Vaccines were supposed to be a game changer for Covid-19 in schools. Back in the more innocent days of spring 2021, it seemed as though once the shots were approved for children, education could pretty much go back to normal — kids would get vaccinated, infections would drop, quarantines would become unnecessary, and teachers and families alike could settle into a new normal that looked a lot like the old one.
It didn’t happen exactly like that. Right now, the Centers for Disease Control and Prevention recommends that everyone age 5 and older get vaccinated against Covid-19. The Food and Drug Administration has given the Pfizer/BioNTech vaccine full approval for people 16 and older, and emergency use authorization (a form of limited approval that still requires data showing a treatment is safe and effective) for children 5 to 15. However, families have been slow to vaccinate their kids; by early February, just 22 percent of 5- to 11-year-olds were fully vaccinated.
At the same time, the omicron variant has increased transmission, driven up cases, and forced closures of classrooms, schools, and even entire districts due to quarantines, staffing shortages, and labor disputes. The surge now appears to be easing, but it’s still far from normal out there.
All this has led to renewed debate about vaccines in public schools. Should they be required for attendance? Would such requirements stand up in court? Will we ever get to a place where Covid-19 vaccines will be considered standard for schoolchildren the way measles vaccines are today?
These are all difficult questions, but after years of a pandemic and months of a vaccination program, experts have some insight into the future — as well as some lessons from the past. “I have to believe that we will get to a point where a lot of things related to Covid” — including vaccines — “are routine,” said Ibukun Kalu, a pediatric infectious disease physician and professor at Duke University. “I just don’t know when that will be.”
Why is the Covid-19 vaccine important for kids?
In some ways, it’s not surprising that Covid-19 vaccines for children have been a tougher sell than those for adults. Children are less likely to become severely ill from Covid-19, perhaps decreasing the urgency of vaccination for some families. What’s more, parents are often more anxious and cautious about their children’s health than their own, said Richard Meckel, an emeritus professor of American studies at Brown, who has studied the history of childhood and health policy. Parents who were willing to get vaccinated themselves may be more concerned about side effects when it comes to their children.
However, public health experts emphasize that vaccinating children against Covid-19 is important for them, their families, and their communities. “We do not want to leave children as the only group susceptible to an infection,” Kalu said. Vaccinations help protect children from Covid-19 (which can be severe in younger people, even if it’s less common), as well as protecting the entire population by bringing up the percentage of people who have some immunity. Also, kids will become adults one day: Doctors begin vaccinating people for many diseases as children, Kalu said, so they can build up their protection over time.
Indeed, Covid-19 vaccines are no different from the other vaccines children typically need to get in order to attend public school, which include TDAP (a vaccine that protects against tetanus, diphtheria, and pertussis), MMR (measles, mumps, and rubella), polio, and varicella (chickenpox). Vaccinations are one of the ways that public health officials “keep all children, across age groups across all of our different demographics, attending school safely,” Kalu said. “There is no reason why a vaccine-preventable illness, which SARS-CoV-2 or Covid-19 is becoming — should be taken out of that equation that we’ve all accepted for years and years.”
So are school districts requiring vaccines?
Nonetheless, Covid-19 is outside that equation, at least for now: Vaccination against the virus, especially for kids, remains a politically charged issue. In part because of this, public school districts have been slow to add the vaccine to their lists of required shots. (In some cases, private schools have more leeway to make their own decisions, and some have imposed mandates.)
In fact, they’ve been moving in the opposite direction: A number of districts, like those in Oakland and San Diego, announced vaccine mandates for students and then pushed back their deadlines, said Bree Dusseault, principal at the Center on Reinventing Public Education (CRPE), which has been tracking Covid-19 policies at 100 large districts nationwide. In many cases, the reason is simply low vaccination rates. In Oakland, for example, so many children remained unvaccinated that it would have been impossible to accommodate them at the district’s virtual school.
So far, New Orleans is the only large school district that CRPE is aware of in which a vaccine mandate has actually gone into effect, Dusseault said. That mandate started on February 1, and students will be able to obtain a waiver for medical, religious, or philosophical reasons, so it may take some time to know what effect, if any, the rule will have. Still, the district is “one to watch” to gauge the impact of mandates in the months ahead, Dusseault said.
What about teacher vaccination mandates?
Vaccination requirements for teachers and staff have been less controversial than student mandates, but only slightly. As of last December, 17 districts in CRPE’s sample required teachers and staff to be vaccinated, while another 28 required them to be vaccinated or test regularly.
Though teachers unions have often pushed for stricter Covid-19 protocols during the pandemic, such as distancing and testing, their stance on vaccine mandates has been more complicated.
The largest national teachers unions have been broadly supportive of vaccinations, but they have not come out in favor of mandates for teachers and staff, said Bradley Marianno, a professor of education policy and leadership at the University of Nevada Las Vegas. In part that’s to give local unions flexibility in their bargaining: “If a school district wants a vaccine mandate for teachers, the union’s going to see what they can negotiate along the way” in return, Marianno said.
That position on staff mandates makes it harder for unions to push for student mandates because they could be seen as hypocritical. The situation also varies by region, Marianno said, with some local unions in the West and Northeast coming out in favor of teacher mandates. Meanwhile, “you won’t see unions in the southern half of the United States necessarily come out in favor of vaccine mandates for their membership, because they know where some of their membership stands on that issue,” Marianno said. Local variations in support for teacher mandates “largely align with the politics you would expect them to align with.”
Will more districts require Covid-19 vaccines in the future?
Like everything related to the pandemic, school vaccination policies change all the time, and what’s true today may not be the case tomorrow. For example, California Gov. Gavin Newsom announced last year that as of July 2022, children in the state would have to be vaccinated to attend school. It’s possible that the state mandate will give districts more impetus — and political cover — to enact and enforce their own mandates, Dusseault said.
At the same time, the California mandate will only take effect if the FDA grants full approval to vaccines for children. It also currently only applies to students in 7th through 12th grade.
Meanwhile, 17 states have taken the opposite approach, banning Covid-19 vaccine mandates in schools. In these states, which include Texas, Georgia, and Florida, districts couldn’t require the vaccine even if they wanted to. The federal government is unlikely to step in; any effort by the Biden administration to require vaccines for public school students would likely generate enormous conservative backlash and be blocked by the Supreme Court. (The Court in January blocked a Biden administration rule requiring school districts and other employers to mandate vaccines or testing for staff.)
All of this means that vaccination policies will likely be a state-by-state patchwork for some time to come. To understand what’s coming — and to help districts craft policies that work — it helps to understand what’s gone before.
How did school vaccine requirements come about in the first place?
Vaccines and anti-vaccine sentiment have a long history in America. The first method of vaccination, practiced during the colonial period, involved intentionally infecting yourself with smallpox in order to — hopefully — get a mild case and gain immunity, said Meckel, the Brown professor. One popular method was “arm to arm,” lancing a smallpox pustule on a sick person’s arm and rubbing the resulting pus into a cut on the skin of a healthy person. This was, obviously, disgusting, and sometimes the (formerly) healthy person ended up dying of smallpox. Many people feared and opposed the practice for these reasons.
Over time, though, vaccines became more sophisticated and effective, and in the 19th century, cities began requiring them for public school attendance as part of a larger effort to control epidemics. This, too, inspired backlash. Some parents were worried about the safety of vaccines — which, though better than the old slice-open-a-boil technique, were poorly regulated and sometimes contaminated. Others had more ideological objections.
The 19th century saw “a kind of health reform that was centered on the idea of resisting toxins and purifying the body,” and “the state forcefully putting something into your body” went against that, Meckel said. At the same time, there was a growing resistance to organized medicine, and to state power more generally.
The result was a series of court battles, culminating in the 1922 Supreme Court decision Zucht v. King, which upheld a school vaccination mandate in Texas. That case set a precedent that stands today, Meckel said: A school district has the legal right to require vaccines for attendance.
Even after Zucht v. King, however, enforcement of mandates remained a challenge, and districts were forced to create a number of exceptions to the rules, Meckel said. In contrast, there’s another approach that could have more success today.
Short of mandates, how can schools encourage families to vaccinate kids?
While cities required vaccination against smallpox, another vaccine — against diphtheria — remained largely voluntary, Meckel said. Instead of mandates, public health officials in the 1920s “borrowed from the new advertising and motion picture industry to essentially pass on the message that you were a good parent if you got your child vaccinated.”
That kind of large-scale public relations campaign might be what’s needed when it comes to Covid-19, Meckel said. Mandates, he fears, will only lead to more resistance, as they have in the past. What’s needed is messaging linking Covid-19 vaccination to being a good parent, because right now, many people believe good parenting means protecting your child against vaccines.
Beyond PR campaigns, there are other ways schools and districts can motivate families to vaccinate children. Some have used incentives, like money, gift cards, or free tickets to prom. Many — about two-thirds of the districts CRPE studies — offer vaccine clinics on campus to make it easy for students to get the shot.
It’s also important for clinicians and public health officials to be able to talk with families about the vaccine. Parents’ view on vaccines often depends on “if they have access to information or reliable experts that can help address questions,” Kalu said.
Overall, experts emphasize the importance of normalizing the Covid-19 vaccine as just another part of the childhood immunization process. “People that do not have young kids, or do not remember being a young child, may forget how often vaccines are a part of normal preventive care for children,” Kalu said. “Approaching it from that perspective, somewhat removed from the chaos of Covid itself, might be helpful.”
At the same time, even what many people now accept as normal childhood immunizations have been the subject of controversy and resistance for centuries. Public health officials and school districts may have a long road ahead of them — but if it’s any consolation, it’s one many have traveled before.