Schools across the country are planning on reopening in the fall for in-person instruction, but not all are requiring COVID-19 vaccinations for kids who are eligible to get inoculated. In fact, a handful of states — Alabama, Arkansas, Florida, Indiana, Montana, Oklahoma and Utah — have passed laws that would prohibit public schools from requiring COVID-19 vaccinations or proof of vaccination, according to CNN.
The vaccine-related laws are clearly targeting COVID-19 vaccines specifically, the administering of which has become a victim of the culture war. For example, Alabama Governor Kay Ivey (R.) signed a bill into law that states that "institutions of education may continue to require a student to prove vaccination status as a condition of attendance only for the specific vaccines that were already required by the institution as of January 1, 2021." In Arkansas, the law states that a coronavirus vaccine "shall not be a condition of education." (Currently, children over the age of 12 are eligible for the COVID-19 vaccine.)
While it may be another few months before elementary school-aged children can get inoculated, requiring vaccinations to attend school is nothing new; immunization exemptions — religious, medical or philosophical — vary from state to state. But as Dr. William Moss, executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health, told CNN on Monday, singling out of the COVID-19 vaccine is "obviously occurring in a broader social and political context around COVID-19 and the extreme politicization of the disease and vaccines."
So, what's at risk when children return to school in an environment where COVID-19 vaccines aren't required?
Doctors tell Salon they are relatively okay with it — provided proper mitigation strategies are still in place.
"I'm comfortable right now with schools not requiring vaccination," Dean Blumberg, chief of pediatric infectious diseases and associate professor in the Department of Pediatrics at the University of California, Davis, told Salon. "We knew even before vaccines were available that we were able to have safe in-person schooling," he continued. Blumberg noted that school can be a safe place provided that they have masking policies, exclude ill students from in-person instruction, test for COVID-19, have contact tracing protocols, and distance children when not masking.
As the Centers for Disease Control and Prevention (CDC) explains, previous outbreaks in schools happened mostly when prevention strategies weren't implemented or followed. A cautionary tale comes from a school in Israel, which, prior to vaccine availability, shut down less than two weeks after re-opening when two symptomatic students went to school and infected 153 students and 25 staff members. An analysis of the school's coronavirus outbreak found that the children weren't wearing masks because of a heatwave at the time. The school's outbreak shows that when mitigation strategies are lacking, transmission is very possible.
Jeanne Noble, MD, associate professor of emergency medicine at the University of California – San Francisco, told Salon she believes requiring vaccinations for schools would help reach the end goal of getting kids back in school and returning to some sense of normalcy.
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"The most important thing in my mind is getting kids back to school — and mandatory vaccinations, I think, would make that happen more quickly," Noble said. "Requiring all kids to get vaccinated would certainly decrease the chances of outbreaks in school and keep kids in school for longer and help ensure that their schools are open."
Noble added that this would be done to primarily protect adults in the school and the community at large.
"Kids transmit COVID at about half the rate or efficacy of adults," Noble said. "It's not a threat, in terms of serious illness and death to kids, numerically, that would typically justify a mandatory vaccine . . . it's really for the greater societal good of protecting adults and other more vulnerable people."
As for masking and social distancing in schools, Noble said she thinks if a county or city has more than five hospitalizations per 100,000 people in the population, it makes sense to mask unvaccinated kids. Noble did not see as much of a necessity for vaccinated children to mask up.
"I think the only argument for having vaccinated kids continue to mask are for social concerns, that some kids are masked and some kids aren't," Noble said. "People can make an argument that that's a fair way to do things." On the other hand, Noble noted that "kids, especially young kids, are having trouble reading the emotions of others when their faces are partially covered up, and kids with speech impediments really suffer."
Noble's opinion is at odds with The American Academy of Pediatrics' (AAP) latest updated guidance for schools, which recommends that all students over 2 years old, along with staff, wear masks, regardless of their vaccination status. The reasoning is twofold: first, because large portions of the student population are not eligible for vaccination, it is difficult to enforce mask policies for those who are unvaccinated; and second, there is a concern about emerging variants that could be more transmissible among children.
"Given what we know about low rates of in-school transmission when proper prevention measures are used, together with the availability of effective vaccines for those ages 12 years and up," the AAP states. "The benefits of in-person school outweigh the risks in almost all circumstances."
The AAP also recommends all children should get vaccinated as soon as they are eligible.
Despite some schools prohibiting vaccine mandates, not all states will require masks or mitigation strategies either.
In South Carolina, school districts are prohibited from mandating masks for students and staff. In Texas, an executive order prohibits schools from mandating face coverings. In other states like Washington, schools must mandate masks or face coverings indoors regardless of vaccination status.
While severe disease and death from COVID-19 is rare in children, Centers for Disease Control and Prevention Director Dr. Rochelle Walensky pushed back on that narrative this week emphasizing that proper mitigation strategies are in place for children.
"I think we fall into this flawed thinking of saying that only 400 of these 600,000 deaths from COVID-19 have been in children," Walensky said. "Children are not supposed to die. And so 400 is a huge amount for respiratory season."