Lower Covid risk for children, the temporary nature of Covid vaccines, and the practices of other countries argue in favor of leaving this decision to parents.
Lower Covid risk for children, the temporary nature of Covid vaccines, and the practices of other countries all argue in favor of leaving this vaccination decision to parents.
T wo New York City officials recently called on Mayor Eric Adams to require full Covid vaccination next school year as part of the standard vaccination requirements for public schools. Democrats such as Virginia’s Terry McAuliffe don’t think parents should have a say in what schools teach their children, and many also want those same schools to override parents’ role as their children’s first and most important caregivers. Yet mandatory Covid-vaccination policies for schoolchildren worry 53 percent of parents, and 76 percent of parents are concerned about long-term effects of the Covid vaccine in children.
California, Louisiana, and Washington, D.C., have issued mandates for schoolchildren once the vaccines are fully approved by the FDA. Elsewhere, 17 states have banned Covid-vaccine mandates for students. Senator Ted Cruz (R., Texas) recently proposed an amendment to cut off federal funding for schools that enforce Covid-vaccine mandates.
Democrats like to conflate opposition to vaccine mandates with opposition to vaccines and science in general. Republicans such as Virginia’s Republican governor Glenn Youngkin, however, note that vaccines have reduced the risk of severe complications and death for individuals, particularly those at high risk, while also championing the right for Americans to decide for themselves. They favor persuasion over mandates.
While the decision to receive medical treatment should be an individual choice, vaccination policies for schoolchildren are complex given standard vaccine requirements for school attendance to prevent community transmission. The Centers for Disease Control recommends vaccines through its Advisory Committee on Immunization Practices (ACIP) — a group created decades ago to gather public-health and medical experts to advise the agency. States typically determine school vaccine requirements based on these recommendations, and the ACIP currently recommends the Pfizer Covid vaccine for children five and older.
Several factors regarding Covid vaccines deserve special consideration in the context of school requirements, including length of follow-up studies of vaccine recipients to observe safety and efficacy data, historical trends, Covid risk factors, and medical non-consensus on the risk–benefit ratio for children. One can oppose Covid-vaccine mandates without opposing all school vaccine mandates.
In September 2020, pediatricians published a framework of nine standard criteria that should be considered when evaluating new additions to mandatory school immunization programs. The top priority they listed was vaccine safety, including data on long-term follow-up. Even after vaccines receive full FDA approval, years of safety data from post-licensure studies are often required to fulfill the criteria of a full safety assessment before a mandate for children is considered. Covid vaccines are still too new to meet this criterion. Moreover, Pfizer’s Covid vaccine is still under emergency-use authorization for children under age 16.
Historical trends for vaccine requirements are also important. Six of the seven vaccines that are required for schoolchildren in all 50 states have been approved by the CDC for more than 50 years and thus have years of available safety data. Polio is an interesting example. Despite the widespread fear of the disease among parents in the mid 20th century and the landmark approval of a vaccine in 1955, it still was required only in ten states by 1963.
The newest vaccine that is required for child-care settings and for schoolchildren in all 50 states is the chickenpox vaccine. It was approved by the FDA in 1995, recommended by the CDC in 1996, and first required for schoolchildren in Washington, D.C., in 1997. However, the majority of states took several years to make it a mandatory vaccine for schoolchildren.
Importantly, the waning protection of Covid vaccines makes them more similar to the longevity profile of flu vaccines than required vaccines that offer long-term or lifelong protection. The influenza vaccine first became available in 1945 but was not recommended for infants, children, and teens until 2002. As of 2020, Massachusetts was the only state with a flu-vaccine requirement for schoolchildren.
Ironically, states are now considering Covid-vaccine mandates in schools just as the federal and state governments are backing off mask mandates and other restrictions. Declining case numbers led the CDC to recently drop mask recommendations for counties with low or medium Covid risk. This was true in 90 percent of U.S. counties last week. At the same time, cumulative data from the American Academy of Pediatrics showed there have been 12.7 million total child cases with 0.1 percent to 1.5 percent resulting in hospitalization and 0.0 percent to 0.01 percent resulting in death. In other words, children are at very low risk of severe Covid.
Many in the U.S. and around the world have been questioning the benefits of Covid vaccinations for children. Public-health officials should be especially cautious when considering mandates for healthy children, whose bodies are still growing and developing. Florida’s surgeon general issued guidance that “healthy children aged five to 17 may not benefit from receiving the currently available COVID-19 vaccine.” Sweden does not recommend Covid vaccination for children aged five to eleven. The U.K. is vaccinating only five- to eleven-year-olds at high risk. The World Health Organization prioritizes only children at higher risk of severe Covid. Some U.S. doctors have expressed concern about vaccinating the millions of children who have already had Covid because of lack of additional benefit in the clinical trial.
Proponents of the Covid vaccine for children highlight that it offers individual protection against severe disease and long-term complications, in addition to the potential for reduced community transmission. Policy-makers implementing Covid school vaccination requirements cite public-health benefits including reducing disparities in vaccine uptake, protecting students and staff, and ending the pandemic. However, the current evidence and the CDC’s changing policies do not substantiate the need for vaccine mandates for schoolchildren to achieve these public-health goals.
Parents should have the primary responsibility to make decisions about Covid vaccines for their children. States mandate other vaccines for schoolchildren based on strong scientific evidence to protect our kids, not to make political statements. We must do the same with Covid vaccines.
Bobby Jindal was the governor of Louisiana from 2008 to 2016 and a candidate for the 2016 Republican presidential nomination. Heidi Overton, M.D., is the director of the Center for a Healthy America at the America First Policy Institute.