Suryansh Agarwal, an incoming first-year student from Kanpur, India, was excited to attend the University of Michigan in Ann Arbor in the fall and looked forward to living on campus after receiving the Covid-19 vaccination in May. Then he read the school’s vaccine guidance.
The University of Michigan has stipulated that any student living on campus must be inoculated with a vaccine authorized by the World Health Organization or U.S. Food and Drug Administration. To safely allow students back this fall, many colleges across the country will operate under these kinds of vaccine mandates for students and faculty.
But this poses an issue for Agarwal, who received Bharat Biotech’s Covaxin vaccine, which does not currently hold WHO or FDA authorization.
“I considered myself really fortunate to get the vaccine,” Agarwal said. But now he worries he may not be able to fully participate in school activities because of his vaccination status.
Some international students who were vaccinated in their home countries are now faced with possibly having to get re-vaccinated, while studies about “mixing and matching” vaccines are still ongoing.
In India, Covaxin and Serum Institute of India’s Covishield developed by Oxford-AstraZeneca became available for people ages 18 to 44 on May 1.
“I booked the first slot I could get without thinking about Covaxin vs. Covishield or anything like that because the situation was really bad at that time,” Agarwal said. “There was an actual shortage of beds and oxygen, and Covid-19 cases were at an all-time high for the time, so I got it without having a second thought.”
With more than 31.5 million Covid-19 cases to date, which is likely an underestimate, India has been one of the countries hardest hit by the pandemic. In addition to oxygen shortages and overflowing hospitals, vaccine access also poses an issue with a population of almost 1.4 billion people. Currently only 7.3% of the population in India is fully vaccinated, The New York Times reported.
According to theUniversity of Michigan website, if you have received a vaccine not approved for use in the U.S., “you will not be considered fully vaccinated, so you will be expected to comply with required weekly testing and mitigation procedures until you are fully vaccinated with an approved vaccine.”
The University of Michigan responded to NBC News' request for comment with guidance on its website that states that it will offer vaccination opportunities for any students who wish to be revaccinated with a WHO- and FDA-authorized vaccine.
Agarwal is unsure whether he is comfortable getting revaccinated with a vaccine from a different manufacturer.
“I am on the fence right now,” he said. “I have not seen any studies about the predicament that I am in, with taking Covaxin and then another shot. When and if those studies come out, I could make a decision.”
The Com-COV study conducted by the University of Oxford showed that a two-dose regimen with one dose of AstraZeneca followed by a dose of the Pfizer vaccine has “proven efficacy against COVID-19 disease and hospitalization.”
While this study showed promising results, the WHO still warns against individuals mixing and matching vaccines. Soumya Swaminathan, chief WHO scientist, earlier this month tweeted, “Individuals should not decide for themselves, public health agencies can, based on available data. Data from mix and match studies of different vaccines are awaited — immunogenicity and safety both need to be evaluated.”
Uli Strych, director for strategic initiatives and program development at Texas Children’s Hospital Center for Vaccine Development product development partnership, agreed.
“From my expectations, there should not be any issues with combining any types of vaccines; they could even be advantageous,” Strych said. “But all of this is trumped by the fact that the testing of vaccines needs to be a monitored and controlled process.”
Referring to what is called a "heterologous prime-boost," mixing and matching vaccines could actually be more effective, but there are still ongoing studies to determine the safety and efficacy of receiving two different Covid-19 vaccines.
Guidance from the Centers for Disease Control and Prevention indicated, “No data are available on the safety or efficacy of receiving a COVID-19 vaccine currently authorized in the United States after receipt of a non-FDA-authorized COVID-19 vaccine. However, in some circumstances people who received a COVID-19 vaccine not currently authorized in the United States may be offered revaccination with an FDA-authorized vaccine.”
Despite limited guidance, some international students have decided to move forward with a mix-and-match approach, in part because of issues with travel timing.
Dami Adekeye is an incoming senior at Yale University in New Haven, Connecticut. Her family currently resides in Abu Dhabi, United Arab Emirates, where Adekeye spent the fall 2020 semester.
She received the Sinopharm vaccine while she was in the UAE in January. But before she could get the second dose of Sinopharm, she had to return to Yale for the spring semester.
“I kept thinking something bad could happen if I got different vaccines,” Adekeye said. “But I was guided by professionals who said if you wait a long enough time, there won’t be any negative side effects.”
She then received one dose of the Pfizer vaccine through Yale’s vaccination program.
The Sinopharm vaccine produced by Beijing Bio-Institute received WHO authorization May 7. This was followed by WHO authorization of the other Chinese vaccine, Sinovac-CoronaVac, on June 1.
In accordance with Yale policies, which require students and faculty to be fully vaccinated with a WHO-authorized vaccine, both of these vaccines will be accepted.
But the wait for university policies to come out also caused some issues for international students who weren’t sure whether to get the vaccinations that were available in their home countries.
Coco Chai, an incoming junior at Yale from Beijing, waited until July to get her vaccine.
“I didn’t want to get it too early because I wasn’t sure what policy Yale would have,” she said.
After taking a gap year and staying in Beijing for the 2020-2021 school year, Chai was determined to get back to New Haven for her next year of college.
When the WHO added CoronaVac to its authorized list, Chai decided to get the vaccination.
“Adding CoronaVac to the list was a huge relief for me to hear because it was getting hard to get the Sinopharm one in Beijing,” Chai said.
As the WHO evaluates different vaccines, university policies will be adjusted accordingly.
“It would be important for WHO to try to help deal with this issue of disparate vaccines and disparate brands and how this affects people’s ability to be claimed fully vaccinated,” Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, noted.
But some international students remain completely unvaccinated.
“There are some international students where there is simply no availability for vaccination where they are,” Adekeye said. “People can’t control where they are, and people cannot get vaccines out of nowhere.”