Influenza Vaccination: Challenges for Adolescent and College Healthcare

Allan L. Markus, MD, MS, MBA


January 15, 2008

In This Article

Seasonal Influenza: Novel Preparedness Approaches at Arizona State University

Arizona State University (ASU) is a 63,000-student university located in the greater Phoenix metropolitan area. Its largest campus is the Tempe campus, having 55,000 students who attend classes and with about 9000 living on campus. The Campus Health Service provides the primary healthcare services on the 55,000-student Tempe Campus and collaborates with its healthcare partners at the 3 other campus locations. ASU decided to partner with both a vaccine manufacturer (CSL Biotherapies) and an advertising agency (Hal Lewis Group) to improve messaging and increase the vaccination numbers on our campus.


ASU was approached by CSL Biotherapies with the concept of developing a more comprehensive program to distribute vaccine to students, faculty, and staff. We used a marketing theme called "Season Pass." The strategy for increasing vaccination rates was multifaceted:

  • Influenza vaccine distribution events: Campus Health Service held 2 week-long events at the Student Union. Timing was done during the peak period of student activity from 10:00 am to 2:00 pm.

  • Giveaway strategy: All students who received a vaccine received an ASU T-shirt that displayed the Season Pass logo and passed on the message to make the campus "Flu-less." Students also received a postage-paid postcard that they could send home to inform parents that they had received their flu shot.

  • Residence hall distribution: Nursing staff planned days to administer vaccine in the residential halls.

  • Campus signage and advertising campaign: ASU, in association with a professional branding and marketing team, developed signage and media advertising that included student newspapers and radio stations marketing the Season Pass campaign.


In the 2006-2007 season, ASU ran a number of employee flu clinics and distributed vaccine through our health center and the Student Union to students. Nine hundred twenty-seven vaccines were distributed to students, and 1416 were distributed to employees for a total of 2343 doses of vaccination.

During the fall 2007 season, using the new methodology above, 2049 students were vaccinated and 1931 employees were vaccinated, for a total of 3980 vaccinations distributed (Figure). These results occurred despite an increase in price from $10/vaccination in 2006 to $18/vaccination for students and $20/vaccination for employees in 2007.


Influenza vaccine administration at Arizona State University, autumn 2006 to winter 2007 vs autumn 2007.


Influenza can be a debilitating disease on a college campus. With influenza's potential for a high infectivity rate, the close living and teaching areas in colleges, and the traditionally lower rates of annual vaccination of the population, colleges and universities can be particularly vulnerable to influenza outbreaks on their campuses. Although it does not have a high mortality rate, the costs in missed classes, lack of academic performance, and potential for nonretention of students who miss too much class make this a serious concern for both college health center directors and university officials.

We believe that instituting programs, such as the ones described here that improved our vaccine distribution by 70% in 1 year, will have a positive effect on these outcomes. Although not studied, we know that a number of students and employees when exposed to the repetitive messaging of the Season Pass campaign went to their own physicians and obtained their influenza vaccination from their primary care providers.

We did not design this program to study differences in the outcomes of academic performance or retention for the university, but this could be an important future area for research. The annual variability in the antigenic drift in the flu virus and how well the vaccine "matches" with the flu strain that ultimately comes to the ASU campus are important but uncontrollable variables in containing an influenza outbreak on our campus during the 2007-2008 season.

Plans for future events include planning a vaccination event during parents' weekend. We know from other studies that parents can have a strong influence on students' likelihood of obtaining vaccinations.[12] Although we did enlist some student volunteers, we will need to have a stronger presence of student workers to relay the messages on the importance of vaccination to reduce influenza-like illness, missed workdays, and physician visits. Future studies will need to include an economic analysis of running a similar campaign and the potential academic impact on college students' performance and retention.

In conclusion, we believe that convenient timing/location of vaccination events, giveaways that are directed at the college-age population, and having information that directly addresses influenza vaccination myths can all be used to improve vaccination rates in this population. Collaborations between colleges and industry partners may be one method of improving vaccination rates on college campuses.


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