How and Why Columbia’s Vaccine Mandate Worked

Columbia University is welcoming some 30,000 students and many thousands of faculty and staff to campus this month. While the world remains in the grip of a global pandemic—a pandemic that has seen millions of lives lost worldwide—it’s worth stepping back to reflect upon how we got to this point.

President Lee C. Bollinger and the University’s COVID-19 Task Force made many critical decisions over the last 18 months. Perhaps the most important was an early call to mandate COVID-19 vaccinations for the entire Columbia student body and all its faculty and staff. Columbia was one of the first universities to adopt a vaccination mandate, and it proved crucial to the scene unfolding now: our entire community returning to campus, to resume their academic and professional lives.

As President Lee C. Bollinger said in his letter welcoming students to campus, “Columbia led the way.” To date, 99% of faculty and staff, and 93% of students, have uploaded their vaccine documentation. It has been a team effort.

Columbia News reached out to four key members of the COVID-19 Task Force to talk about how the mandate came about, the challenges the university had to overcome, and the lessons learned. They are Melanie Bernitz, senior vice president for Columbia Health; Wafaa El-Sadr, university professor of epidemiology, director of ICAP and Columbia World Projects; Donna Lynne, senior vice president and chief operating officer, Columbia University Irving Medical Center and University COVID director; and Gerry Rosberg, senior executive vice president.

El-Sadr: I can recall the exact moment last spring when we decided on the mandate. We had been having discussions in the Public Health Group for several weeks about the importance of vaccination for control of this pandemic. I distinctly remember being on a call with the bigger COVID-19 Task Force and all of a sudden, looking at this Zoom screen with all of the people in these little boxes, and marveling as one person expressed support for a mandate and then another and another. It was like an avalanche of support. It was remarkable.

We are so proud that Columbia was ahead of the curve. After we announced the mandate, other colleges and universities followed. One of the important distinctions with the mandate at Columbia is that we requested compliance by everybody—faculty, staff, students. Some institutions only mandated it for students. Columbia said this is going to be universal.

Bernitz: It seems obvious now, but at the time, there was no playbook for this. Once we determined that a full return to campus was likely, a vaccine mandate was necessary to protect the campus.

Lynne: There is a tremendous sense of pride that we were definitive on this. On April 19, we announced the mandate for students. And a few weeks later, we announced it for faculty and staff.

One of our challenges was the scale and complexity of administration. We also faced skepticism that there would be no wiggling out of it—that it would remain a mandate. And we were concerned about employee and staff refusals. If you look at our 99% compliance rate, that did not happen.

El-Sadr: There were a lot of people who questioned our early adoption of a mandate, before Food and Drug Administration (FDA) approval of the vaccines. My response has always been, we have a pandemic, this is an emergency. This is not business as usual. The virus is spreading around globally, and we’re dealing with the loss of hundreds of thousands, if not millions, of lives around the world.

It’s for this type of situation that we have the process for “emergency use authorization” by the FDA. This was the time to be bold, to say we have sufficient data that tells us the benefits of these vaccines far outweigh the risks.

Lynne: We were fortunate to have support from President Bollinger and the Board of Trustees. The unions were also helpful in advocating for vaccination.

Rosberg: And as with everything else involving COVID, it was our public health experts who took the lead—in formulating our policy, adjusting it as needed, ensuring that all our decisions were solidly based on evidence and not conjecture—which made getting buy-in from all the different constituents easier.

El-Sadr: Keep in mind, it’s not sufficient to just announce a mandate; it then becomes necessary to secure the highest possible uptake on vaccination. That requires explaining publicly why we put it in place, who is eligible, and so on. And of course, we had to provide vaccines. Remember, at that time it was difficult to get them, there was a lot of demand with insufficient supply.

The task of documenting who had been vaccinated was a major task in itself. Evidence of documentation would have to be done electronically through the CU app. And there had to be clarity on who this covers. Though it is a universal mandate, some in our community have legitimate reasons to seek exemption. Those exemptions need to be adjudicated.

At a very micro level, we had to track down the individuals who lagged behind in uploading their evidence of vaccination or had not submitted their exemption request. We were committed to support all in achieving this and making it easy for them. All of this required many people working seamlessly together day in and day out to get where we are now. 

Lynne: I think what surprised me the most, was that it seemed harder to get to 80% compliance, than it did to get the last few people into compliance. There was almost no animosity about the mandate.

El-Sadr: Like with any public heath intervention, there are the early adopters. They are the ones who are eager and promptly sought to get vaccinated. Our commitment was to use every available means to inspire the late adopters who needed an extra nudge, through more information and assurances.

Bernitz: If we were to do this all again, I’d recommend earlier deadlines!

El-Sadr: I think our student outreach has been strong. The webinars that were geared to domestic and international students were critical, as were the general forums for faculty and staff. We also had to depend on schools and smaller university units to get the word out.

What I learned is that while it’s important to communicate on the university level, it’s equally important to communicate at the school and unit level, to segment the population even more. Some people may pay more attention when information comes from their school, from their direct supervisor, from their unit.

Rosberg: This whole plan was going to work only if we could persuade people to get vaccinated. We had to convey to employees at every level that there would be serious consequences for non-compliance, up to and including termination. We have not in fact terminated anyone to this point. There may be some people, knowing what is required, who have decided to resign their positions. We have sent out several letters and messages telling people that if they don’t comply, they will be subject to suspension of their salary—that is, placed on “unpaid administrative leave”—and offered assistance in complying with the mandate. This isn’t intended to be a punishment. Our goal, in fact, is to keep people from losing their jobs by persuading them to get vaccinated. We’re not mad at anyone. We just want them to get vaccinated.

We had to say we are really serious about this. It isn’t optional. This is a condition of employment at Columbia.

We’ve been very careful not to do what a few other universities have done, which is to have a mandate that is porous. When you walk onto our campus, you should have confidence that any Columbia person you meet—student, staff, researcher, faculty member—is vaccinated.

We hope that these people will say, OK, I was hesitant, but I’m willing to do it. And that, we believe, is not only what will be good for Columbia, but good for them and their families, too.

El-Sadr: We feel very strongly that vaccines are the key to a safe community. That getting vaccinated is not only a benefit for the individual and their loved ones, but also for our community’s benefit. With an infectious disease, like COVID-19, your decision not only has implications for you, it also has an impact on the people around you. I have to applaud Gerry and the entire HR team for all their interventions and tireless efforts in providing information and trying to allay anxiety and achieve the highest possible compliance.

Rosberg: It’s important to remember that compliance means either you have been vaccinated, or you’ve obtained an approved exemption.

The rules that we have traditionally had for student vaccination mandates allowed two grounds for exemption: one is a medical condition that made it inadvisable to be vaccinated, and the other is a religious exemption. The legal advice we received was that if we were going to require employees to be vaccinated, then we should allow those same two accommodations. So, people had the option to apply and if, after adjudication, their case is found meritorious they would be granted an exemption. At that point, they are permitted to work at the university. In addition to the vaccination mandate, Columbia has put in place other safety measures that are adjusted based on the state of COVID-19 in our city and community. We have granted some exemptions, but the number is extremely small. Many were turned down. By the time we’re done, we expect that less than 1% of the population will have received an exemption. 

Lynne: At the start of this, there was no employee immunization mandate in place similar to what we historically have had for students.

Bernitz: We have been doing vaccine compliance for students for decades. The systems were already in place. We have a system within the secure patient portal to allow students to upload their required Measles, Mumps, and Rubella (MMR) documentation, and we had expanded that process last year to manage the student influenza vaccination mandate. This process required students to both enter the dates of their vaccine and upload proof of vaccination. The Columbia Health team reviews each individual record, and ensures we have all the information that is needed, and that it meets the mandate requirement. If information is missing, we individually message the student to get the required details. With more than 25,000 students submitting records, it was time-consuming, to say the least.

The review process took extra diligence for our large number of international students. We accept any vaccine that is authorized by FDA or WHO, but we had to examine every vaccine upload to ensure these criteria were met.

Some of our international students had not had access to any vaccines in their home country, some had received a non-authorized vaccine, and others had not been able to get both doses of a two-dose series. There has been a lot of individual troubleshooting to guide each student depending on their unique situation, and to bring them into compliance once they arrive in the United States.

For organizations that are starting from scratch and considering a vaccine mandate, all I can say is: The data to support such a mandate is strong; have confidence in the decision. Vaccines are our biggest protection.

El-Sadr: My advice is to put together a very detailed plan with all the different essential components necessary for success: the communications piece, the operations piece, the follow-up piece, the human resource piece, the advocacy piece. And break down everything into small steps. The nitty-gritty details and the mechanics of how to implement and measure progress are very important. And remember that peer buy-in and advocacy can be very valuable.

Lynne: Also, make sure you have buy-in from leadership.

Rosberg: In some ways it’s easier to do a mandate now because there’s a lot of support for doing it by so many other universities and colleges, various agencies, and the private sector as well. When Columbia did it, we were out in front of everyone, and that made it a tough decision for the university. We meant business right from the start, and that made all the difference.

El-Sadr: And the mandate worked. We stood strong. Moreover, it motivated innovation, it forced us to think outside the box, it forced us in a very serious way to work with HR, with union leadership, to mobilize students and others to serve as ambassadors and peer supporters. So, in the end, it was a very concerted effort across all of the schools, across all of the units, and I think that’s the reason we’ve come as far as we’ve come.