News, 2021; York University, 2021), a cost imposed by many institutions well into the winter of 2022 (University of Western Ontario, 2022). Clearly, what “uptake” indicates would differ radically whether it reflects a voluntary decision on the part of subjects of a policy or the power of external forces over subjects’ decision-making process, in this case, the policy of mandated vaccination (Riga, 2021; The Canadian Press, 2021). If the latter is the case, because the alternative to compliance is extremely undesirable, then “uptake,” high or low, should be labeled “coercion” rather than “acceptance,” as it would in most other contexts (Raypole, 2020; Wikipedia, 2022). However, the term “coercion” did not appear once in the articles retrieved through my PubMed search.

The only evidence that counts is that consistent with the “scientific consensus”

The literature also appeared to assume that low uptake, when driven by a reluctance to get vaccinated—rather than lack of access, or so-called “complacency” (WHO/Sage, 2014)—can neither be reasonable nor based on evidence. No author mentioned peer-reviewed published evidence for the disproportionate adverse effects of Covid-19 vaccines on children, youth, and young adults, including subclinical myocarditis (Mansanguan et al., 2022; Naveed et al., 2022), “transient” reduction of sperm motility (Wesselink et al., 2022), or menstrual abnormalities (Muhaidat et al., 2022). No article cited publicly available pharmacovigilance data, such as that retrievable through VAERS, ⁴ revealing that, for instance, as of December 30, 2022, of the 2,394,197 post-vaccine injuries reported corresponding to all vaccines administered for over three decades, 1,494,382—or 62%—were attributable to Covid-19 vaccines (or boosters) since December 2020. Of these, 60,994 have occurred among children 17 years of age and under, 10,427 of whom were not recovered at the time of this writing (OpenVAERS, 2022). However, neither VAERS, a leading pharmacovigilance system, nor OpenVAERS, which makes the data more accessible to the public than VAERS itself, were mentioned in any of the articles in my sample. When adverse events were mentioned they were dismissed as “rare occurrences” offset by the benefits of vaccination (Lo Moro et al., 2022a) or attributed to “misinformation” (Khubchandani et al., 2022).

A morally just response implies universal vaccination

Many authors implied that to manage the crisis universal vaccination was required as a matter of justice, at times explicitly recommending mandates as the “equitable solution” (Khubchandani et al., 2022), without elaborating on what this “equity” may entail. Concerningly, no author appeared to find—in light of the long-standing bioethical principles of informed consent established at Nuremberg (International Military Tribunal, 1946) and the principles of beneficence and nonmaleficence embedded in the Hippocratic Oath (History of Medicine Division, NIH, 2022), all enshrined in ethical clinical practice (Varkey, 2021)—anything ethically problematic with vaccination policies in postsecondary institutions. Nor did any article acknowledge debates around the violation of democratic principles in the name of “protecting the public good,” even if the evidence for this “protection” is wanting (Edgell et al., 2021). Policy recommendations followed predictably from the assumptions: from improving “educational activities” to promote vaccination (Gautier et al., 2022), to considering idiosyncrasies of students as a group (e.g. high exposure to social media) when designing pro-vaccine interventions (Luo et al., 2021), to assuring that pro-vaccine public health campaigns are “inclusive” of young adults (Mustapha et al., 2021), to “strengthening the management of information and news on vaccines” to weed out unapproved sources (Li et al., 2021b).

Mental distress or the presence of an absence

Finally, notably absent from the expert literature sampled was the emotional distress that young adults have experienced, and continue to experience, as a result of the joint effect of postsecondary Covid-19 policies, which compound the impact of broader societal policies (Herby et al., 2022). This absence notwithstanding, concerns about the unforeseen (or neglected?) effects of Covid-19 policies have been raised by a few lone voices, external to my PubMed search: one author, who underscored the distress among students generally resulting from trying to make sense of Covid-19 countermeasures while maintaining low-paying jobs and attempting to complete a course of studies, yet still recommended improving the messaging targeting young adults with a “positive framing” to assure that it “reflects [the] lived experiences of this age demographic” (Cheng et al., 2021), rather than challenging the policies on their merit; another author, notably a doctoral student, who alerted about the trauma that a forced medical intervention may cause to one of the most vulnerable groups in society—persons labeled as “mentally ill”—who may experience “chemical retraumatization” as a result of mandated vaccination, and pointed to potential violations of students’ rights in the policy (Procknow, 2022), yet stopped short of questioning the policy when applied to all students.

Discussion

The expert literature on postsecondary education vaccination uptake, produced by researchers with academic affiliations worldwide and published in refereed journals, overlooked, downplayed, or dismissed students’ concerns with the side effects and risk-benefit ratio considerations of Covid-19 vaccination, as if these could not possibly have any empirical basis, despite mounting evidence to the contrary available as early as the launch of the global vaccination campaign (Doshi, 2020). It also dismissed, when not altogether ignored, the potential negative effects of postsecondary vaccination policies themselves (Bardosh et al., 2022a; Procknow, 2022), and the absence in these policies of any considerations for the principles of beneficence, nonmaleficence, autonomy, and informed consent (Varkey, 2021), built into their very structure. This homogeneity was observed regardless of the geographical location of the study site, the academic affiliation of the authors, the ideological orientation of the countries where these authors were located (e.g. communist China vs capitalist USA), or the system of governance (e.g. democratic Netherlands vs autocratic Saudi Arabia).

Even more compelling than the absence of debate around risk-benefit ratio consideration was the absence of debate around the remarkable process whereby certain cognitive, psychological, and behavioral features of a demographic group that has shown a high degree of compliance with the policy of vaccination—nearly 100% according to some university websites (University of Western Ontario, 2021)—have jointly been construed as the “problem” of less than desirable “uptake.” Indeed, not a single author questioned whether “uptake” was a “problem”—and if so, a problem for who—requiring intervention, or tried to understand whether a certain degree of reluctance may be warranted. All of them tried to “manage” this reluctance, however minuscule, with full compliance presented always as the only scientifically justified and morally right course of action. Alternatives appeared not only unscientific or wrong, but simply unimaginable.

The ideological work of creating a policy problem when it could reasonably be argued that no such problem exists was achieved by assuming, rather than demonstrating, that vaccination with subsequent boosters for the foreseeable future is the only policy intervention able to end the Covid-19 crisis, not only in the public health but also in the social, economic, and political realms. While a thorough critique of this assumption is beyond the scope of this study, as I have shown, a wealth of scientific evidence indicates that this assumption is unwarranted—evidence, I also note, that was ignored by the authors or at best dismissed as “misinformation.” A revealing instance of what has been dubbed the “censorship-industrial complex” (Shellenberger, 2023), that academia is a key part of, is the case of Timothy Caulfield, who holds a law degree, is Canada Research Chair in Health Law and Policy, was recently invested into the prestigious Order of Canada for his work on “fighting misinformation” (Mulcahy, 2022), and whose research has been funded by several Canadian government agencies, including Public Health Canada (Caulfield, n.d). Responding to criticisms about his attack on UK cardiologist Aseem Malhotra’s assertion that the public should ask questions about Covid-19 vaccination given its documented adverse cardiovascular effects, Caulfield tweeted to his 5613 followers that “Asking questions [is] key to good science! But “just asking questions” (aka JAQing off) is a #misinformation strategy [whose real goal is] “to create doubt & noise” (Timothy Caulfield [@caulfieldtim], 2023). It appears that “misinformation experts” need no subject matter expertise to dictate which questions around a subject are legitimate and that the sole criterion is whether they are approved by “right thinking” people and institutions.

The question however remains: what explains the extraordinary homogeneity in the dominant messaging on Covid-19 vaccination policy in postsecondary education emerging from academic researchers and its almost perfect overlap with the so-called scientific consensus, with no hint of critique, and no hesitation to dismiss, demonize, or if necessary, suppress dissent to achieve official policy goals? Potential explanations include material and ideological ones. A material explanation may be that, given how corporate (Lexchin, 2017) and foundation funding influence public institutions—even when performed “under the mask of philanthropy” (Roelofs, 2017)—increasing funding of academia by so-called public-private partnerships may be leading to the replacement of “public intellectuals with privatized intellectuals” serving “the corporate state” and becoming “subservient to the needs of capital” (Giroux, 2009). Consider, for instance, the Bill & Melinda Gates Foundation award of $11.6bn to 471 higher education institutions in 66 countries over the past 10 years (UniversityPhilanthropy.com, 2021) and the acknowledgment by Bill Gates that his “best investment turned $10 billion [invested in vaccines] into $200 billion worth of economic benefit” (Belvedere, 2019). These facts may explain at least partly why the discourse of academic researchers is often virtually indistinguishable from that of the private global health actors on whose largess their careers and institutions increasingly depend.

I also propose an ideological explanation for my findings, one rooted in forms of power different from direct material (e.g. moneyed) rewards, although sometimes these different forms of power, like social prestige, may facilitate accruing material rewards. I am alluding to the system that rewards academics for contributing to the reproduction of the societal structures that make their livelihood, this author’s included, possible, one that may appear to encourage debate, albeit within managed boundaries dictated by the power structure supporting the system (Navarro, 2004). If this is the case concerning research on postsecondary vaccination policy, then the managed debate that I have identified may illustrate an increasing “illiberalism” in academia—illiberalism defined as an assault on the traditional liberal values of free speech, respect for differences, equal moral worth of all individuals, and so on—threatening academic freedom, that has concerned scholars from diverse ideological persuasions.

While I cannot do justice to this complex topic in a few paragraphs, allow me to illustrate the issue with examples, of necessity incomplete, that suggest potential explanations: some conservative thinkers have attributed illiberalism in academia to a misguided “identity politics” and “political correctness” culture, driven by liberal and left-wing ideology that has substituted a culture of unjustified victimhood for one that upholds traditional, universal, civil rights, and in so doing has threatened those rights, including the right to free speech (D’Souza, 1991). In turn, some liberals have argued that illiberalism has been driven by conservatives—especially the “fringe right”—but at times also by sectors of the left, on the latter’s misguided belief that free-speech rights are a zero-sum game between oppressed and oppressors (Chait, 2017). On their part, some socialists/Marxists observers have accused liberals of merely replacing aristocratic privileges with bourgeois ones because, these observers argue, true liberal values cannot flourish under the capitalist social relations whose influence liberals fail to fully acknowledge (Schwartz, 2016), whereas other left-leaning scholars have attributed the rise of illiberalism largely to “right-wing populism,” rejecting the claim that liberalism can be “illiberal.”

Yet other scholars, from a radical/anti-imperialist persuasion, have asserted that contemporary liberals who only blame conservatives, rightly or wrongly, for the rise of illiberalism, overlook the historically well-documented, liberal fear of majority opinion and the liberal self-serving assumption that ordinary people, in contrast to experts and intellectuals (as “vetted” by liberals themselves), lack the moral and intellectual capacities needed for free reasoning and proper behavior, and must therefore be “nudged” toward the “correct” views and decisions (Thaler and Sunstein, 2021). “Illiberal liberalism,” note these scholars, caused by this “bad faith” brand of liberalism, is better described as paternalism, and can be as intolerant as the authoritarian, right or left, movements it critiques (Furedi, 2022). The bottom line seems to be that all positions, at face value, agree that academic freedom matters and should be respected. None of them embrace, at least not openly, authoritarianism, bigotry, and unfairness, although they differ in what they mean by these concepts. It is left to members of the public, especially in their capacity as taxpayers contributing to postsecondary institutions, to appraise to what degree the rhetoric matches action in specific cases of discourses, research, and practices within academia.

Discussing the rationale behind university vaccine mandates, Bardosh et al also reflect on the trend toward “intolerance”—insinuating illiberalism—by postsecondary institutions, by post secondary “bureaucracies that value compliance over individual freedoms,” reasoning that “mandates, by their nature, encourage conformity and acquiescence to authority, and exclude those with different views or values (Bardosh et al., 2022b)(page 10),” thus presenting a real threat to the value of inclusivity that academia prides itself to uphold. Several scholars have also discussed Covid policies in the context of medicalization, social control, and biopower, following Foucault’s notion of biopower, meaning a state with “power over life” through mechanisms of social control and surveillance (Foucault, 1975). Yet other scholars have begun to pay attention to how health policy is increasingly affected by the relationship between big Pharma and government (Rawlinson, 2017) and yet others have highlighted key components of imperial power—economic influence, citizen belief and government rule—intrinsic to social control mechanisms based on medical frameworks (Katz Rothman, 2021). In the same spirit, elsewhere I have discussed how academic institutions have reinforced biopower by imposing vaccine and other mandates coercively, echoing the prevailing political discourse that the unvaccinated are a danger who must be excluded or disciplined Chaufan et al. (2023).

Limitations

My study has limitations, inherent to all qualitative inquiry: small sample sizes that threaten replicability, subjectivity when articulating a research question, and biases, disciplinary and personal, when interpreting findings, among others. Except for the issue of small sample size, I note that these limitations are shared by quantitative approaches, for instance, when crafting indicators to quantitatively study a phenomenon or even choosing what question to ask (Bowker and Leigh Star, 2000). I also did not strive to reach out to study authors for clarifications or interview them to allow them to elaborate on their views, relying instead on the analysis of documents. To counter these limitations, I have made the process of inquiry as transparent as possible so that other researchers can reproduce it (Tracy, 2010). If anything, the limitations of my study indicate the need for further research on the role of academia in reproducing dominant discourses and silencing dissent in the Covid-19 era, practices that are historically pervasive in academic and scientific institutions (Moran, 1998), notably in vaccination research (Elisha et al., 2022a, 2022b; Shir-Raz et al., 2023).

Conclusions

My analysis of research on postsecondary vaccination policy reveals a major threat to academic freedom, held in high esteem by academics of all ideological persuasions, at least publicly (American Council on Education, 2022; University Of Essex, 2016). Clearly, if in matters of such grave importance as a crisis that has pervaded all areas of life and structured life choices and chances across the globe for the past 3 years, postsecondary students operate within an academic culture that calls for following the “scientific consensus” without questioning, discourages challenges to conventional wisdom, and suppresses any resistance to authority, including the authorities implementing the policies developed ostensibly “in the name of health” and “for our own good” (Zola, 1975), then the prospects of a constructive role for academia in society and even for the narrower goal of academic integrity are grim.

Author biography

Claudia Chaufan M.D., Ph.D. is Associate Professor of Health Policy at York University in Canada. She researchers and teaches the social and political determinants of health, comparative health policy, and medicalization and social control, has published widely in academic and lay venues, held grants from US and Canadian federal agencies, and is editorial board member and reviewer for various refereed journals. Current projects include the politics of sanctions policy, the geopolitics of anti-Asian racism, and medicalization and social control in the Covid-19 era.