The long-simmering national debate over childhood vaccination is barreling towards America's public schools, and they aren’t ready.
With 56 million students, nearly 4 million teachers and millions of other critical school staff, the nation’s education system has a greater share of the vaccine-eligible population than any other public institution, and it’s going to be ground zero for the nation’s COVID-19 inoculation campaign.
But unless policymakers quickly and transparently address a host of looming challenges, the nation’s 100,000 public schools, to no fault of their own, will be unprepared to navigate this charged issue.
Over the past two weeks, there have been strong signals that the federal government is preparing to attempt to release a COVID-19 vaccine by the end of the year, if not sooner. Many scientists, including some from within the Trump administration itself, do not see this as a plausible timeline.
Yet vaccine-purchasing agreements have been signed with at least six companies; medical supply companies are being granted authorization to distribute needles and syringes, and the administration, through the Centers for Disease Control and Prevention, notified governors that they should be prepared for large-scale deployment of a vaccine by Nov. 1.
These developments coincided with the release of the first draft recommendations from the National Academies of Medicine Committee on the Equitable Allocation of a COVID-19 vaccine, which proposed a priority order in which vaccines will be administered. The draft recommended teachers and school staff receive the vaccination in the second highest priority tier, after “frontline” health workers and older Americans with comorbidities in group living environments, while students occupy a more distant third tier.
Schools have historically played important roles in successful vaccination campaigns. Since 1875, they have been vaccination distribution sites against smallpox, polio, rubella, varicella and the 2009 H1N1 pandemic influenza.
While vaccination policies are determined at the state level, school facilities are often the point of implementation for these policies. Schools maintain vaccination records; ensure students comply with state mandates and, in some cases, partner with local health care providers to administer vaccinations.
But it may be harder to turn public schools into vaccination hubs during today’s pandemic.
A major challenge is that mandated childhood vaccination is becoming more controversial among the public. According to a recent Gallup poll, 84 percent of adults report that childhood vaccination is extremely important or very important. That’s a decrease of 10 percent over the last two decades.
Look no further than Massachusetts to see the implications of the trend. Last month, the state became the first in the country to establish an influenza vaccination mandate, requiring vaccinations of children over the age of six months attending childcare and students under the age 30, even if they are participating in only remote learning.
But thousands of parents, children, educators and public health workers have rallied against the Bay State mandate, for a range of probable reasons: fading collective memory about diseases — polio, diphtheria, measles and rubella — that have all been made largely preventable by vaccination; rising anxiety about vaccine side effects and efficacy; persistent concern about commercial interests; collapsing trust in institutions; and a sentiment that mandatory vaccinations infringe on the right to personal liberty.
Public hesitancy around the COVID-19 vaccine looks to be even more prevalent. In a recent Pew survey, 49 percent of Americans reported that they definitely or probably would not get vaccinated against the coronavirus. While no poll has captured t parents’ willingness to have their child vaccinated, 41 percent of parents of children under 18 said in a recent Gallup poll that they would not get vaccinated.t. That the COVID-19 vaccination debate is swirling in a funnel cloud of partisan national politics in an election year won’t make things any easier for school communities.
Given these challenges, how should states respond to the CDC’s communication that they prepare for a massive vaccination effort? There are several things they should consider:
Publish and make widely available recommendations of the CDC’s Advisory Committee on Immunization Practices, determine the period for interim review and ensure that updates are provided in a timely and public manner.
Publish and make broadly available clear outcome reviews of the clinical vaccine trials, including whether the vaccine has been thoroughly tested in children, what the side effects are, how the vaccine will be delivered (injection, inhaled, or orally) and what the financial burden will be for parents. Do the same for school staff, many of who are at risk of serious illness if infected by COVID-19.
Require that all public health decision-makers publicly disclose personal investments in any of the COVID-19 vaccine producers and either divest or recuse themselves from the decision-making processes.
Provide thorough education and training to public health officials and school staff, including school nurses or other school-based personnel that handle health and wellness issues, on vaccine trial outcomes, efficacy and risks, specifically for children and school staff.
Hold public, state-level hearings on key policy decisions, including any potential vaccination mandates for specific populations such as school staff and students.
Supply detailed rationale on the vaccination exemption process and the implications for attending public childcare and K-12 school.
Congress also has a role to play. Open hearings that include representative views on childhood vaccination and nonpartisan scientists that can discuss vaccine safety records would send important signals to the American public that the seriousness of the moment demands a transparent and inclusive dialogue.
If we are going to ask our schools once again to play a major role in childhood vaccination, they need significant support and they need it now.
Mario Ramirez is an emergency medicine physician and he served as acting director for pandemic and emerging threats at the U.S. Department of Health and Human Services. He is managing director of Opportunity Labs, a non-profit consultancy, and a senior fellow at FutureEd at Georgetown University.
Andrew Buher is the founder of Opportunity Labs, a former chief operating officer of the New York City Department of Education and a senior fellow at FutureEd at Georgetown University.