Mandatory Vaccination Policies Research Articles

To Vax or Not? A Human Rights Review of the Implications of Mandatory Vaccination as a Response to COVID-19

The COVID-19 pandemic precipitated the largest public health emergency so far experienced in the twenty-first century. As the world frantically pursues a sustainable solution, several vaccines have been tested and approved by the World Health Organization (WHO) under the Emergency Use Listing procedure. On the heels of this development have been moves by some States to adopt mandatory vaccination policies. Several private firms have also required their employees to be vaccinated as a pre-condition for resuming work. This fast-evolving situation brings into sharp focus the tensions between the rights to health, privacy, bodily autonomy and the right to consent to medical treatment on the one hand, and the public health and safety imperatives of protecting global populations against a ravaging pandemic on the other hand. This article argues that aggressive mandatory vaccination policies being propagated globally violate human rights by strengthening prejudices, and stereotypes, and furthering discrimination against those who may be unwilling to take the vaccines for one reason or another. Ultimately, therefore, there will be a need for States to adopt their own tailor-made vaccination frameworks that ensure the respect of individual rights on the one hand, but also ensures that it does not prejudice public safety in the wake of a ravenous pandemic.

Children, COVID, and confusion: How frontline workers cope with the challenges of vaccine mandates

AbstractWith the emergence of COVID‐19, many governments around the world co‐oped non‐health actors into enforcing comprehensive mandatory vaccination policies. Implementing these policies can be challenging, creating irreconcilable goals and problems with knowledge and understanding of areas outside the implementers’ direct field of expertise or scope of work. We know very little about how such frontline workers cope with these challenges associated with implementing policies whose goals lie well outside their remit (which we describe as generating exogenous policy pressures), and what this means for the operation of the policies. This article uses policies in place prior to the pandemic to fill this gap. It examines attitudes and experiences of frontline childcare educators who implement Australia's No Jab, No Play childhood vaccine mandate policies within the states of New South Wales, Queensland, and Victoria. Through qualitative analysis of interview and focus group data, we find that these frontline workers cope with moral conflict, confusion, and a lack of knowledge by moving against clients: they rigidly follow the rules beyond legislative requirements, and sometimes break them, generating a new coping category we call ‘rigid rule breaking’. However, their need to employ coping strategies is informed by the extent to which government has designed the policy to coerce the behaviour of the providers, families, or both. The implementation of more coercive variants of No Jab, No Play policies deviates more from what legislators intended, while providers given scope to make their own decisions about enrolling unvaccinated children report satisfaction in their decision‐making.Points for practitioners Australian state mandatory vaccination policies generally require childcare providers to exclude unvaccinated children. Street level bureaucrats face pressures when implementing coercive policies exogenous to their remit. They may simplify policy implementation in ways that counter governments’ goals. Actors given more discretion about passing on coercion to policy targets demonstrate better understanding and ownership of policies.

The association between vaccination status identification and societal polarization.

Public discord between those vaccinated and those unvaccinated for COVID-19 has intensified globally. Theories of intergroup relations propose that identifying with one's social group plays a key role in the perceptions and behaviours that fuel intergroup conflict. We test whether identification with one's vaccination status is associated with current societal polarization. The study draws on panel data from samples of vaccinated (n = 3,267) and unvaccinated (n = 2,038) respondents in Germany and Austria that were collected in December 2021 and February, March and July 2022. The findings confirm that vaccination status identification (VSI) explains substantial variance in a range of polarizing attitudes and behaviours. VSI was also related to higher psychological reactance toward mandatory vaccination policies among the unvaccinated. Higher levels of VSI reduced the gap between intended and actual counterbehaviours over time by the unvaccinated. VSI appears to be an important measure for predicting behavioural responses to vaccination policies.

Association between COVID-19 vaccination status, time elapsed since the last vaccine dose, morbidity, and absenteeism among healthcare personnel: A prospective, multicenter study

AimWe assessed the impact of COVID-19 vaccination status and time elapsed since the last vaccine dose on morbidity and absenteeism among healthcare personnel (HCP) in the context of a mandatory vaccination policy. MethodsWe followed 7592 HCP from November 15, 2021 through April 17, 2022. Full COVID-19 vaccination was defined as a primary vaccination series plus a booster dose at least six months later. ResultsThere were 6496 (85.6 %) fully vaccinated, 953 (12.5 %) not fully vaccinated, and 143 (1.9 %) unvaccinated HCP. A total of 2182 absenteeism episodes occurred. Of 2088 absenteeism episodes among vaccinated HCP with known vaccination status, 1971 (94.4 %) concerned fully vaccinated and 117 (5.6 %) not fully vaccinated. Fully vaccinated HCP had 1.6 fewer days of absence compared to those not fully vaccinated (8.1 versus 9.7; p-value < 0.001). Multivariable regression analyses showed that full vaccination was associated with shorter absenteeism compared to not full vaccination (OR: 0.56; 95 % CI: 0.36–0.87; p-value = 0.01). Compared to a history of ≤ 17.1 weeks since the last dose, a history of > 17.1 weeks since the last dose was associated with longer absenteeism (OR: 1.22, 95 % CI:1.02–1.46; p-value = 0.026) and increased risk for febrile episode (OR: 1.33; 95 % CI: 1.09–1.63; p-value = 0.004), influenza-like illness (OR: 1.53, 95 % CI: 1.02–2.30; p-value = 0.038), and COVID-19 (OR: 1.72; 95 % CI: 1.24–2.39; p-value = 0.001). ConclusionsThe COVID-19 pandemic continues to impose a considerable impact on HCP. The administration of a vaccine dose in less than four months before significantly protected against COVID-19 and absenteeism duration, irrespective of COVID-19 vaccination status. Defining the optimal timing of boosters is imperative.

COVID-19 vaccine hesitancy and its drivers among dental students at University of the Western Cape, South Africa.

Vaccine hesitancy has seen an uprising over the decades, even though there have been many advances regarding vaccine-preventable diseases. Of late, vaccine hesitancy has resurged towards the coronavirus disease 2019 (COVID-19) vaccine. The SARS-CoV-2 virus has major effects on the human body and has led to the development of different vaccines, which have been shown to provide immunity against the novel coronavirus. Dentists are at an increased risk to COVID-19 because of the nature of their work. It is imperative to have high vaccination coverage for this group. The aim of this study is to determine vaccine hesitancy and drivers associated with vaccine hesitancy among dental students at a university in South Africa. A dental school in South Africa was chosen as the setting for this study. An analytical cross-sectional study was conducted by means of an anonymous, online, validated questionnaire to determine vaccine hesitancy. Of the 205 dental students participated, 83.9% (n = 172) students were vaccine not hesitant. The main concerns regarding the vaccines were identified as safety and efficacy of the vaccine. Pressure by family or friends and the university to get vaccinated was evident. Vaccine hesitancy is high despite mandatory vaccination policies in South Africa. Specific drivers contributing to vaccine hesitancy were identified as doubt in the efficacy and safety of the vaccine. This study has highlighted the prevalence of vaccine hesitancy among dental students at University of the Western Cape, prior to compulsory vacccination implementations.

A Libertarian Legitimacy for Mandatory Covid-19 Vaccination

Since its inception, the 2019 coronavirus disease (Covid-19) outbreak has become a major health problem. At the same time, countries worldwide have been waiting for a Covid-19 vaccine to be sufficiently available. When the Covid-19 vaccine became available, several countries began to adopt mandatory Covid-19 vaccination policies. However, mandatory Covid-19 vaccination has received strong opposition from the start. Rejections have emerged from various parties, including from libertarians. The researcher observes that the current research attempting to analyze the mandatory Covid-19 vaccination still revolves around the perspective of human rights and utilitarianism. Then, this study aims to explore and find out how the libertarian perspective toward mandatory vaccination. Normative research methods with conceptual and comparative approaches were used in this study. After analyzing secondary data sources with prescriptive analysis methods, this study finally succeeded in finding that mandatory Covid-19 vaccination has its place, legitimacy, and justification on the ideological side of libertarianism. It is because libertarians accept that the government may require a mandatory vaccination program against Covid-19. In addition, due to the libertarian framework, the government is still justified in enforcing coercive policies that violate the rights of certain individuals if the policy is necessary to avoid greater harm to others.

How policymakers employ ethical frames to design and introduce new policies: the case of childhood vaccine mandates in Australia

Australian states exclude unvaccinated children from early education and care via ‘No Jab No Play’ policies, but some offer exemptions for the socially disadvantaged. Such mandatory vaccination policies provoke heated arguments about morality and potential downstream impacts, and the politics of which kinds of people get exempted from mandates are often fraught. Synthesising existing frameworks for considering the role of moral principles and rational-technical justifications in policymaking, we show how the same values can be the focus of both ‘rational-instrumental’ and ‘morality’ frames, while ‘pragmatic’ approaches are crowded out by high epistemic or moral certainty.

Attitudes of Physicians and Nurses in Oman Toward Mandatory COVID-19 Vaccination.

ObjectivesTo investigate the relationship between attitudes toward COVID-19 vaccines and disapproval of the policy of mandatory COVID-19 vaccination among unvaccinated physicians and nurses in Oman.MethodsThe subjects were (N = 346) unvaccinated physicians and nurses in Oman. Their demographic data and attitudes regarding COVID-19 vaccines and mandatory vaccination policy were collected through an anonymous web-based survey and statistically analyzed.ResultsThe participants’ negative attitudes toward COVID-19 vaccines were positively related (r = 0.68, p < 0.001) to the extent of their non-support for COVID-19 mandatory vaccination policy. Analysis of variance test showed that after controlling for age, male healthcare providers were more likely to endorse mandating COVID-19 vaccinations. There was no difference between physicians and nurses in support of mandatory vaccination, after controlling for age.ConclusionsRegardless of job type, male, and older physicians, and nurses in Oman were more supportive of mandatory COVID-19 vaccination than their younger and female counterparts. This research provides insights from an Arabian Gulf country about the attitudes of its unvaccinated healthcare providers toward compulsory COVID-19 vaccination.

Organisational and Structural Drivers of Childhood Immunisation in the European Region: A Systematic Review.

Despite the implementation of widespread vaccination programs, the European Health Systems continue to experience care challenges attributable to organizational and structural issues. This study aimed to review the available data on aspects within the organizational and structural domains that might impact vaccination coverage. We searched a comprehensive range of databases from 1 January 2007 to 6 July 2021 for studies that reported quantitative or qualitative research on interventions to raise childhood vaccine coverage. Outcome assessments comprised organizational and structural factors that contribute to vaccine concern among pediatric parents, as well as data reported influencing the willingness to vaccinate. To analyze the risk of bias, the Ottawa, JBI’s (Joanna Briggs Institute) critical appraisal tool, and Amstar quality assessment were used accordingly. The inclusion criteria were met by 205 studies across 21 articles. The majority of the studies were conducted in the United Kingdom (6), the European Union (3), and Italy (3). A range of interventions studied in primary healthcare settings has been revealed to improve vaccination coverage rates including parental engagement and personalization, mandatory vaccination policies, program redesign, supply chain design, administering multiple/combination vaccines, improved vaccination timing and intervals, parental education and reminders, surveillance tools and Supplemental Immunisation Activity (SIA), and information model.

A Game-Theoretic Model of Voluntary Yellow Fever Vaccination to Prevent Urban Outbreaks

Yellow fever is a vector-borne acute viral hemorrhagic disease. It is endemic in tropical areas of Africa and Latin America but demonstrated the potential for international spread during the 2016 outbreak in Luanda, Angola. Yellow fever can be prevented by vaccination, vector control, and avoiding mosquito bites. To account for human behavior in disease dynamics, we add a game-theoretic component to a recent compartmental model of yellow fever transmission. The self-interested individuals evaluate the risks of contracting yellow fever and choose to vaccinate or avoid the bites to minimize the overall costs. We find the Nash equilibria, the optimal levels of vaccination and bite protections if the individuals can decide on the use of only one of the prevention methods as well as when they can decide on the use of both of them. In the later case, we show that vaccination is the preferred method of protection from the individual standpoint and, in the Nash equilibrium, individuals use vaccination only. Our model predicts the vaccination coverage in Angola to be around 65%, which is in reasonable agreement with the empirical value of 68%. We also study whether voluntary prevention can lead to the elimination of the disease in endemic areas. We show that voluntary vaccination alone is not enough to mitigate the risks of outbreaks, suggesting that a mandatory vaccination policy is necessary.

Comparative analysis of pre-Covid19 child immunization rates across 30 European countries and identification of underlying positive societal and system influences.

This study provides a macro-level societal and health system focused analysis of child vaccination rates in 30 European countries, exploring the effect of context on coverage. The importance of demography and health system attributes on health care delivery are recognized in other fields, but generally overlooked in vaccination. The analysis is based on correlating systematic data built up by the Models of Child Health Appraised (MOCHA) Project with data from international sources, so as to exploit a one-off opportunity to set the analysis within an overall integrated study of primary care services for children, and the learning opportunities of the 'natural European laboratory'. The descriptive analysis shows an overall persistent variation of coverage across vaccines with no specific vaccination having a low rate in all the EU and EEA countries. However, contrasting with this, variation between total uptake per vaccine across Europe suggests that the challenge of low rates is related to country contexts of either policy, delivery, or public perceptions. Econometric analysis aiming to explore whether some population, policy and/or health system characteristics may influence vaccination uptake provides important results-GDP per capita and the level of the population's higher education engagement are positively linked with higher vaccination coverage, whereas mandatory vaccination policy is related to lower uptake rates. The health system characteristics that have a significant positive effect are a cohesive management structure; a high nurse/doctor ratio; and use of practical care delivery reinforcements such as the home-based record and the presence of child components of e-health strategies.

Group Communication for Raising Public Awareness on COVID-19

The growing pandemic of COVID-19 demands public awareness across the globe for people’s health and safety. Accordingly, the government of Indonesia has implemented the PSBB, PPKM, and mandatory vaccination policies. The current study used a descriptive and quantitative approach employing surveys and questionnaires as the main data collection tools. The research was conducted on a group of traders at Pondok Labu Market, South Jakarta, which consisted of five trade groups – clothes, fruit, grocery, vegetables, and gold. Of them, 94 respondents were selected as the study sample. Freire’s theory of consciousness and bona fide group theory were followed. The results indicated that by implementing health protocols, awareness continued to process, develop, and expand from the level of ”naive awareness” and ”critical awareness” to the highest level of ”awareness.” The limitations noted were the lack of handwashing facilities and hand sanitizers provided to the traders. Although the implementation of PSBB and PPKM has affected the overall business of the traders, they continue to comply with the government protocols.&#x0D; Keywords: public awareness, group communication, spread of COVID-19

To trust or not to trust: an exploratory qualitative study of personal and community perceptions of vaccines amongst a group of young community healthcare workers in Soweto, South Africa.

As South Africa debates the implementation of mandatory vaccination policies to address coronavirus disease 2019 (COVID-19) vaccine hesitancy, many adults remain unpersuaded of the need and benefits of vaccination. Several surveys suggest that this is particularly true for younger adults and for those living in low-income communities. Therefore, we sought the views of youth training to become community health workers (CHWs) as a youth group at the intersection of the community and the health system. This research was conducted in a township of South Africa, a country with a long history of political mistrust. Using semi-structured interviews and an interview guide, we explored young CHWs’ perceptions (n = 20) of vaccine hesitancy for themselves, their peers and the community. Audio-recorded interviews were transcribed, and thematic analysis was undertaken. Findings suggest widespread COVID-19 vaccine hesitancy in this community, especially amongst young people. Reported reasons for this hesitancy appear linked to a complex interrelated network of factors, including ‘uncertainty’ about the outcome and effectiveness of the vaccines; ‘fear’ of the vaccines, driven by a myriad of rumours and conspiracy theories within the community; a ‘lack of control’ over other people’s behaviour and a desire not to be controlled especially by the government but at the same time a resignation towards impending mandatory vaccine policies and a ‘lack of trust’ particularly in the government’s intentions with vaccine roll-out and their health messaging. While mandatory vaccination policies in several organizations have shown success, with South Africa’s complex social history and recent civil unrest, the roll-out of any mandatory vaccination policy will require careful health messaging with a focus on trust-building between communities, health systems and authorities through more personalized approaches that consider contextual nuances.

MENGUJI FAKTOR-FAKTOR YANG MEMPENGARUHI NIAT VAKSINASI HALAL COVID-19 MASYARAKAT MUSLIM

Covid-19 outbreak, which is considered to be still not optimal enough, the Indonesian government seems to be risking its efforts on a mandatory vaccination policy. However, this intervention will not succeed without the participation of the community in the form of their interest in receiving the Covid-19 vaccination. Therefore, by involving 422 Muslim respondents who live in the Special Region of Yogyakarta, the main objective of this study is to focus on the factors that influence or predict halal Covid-19 vaccination intention. Thus, it is clear that this research is a quantitative descriptive study with a cross-sectional survey. The results of the descriptive analysis of this study then explained that the majority of respondents were Muslim people who were male as much as 217 (51.42%), aged 19 - 24 years (38.39%), domiciled in the city of Yogyakarta (38.63%) and worked as students as many as 188 people (44.55%). While the results of quantitative analysis using the Partial-least square structural equation modeling (PLS-SEM) method in this study revealed that halal Covid-19 vaccination intention was influenced by factors such as attitude toward halal vaccination (β = 0.541, t-value = 10.199, -value = 0.000), subjective norm (β = 0.196, t-value = 3.913, -value = 0.000), and social norm (β = 0.156, t-value = 3.374, -value = 0.001) positively and significant. In addition, the theoretical and practical implications based on the results of the research are also discussed in this study.

“I don’t think there’s a point for me to discuss it with my patients”: exploring health care providers’ views and behaviours regarding COVID-19 vaccination

ABSTRACT Background Health care providers’ knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines, and their patients’ vaccine uptake. This qualitative study’ objective was to better understand health care providers’ vaccination decisions, their views on barriers to COVID-19 vaccine acceptance and proposed solutions, their opinions on vaccine policies, and their perceived role in discussing COVID-19 vaccination with patients. Methods Semi-structured interviews on perceptions of COVID-19 vaccines were conducted with Canadian health care providers (N = 14) in spring 2021. A qualitative thematic analysis using NVivo was conducted. Results Participants had positive attitudes toward vaccination and were vaccinated against COVID-19 or intended to do so once eligible (two delayed their first dose). Only two were actively promoting COVID-19 vaccination to their patients; others either avoided discussing the topic or only provided answers when asked questions. Participants’ proposed solutions to enhance COVID-19 vaccine uptake in the public were in relation to access to vaccination services, information in multiple languages, and community outreach. Most participants were in favor of mandatory vaccination policies and had mixed views on the potential impact of the Canadian vaccine-injury support program. Conclusions While health care providers are recognized as a key source of information regarding vaccines, participants in our study did not consider it their role to provide advice on COVID-19 vaccination. This is a missed opportunity that could be avoided by ensuring health care providers have the tools and training to feel confident in engaging in vaccine discussions with their patients.

Vaccination policies for healthcare personnel: Current challenges and future perspectives

Healthcare personnel (HCP) are at occupational risk for acquisition of several vaccine-preventable diseases and transmission to patients. Vaccinations of HCP are justified to confer them immunity but also to protect susceptible patients and healthcare services from outbreaks, HCP absenteeism and presenteeism. Mandatory vaccination policies for HCP are increasingly adopted and achieve high and sustainable vaccination rates in short term. In this article we review the scientific evidence for HCP vaccination. We also address issues pertaining to vaccination policies for HCP and present the challenges of implementation of mandatory versus voluntary vaccination policies. Finally, we discuss the issue of mandatory vaccination of HCP against COVID-19.

The ethics behind mandatory COVID-19 vaccination post-Omicron: The South African context

The legitimacy of mandatory vaccine policies is underscored by a public health ethics framework based on the principles of limited autonomy, social justice and the common good. Ideally, vaccine uptake ought to occur on a voluntary basis as an act of solidarity to ensure that everyone is protected. Given that the altruistic approach has failed and vaccine uptake remains sub-optimal in South Africa, in this paper, I argue for vaccine mandates, in a post-Omicron context. This viewpoint is substantiated by several considerations. Healthcare workers are fatigued after 2 years of treating COVID-19 and many are still treating patients with post-viral syndromes, mental health conditions and cardiovascular complications. Health systems remain under pressure as people with non-COVID diseases, neglected during the pandemic, are also now presenting to medical practices and hospitals. Although South Africa has emerged from a relatively less severe fourth wave of COVID-19, there have been many deaths. Vaccine and natural immunity in a relatively young general population has been advantageous. However, the country has a high prevalence of HIV and those who are untreated may not be able to clear the coronavirus easily. Similarly chronic illnesses place many at risk for severe disease from COVID variants, especially if unvaccinated. The future is shrouded in uncertainty. The next variant could be similar to or less severe than Omicron, yet still impact negatively on health systems, education and the economy. Physical distancing is not ideal in many low socio-economic settings, making vaccines an important component of our prevention toolbox. Our safest option now is to ensure that as many South Africans as possible are vaccinated and receive boosters. Vaccine mandates work to achieve this end. Significance: The legitimacy of COVID-19 vaccine mandates post-Omicron is explored from an ethical perspective, given that the fifth wave remains unpredictable in South Africa – a country with a high prevalence of HIV, vulnerable unvaccinated adults and children, and fragile public health systems. The emergence of new variants is uncertain. However, vaccines are central to an appropriate response to protect public health, health systems and the economy.

Public misunderstanding of pivotal COVID-19 vaccine trials may contribute to New Zealand’s adoption of a costly and economically inefficient vaccine mandate

New Zealand adopted a policy of mandatory COVID-19 vaccination for workers in many sectors. Existing analysis suggests expected costs of this mandate policy far outweigh benefits. This paper discusses an issue potentially contributing to adoption of this costly vaccine mandate policy. There is a widespread public misunderstanding about the testing the vaccines underwent in the pivotal trials underpinning their approval, with over 95% of New Zealand’s voting-age public believing that the vaccines were tested against more demanding criteria than was actually the case. Consequently, public expectations about performance of these vaccines were likely inflated, and expected benefits of vaccine mandates may have been overstated. The ambiguous evidence on effects of COVID-19 vaccination on mortality risk also highlights the importance of these informational problems. If the public misunderstanding described here persists, a continuation of inefficient vaccine mandates whose costs exceed benefits is likely.

Mandatory COVID-19 Vaccination for Healthcare Professionals and Its Association With General Vaccination Knowledge: A Nationwide Cross-Sectional Survey in Cyprus.

COVID-19 compulsory vaccination for healthcare professionals (HCPs) is a sensitive and controversial topic, with different support rates worldwide. Previous studies in Cyprus identified a low COVID-19 vaccination acceptance among HCPs, however, no studies have investigated their perceptions toward mandatory COVID-19 vaccination. This is the first study to investigate the attitudes of HCPs toward mandatory COVID-19 vaccination and its association with general vaccination knowledge. A cross-sectional study was conducted, using an online self-administered, anonymous questionnaire to collect data on sociodemographic and health-related characteristics, trust and satisfaction with the healthcare system, utilization of preventive healthcare services, COVID-19 vaccination information, vaccination knowledge, and attitudes among HCPs toward mandatory COVID-19 vaccination. A total of 504 HCPs participated in the survey, with 34% being in favor of mandatory COVID-19 vaccination. A sufficient vaccination knowledge score was identified among the HCPs, with higher scores being associated with mandatory vaccination support (p < 0.001). As age increases by one year, the odds of supporting mandatory vaccination increase by 1.03 units (95% CI: 1.01–1.06). In addition, as the general vaccination knowledge score increases by one unit, the odds of supporting mandatory COVID-19 vaccination increase by 1.55 units (95% CI: 1.33–1.81). Our findings show that about two-thirds of the HCPs in Cyprus were opposed to a mandatory COVID-19 vaccination policy. Older age and general vaccination knowledge were found to be the strongest predictors of mandatory vaccination support. To avoid unforeseen outcomes, mandatory vaccination policies should be implemented with caution and consultation.

High Prevalence of Both Previous Infection with SARS-CoV-2 and Persistent Symptoms.

Universities are unique settings with large populations, congregate housing, and frequent attendance of events in large groups. However, the current prevalence of previous COVID-19 infection in university students, including symptomatic and asymptomatic disease, is unknown. Our goal therefore was to determine the prevalence of previous infection, risk factors for infection, and the prevalence of persistent symptoms following infection among university students. This was a cross-sectional study set in a large public university between January 22 and March 22, 2021. We surveyed students about demographics, risk factors, and symptoms, and simultaneously tested their saliva for IgA antibodies to SARS-CoV-2. To estimate the prevalence of previous infection we adjusted our intentional sample of a diverse student population for year in school and age to resemble the composition of the entire student body and adjusted for the imperfect sensitivity and specificity of the antibody test. Univariate and multiple regression analysis was used to identify independent risk factors for infection, and the proportion of students with persistent symptoms following acute infection was determined. A total of 488 students completed the survey, 432 had a valid antibody result, and 428 had both. The estimated prevalence of previous infection for 432 participants with valid antibody results was 41%. Of 145 students in our sample with a positive antibody test, 41.4% denied having a previous positive polymerase chain reaction (PCR) test for SARS-CoV-2 and presumably had an asymptomatic infection; in our adjusted analysis we estimate that approximately 2-thirds of students had asymptomatic infections. Independent risk factors for infection included male sex, having a roommate with a known symptomatic infection, and having two or fewer roommates. More frequent attendance of parties and bars was a univariate risk factor, but not in the multiple regression analysis. Of 122 students reporting a previous symptomatic infection, 14 (11.4%) reported persistent symptoms consistent with postacute COVID-19 a median of 132 days later. Previous COVID-19 infection, both symptomatic and asymptomatic, was common at a large university. Measures that could prevent resurgence of the infection when students return to campus include mandatory vaccination policies, mass surveillance testing, and testing of sewage for antigen to SARS-CoV-2.