Third-level colleges will not require students and staff to be vaccinated against Covid-19 in order to access their campuses when they reopen in September, according to reports.

This is a national mistake.

It may well be that the rising rate of infections yet precludes a return to campuses but, if not, mandating that students and staff be vaccinated is a necessary adjunct to social distancing, good ventilation and masking. Facilities that permit frequent (for example, every second day) testing and efficient tracing could allow for exceptions. Indeed, the arguments for a vaccine mandate are likely also to apply to returning schoolchildren over the age of 12 and their teachers.

Hospital Report

First, unvaccinated students and staff are a danger to themselves. In the US, hospitalisations are surging among the unvaccinated, particularly in those under 30. On campus, such students are likely to be in crowded social situations with no mechanism outside classrooms where distancing and masking can be monitored and enforced.

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Second, unvaccinated students and staff pose a risk to their vaccinated colleagues. We now know that despite the most efficient RNA vaccines, breakthrough infections do occur and, indeed, although often mild, that such individuals themselves may in turn be highly infectious.

Third, while the RNA vaccines afford substantial protection against serious infection that can lead to hospitalisation and death, recent figures from Israel suggest that such protection drops from about 95 per cent to about 60 per cent by six months after vaccination. Israel, despite about 80 per cent of the population receiving the Pfizer/BioNtech RNA vaccine, is experiencing a surge in hospitalisation and is accelerating the administration of booster shots to its entire population. In the US, the Center for Disease Control has recently approved booster shots for the immunocompromised and the Biden administration is planning a booster programme for the wider population. Even the vaccinated should be masked and maintain distancing on campus.

Fourth, even if students or staff experience mild or asymptomatic infection, we have no guarantee that they will avoid the syndrome of Long Covid. While the mechanism which underlies this phenomenon is not yet understood, symptoms persisting more than six months after initial infection include lethargy, loss of taste and smell, “brain fog”, cardiovascular, gastrointestinal and respiratory abnormalities, often experienced in recurring waves. Disturbingly, the incidence of Long Covid after the initial waves of the pandemic did not relate to the clinical severity of the infection.

Fifth, infected students and staff will return home where they pose a risk to their families and communities.

Finally, the impressively high uptake of vaccination in Ireland, the absence of a noisy "anti-vax" movement and an educated, outward-looking population means that a vaccine mandate does not represent a high hurdle.

Vaccine mandates

Here in the US, despite lacking such cultural advantages, vaccine mandates for returning students and staff have been introduced by more than 500 universities, including my own, and has recently withstood legal challenge in red state Indiana. The increasing appreciation of the risk presented by the unvaccinated, not just to themselves but to others, has led to a wave of vaccine mandates for their employees by healthcare facilities, private businesses and the US government and armed forces.

Opposition to such vaccine mandates has stemmed largely from a failure to understand or accept the concept of relative risk and from the libertarian ideology that “the people have the right to do wrong”. Some also feel that the vaccines have been developed too quickly.

Relative risk

The relative risk of serious, life-threatening infection versus developing serious adverse effects from the vaccines strongly favours vaccination. The southern states in the US, where vaccination rates lag the national average by about 20 points and libertarian thinking is common, present an experimental laboratory in which to test this assumption. In Louisiana, Mississippi, the Carolinas, Georgia, Florida, Texas and Tennessee, hospitals are being overwhelmed with admissions, increasingly of the young. By contrast, the incidence of serious adverse effects from the vaccines remains anecdotal.

This is also true at a global level, despite millions having been vaccinated. This imbalance in relative risk becomes even more exaggerated when one considers the possibility of broader, chronic consequences of infection, such as Long Covid. We instinctively deploy our understanding of relative risk every day when we drive a car, eat a meal or board a plane. Under current circumstances, it is as logical to refuse vaccination as it would be to avoid crossing the road for fear of being knocked down.

Similarly, while democratic societies traditionally support freedom of choice and personal responsibility, they also curb the individual choice “to do wrong” when it impacts on the welfare of others. The interactive power of vaccination, ventilation, hand hygiene and social distancing in curbing the risks of infection has been established.

Given the current rate of community spread of the virus in Ireland and the unmonitored social mixing intrinsic to a return to campus life, a vaccine mandate for third-level students is both logical and responsible.

The speed and efficiency of vaccine development does not date from the onset of the pandemic. For example, the work of Katie Karriko and Drew Weissman in developing the RNA vaccines unfolded more than 20 years of rigorous research and its rapid application to Sars-CoV-2 depended on sequencing technology refined over the previous three decades. Besides these foundations, the unprecedented public and private investment of resource at a global level accelerated the application of the technology to vaccine development for this pandemic.

Vaccine effectiveness

Finally, from the outset of the pandemic, the vaccines have been subject to randomised controlled trials of their efficacy and safety in different populations around the world. This has allowed us to gauge their comparative effectiveness and safety, the persistence of their effectiveness over time and their safety in vulnerable populations, such as pregnant women.

We have learned a lot about this virus since the pandemic began, and the rapid development and deployment of vaccines has saved lives and alleviated suffering. This is most evident in high-income countries with abundant supplies of the vaccines. A vital challenge is to enhance such access to low- and middle-income countries, particularly as we consider administration of boosters. Like climate change, the pandemic requires an appreciation of our interdependence.

In the meantime, while we have much yet to understand about Covid-19, current evidence is sufficiently strong to support a vaccine mandate in Ireland for students and teachers returning to campus. From experience in the US, we can anticipate some challenges, such as counterfeit vaccine cards, but mandates have been widely accepted by students and teachers here who recognise it as being in their own interest as well as that of others.

This responsibility of care lies with the leadership of our third-level institutions.

Garret A FitzGerald is director of the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania