ARCHIVEHow MiraCosta College Used 148 Tissue Boxes to Fight Flu Season
MiraCosta College's "Flu Season" campaign is a 2017 ambient healthcare installation that used 148 tissue boxes as an interactive display to encourage college students in Oceanside, California to get a flu shot, driving foot traffic directly to Student Health Services on campus.
Published in November 2017 in the United States, the campaign arrived at the peak of flu season — precisely the moment when student attention to preventive healthcare matters most. Standard poster advertising had proven insufficient to capture the wandering attention of a college-age audience, so the MiraCosta College Public Information Office pursued a tactile, environmental solution. The result was a display assembled over four hours, transforming an everyday object associated with illness into a navigational prompt toward vaccination.
What distinguished the installation was its interactive mechanic. Students initially hesitated before taking a tissue — an ordinary, instinctive act — but that moment of pause created an opening for the campaign's message to land. According to Clapboard's editorial record, what began as hesitation evolved into genuine engagement, with the exhibit becoming a memorable experiential moment that directed students toward Student Health Services. The campaign operated entirely within the ambient medium, relying on context and physicality rather than paid media placement, making it an unusually lean piece of healthcare communication for a United States community college environment.
Produced by the MiraCosta College Public Information Office, with Alex Karvounis serving as creative director and copywriter and Kristen Huyck listed in additional credits, "Flu Season" demonstrates how institutional healthcare campaigns can punch above their weight class through conceptual simplicity and precise material choice. The campaign earns a Clapboard Score of 63 out of 100, reflecting its creative ingenuity within a tightly constrained budget and reach context.
ARCHIVECollege students represent a historically under-vaccinated demographic in the United States. The challenge MiraCosta College faced was not unique to its Oceanside, California campus — it reflects a systemic tension in public health communication between institutional messaging and the lived habits of young adults who frequently underestimate flu risk. Standard poster campaigns and table tents produce minimal behavioral change in this audience, a reality that informed the strategic pivot toward an experiential format.
Flu vaccination rates among young adults in the United States have consistently lagged behind older age groups. According to the National Foundation for Infectious Diseases, college students are considered a priority population for flu vaccination outreach precisely because campus density accelerates transmission. This epidemiological reality gave the "Flu Season" installation a genuine public health rationale, not merely a creative rationale. The tissue box — universally legible as a symbol of illness — provided a shortcut past the cognitive resistance students typically apply to institutional health messaging.
In the broader United States healthcare advertising landscape, the dominant spending is concentrated among pharmaceutical giants. According to Ad Age, US pharmaceutical direct-to-consumer advertising spending reached approximately six billion dollars in 2017, with major players such as Pfizer and AbbVie commanding the largest individual budgets. Against that backdrop, a community college ambient installation represents the opposite end of the healthcare communication spectrum — hyper-local, zero-media-spend, and entirely dependent on earned attention rather than purchased reach. This contrast is itself strategically instructive. Where competitors in public health messaging, including large hospital networks and state health departments, default to broadcast and digital channels, MiraCosta College chose physical presence and behavioral interruption as its core mechanism.
Alex Karvounis conceived and wrote "Flu Season" as a piece of ambient advertising that collapses the distance between the problem and the solution. The tissue box is not an arbitrary prop — it is the material embodiment of flu illness itself, and placing 148 of them in a campus environment transforms a mundane object into a directional sign.
The installation was built and deployed over four hours, a constraint that shaped both its scale and its spontaneity. The speed of construction meant the display arrived in students' daily environment without warning, which amplified its disruptive effect. Ambient advertising operates on the principle of unexpected encounter, and the compressed build timeline served that principle directly. The physical quantity — 148 tissue boxes — was sufficient to create visual mass without requiring architectural intervention, allowing the installation to exist within normal campus infrastructure rather than demanding a dedicated venue or significant production budget.
Kristen Huyck contributed to the production under the auspices of the MiraCosta College Public Information Office, an in-house team that manages communications and creative output for the institution based in Oceanside, California, as documented on the college's official website at Miracosta Edu. The decision to execute the campaign internally rather than through an external agency is consistent with the resource profile of a California community college and adds a layer of authenticity to the work — the people building the installation are part of the same campus community being addressed. The interactive dimension emerged organically: students who encountered the display and reached for a tissue found themselves drawn into the campaign's narrative, converting passive observation into participatory engagement.
No verified third-party performance data for the "Flu Season" campaign is publicly available. No independent coverage of the installation has been documented in trade publications including Ad Age, Adweek, Campaign, The Drum, or Contagious, and no quantified outcome metrics — vaccination rate lifts, Student Health Services visit counts, or tracked student responses — appear in any publicly accessible source.
What Clapboard's archive does confirm is that the installation drove traffic to MiraCosta College Student Health Services, which represents the campaign's singular stated objective. On that qualitative basis, the work achieved its intended behavioral outcome. Structurally, the campaign's effectiveness rests on three sound advertising principles: contextual relevance, behavioral interruption, and low barrier to engagement. A student who takes a tissue has already physically interacted with the campaign before reading its message, making the persuasion sequence unusually direct.
The campaign's limitation is its inherently bounded reach. Installed for four hours on a single campus in Oceanside, California, "Flu Season" could only influence the students present during that window. It did not extend into digital channels, generate measurable earned media, or produce content assets suitable for redistribution. These structural constraints explain its Clapboard Score of 63 out of 100 — a mark that recognises genuine conceptual strength while acknowledging the ceiling imposed by a single-location, single-day ambient format with no documented amplification strategy.
The Flu Season campaign was a 2017 ambient installation by MiraCosta College using 148 tissue boxes to encourage flu shot uptake among students. Created by Alex Karvounis and produced by the MiraCosta College Public Information Office, the four-hour interactive display in Oceanside, California directed students to Student Health Services.
The installation placed 148 tissue boxes across a campus space, inviting students to take a tissue. That instinctive act created a moment of engagement with the flu shot message. According to Clapboard's archive, initial student hesitation gave way to genuine interaction, making the display both memorable and effective at directing traffic to health services.
Alex Karvounis served as creative director and copywriter on the Flu Season campaign. Kristen Huyck received additional credit. The MiraCosta College Public Information Office in Oceanside, California produced the work, functioning as the in-house advertising agency for the institution, as documented in Clapboard's campaign records.
Standard poster advertising proved insufficient to engage college students, according to Clapboard's editorial record. The ambient tissue box format created a physical, interactive encounter that bypassed the cognitive resistance young adults typically apply to institutional health messaging, making the flu shot prompt harder to ignore than conventional signage.
The Flu Season campaign received a Clapboard Score of 63 out of 100. The score reflects strong conceptual thinking and effective use of an ambient medium on a constrained budget, balanced against the campaign's limited geographic reach, single-day installation window, and absence of documented amplification beyond the Oceanside, California campus.
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