Efforts to curtail the spread of COVID-19 now center on vaccinating against the coronavirus, but the drive has led to heated debates in schools and districts nationwide.
Rupali Limaye, a social and behavioral scientist and health communication scholar at the Johns Hopkins Bloomberg School of Public Health on Wednesday will release a free series on how educators can train leaders, teachers and parents to become “vaccine ambassadors” to communicate better with parents and community members who have concerns about vaccinating children. Education Week spoke with Limaye about schools’ role in vaccinating students and staff.
The interview is edited for length and clarity.
We’ve now had COVID-19 vaccinations available for those 12 and up since last May and 5-11 children since November. Where are we, nationwide, in getting all school-age children vaccinated?
It’s really varying across the states. So, for example, in Northern Virginia where I live, it has been amazing how many people have done it; more than 50 percent of kiddos between the ages of 5 and 12 have gotten the vaccine. But if you look at it from a nationwide perspective … it’s only been about 20 percent so far of 5- to 11-year-olds have gotten at least one dose. In this area, we had to wait to get our kids in … but then I talked to other parents in Oklahoma and they’re like, there’s no line, no one is bringing their kids. So the problem is that it’s been very uneven. And there are a lot of parents who are like, I got the vaccine, but I don’t feel comfortable with my kid getting it.
Why have vaccinated parents been slow to get their children immunized?
The reason that we’re essentially hearing—and parents have been very upfront about this—is that at this point, like if you are an adult, you have tons and tons of data that you can look upon for people that have gotten the vaccine. Millions of people have gotten it with very, very few issues. With kiddos, the data that came out when [the Food and Drug Administration] approved [Pfizer vaccines for 5- to 11-year-olds] in November, the trials had only included something like 2,000 to 3,000 children. So, from my perspective, can we give parents just a minute? You know, let’s let them talk to other parents. Let’s give them a second.
I think the other issue that we were seeing with kiddos specifically in that age range is just, most kids aren’t having really severe COVID. So then the question really was well, if most kids aren’t going to get hospitalized or aren’t going to have major issues, why should I get my kid vaccinated?
Over the last three weeks, there’s been a record increase in pediatric hospitalizations. So, I think parents are starting to see that, oh, people should stop calling the [omicron] variant mild. It’s mild when you’re comparing it to delta hospitalizations [overall], but this is really the first time that we’ve seen hospitalizations at the numbers that we have in this age group specifically. That’s really concerning.
But my bigger question as a parent with two kids under age of 11 is, what about the long-term effects of this? We’re starting to hear this from doctors that it’s not just about hospitalizations, that it’s more that we don’t know the long-term effects of long COVID in brain development of children.
How much of a role do schools really play in whether or not parents decide to vaccinate their children?
Schools are probably one of the most critical places where people are getting advice for [child] development in general. Yes, people go to their pediatricians about what they should be doing, but schools play a really important role because it’s also a congregate setting. You have children together … and so we’re starting to see more and more teachers get engaged in this space—and not only teachers, but school nurses and just other parents that can talk about the importance of vaccination. …
HPV [the human papilloma virus vaccine] is a perfect example: A lot of parents didn’t really listen to pediatricians. They were really just talking to other parents to figure out whether or not they should get their kid the HPV vaccine. And I don’t think it’s any different here either. So I think it’s such a natural place to make sure that these conversations that parents are having with one another are based on evidence, and that correct information is really being communicated.
Our biggest concern, from a public health perspective, is that an increase in concern related to the COVID vaccine may spill over to other vaccines. Pre-COVID, the biggest issue that parents had with regards to vaccination was related to the measles vaccine, because there was a study that showed that there was a link between autism and measles—even though the study was retracted and the person that wrote it lost his medical license. But that rumor has persisted, and so talking to parents, [the measles vaccine] would be the one that people were most hesitant with regards to routine vaccination. … Now the concern is, if people are in general more distrustful of the government, which I think we are seeing, how is that now going to impact all these other vaccines we recommend?
Should schools provide vaccines on site, or is it better for them to play a less-direct role?
When you look at other vaccine programs in schools, we know that by offering them in schools, it really removes a lot of barriers for parents: making an appointment, taking time off work, just being able to manage everything.
What are the most common mistakes you see school and district leaders making when talking to parents about vaccinations?
The first one is being dismissive. The second is automatically rejecting when people bring up misinformation, just essentially saying, “no you’re wrong,’ which has not been helpful in any way, shape or form. For example, when I talk to people that are hesitant, often they’re just like, “I don’t want the vaccine because there’s a microchip in the vaccine.” Now, there’s no microchip in the vaccine. … But it’s important for me to not be dismissive of that [concern] and not correct that misconception … without really being careful about how you respond. If you put someone on the defensive—which I think is what ends up happening in a lot of these conversations—there’s no way then that this person is going to engage with you.
The third mistake is using authority. I think sometimes school nurses or teachers will think, “If I say it, they’re going to do it.” But it’s really important that it’s a shared decisionmaking conversation.
Are there strategies for better communication about vaccines?
There are all these different techniques that have been tried and effective in the vaccine space, that we’re actually teaching again to individuals who are not in public health, like “presumptive communication” and “pre-bunking.”
In presumptive communication, you structure your conversation in a way that assumes that vaccination is the default or the norm. So if I’m having a conversation with you and you have a 10-year-old … I would say, ‘Hey, your son is 10. When are you gonna sign the person up for the vaccine?” We’ve seen a lot of success in this, for example when doctors say that the normal behavior is that you get your child the vaccine.
Another technique is called pre-bunking. One of the major issues that we’re seeing is that parents, administrators, nurses are confronted by so much misinformation. So essentially think of pre-bunking as a way to give yourself a vaccine to identify and reject misinformation. You teach how to look for telltale signs that something that you’re reading is actually not based in evidence. That has been really critical because there’s a lot of information out there and people have a hard time discerning what is real and what’s not real.
Many districts are also debating whether or not to require vaccines of their employees or students. Are mandates effective or not in getting people fully vaccinated?
We do know that mandates work, particularly at the school level. If you look across different districts that have mandates, they have really helped keep community transmission [of the coronavirus] down. … And so, mandates have been very effective with regards to keeping kids safe and also keeping kids in schools … because if teachers aren’t also vaccinated and a teacher gets [COVID-19], that leads to a staffing shortage. Just in the last two weeks there are states where schools are shutting down because everyone is out with COVID.
With dominant variants like delta and omicron causing more breakthrough infections among people who are fully vaccinated, how should school leaders think about whether to shorten quarantine and isolation limits, as the CDC recently has suggested?
The reason that [schools] are able to do [shorter quarantine periods for vaccinated people] is, if you’ve been vaccinated and you get a breakthrough infection, we have seen consistently that you have a shorter infectious period. If you’re not vaccinated, you’re more likely to do something called viral shedding through your nasal mucus … and you may still have COVID viral shedding 10 days after you got infected. If you are vaccinated and you get infected, the viral shedding is shorter, the symptoms are also shorter and also tend to be less severe, so you’re just less likely to transmit it.