Along with an influx of back-to-school illnesses, the coming school year may bring significant changes to how school-age kids are protected from many viruses. Both shifting political winds and public attitudes toward vaccines are poised to make it harder for many kids to show up to school healthy and ready to learn, public-health experts warn.
Those concerns are rising in the wake of a complete overhaul to a group of doctors and health experts who advise the federal government on vaccines, called the Advisory Committee on Immunization Practices, or ACIP.
States and school districts depend upon the federal government to not only evaluate and approve vaccines, but also to make determinations on what vaccines children should get. These recommendations are baked into state laws and school policies across the country.
Now, public-health experts say the changes to ACIP, which helps decide the childhood vaccine schedule, could make it more difficult for some students to get immunizations and throw a wrench into state laws that mandate vaccines for school-age children. That, in turn, could lead to students missing more school days and losing academic ground when they can least afford to do so.
“There’s clearly well-demonstrated links between attendance, in particular what we call chronic absenteeism, and educational attainment. And there’s also documented links between health and educational attainment,” said Lynn Nelson, the president of the National Association of School Nurses. “If students are out either because they’re ill or because they’re excluded because of their vaccine status during an outbreak, then they lose out on seat time and they lose out on education time, and it impacts their academic progress.”
Who decides if vaccines are safe?
The U.S. Centers for Disease Control and Prevention relies on ACIP, a group of outside experts in medicine, vaccinology, and health research from leading medical institutions to analyze public-health data and advise on U.S. vaccine policy. The group is made up of medical experts appointed by the secretary of the Department of Health and Human Services to four-year terms. Historically, those terms have been staggered to ensure that the panel is not appointed entirely by one administration. (The U.S. Food and Drug Administration, meanwhile, approves and regulates vaccines.)
But on June 9, Health and Human Services Secretary Robert F. Kennedy Jr. dismissed all 17 experts on the ACIP and promptly replaced them with eight new members (one of which has since withdrawn). Several of these new members have expressed anti-vaccine sentiments to varying degrees—worrying members of the broader medical community that the panel is now staffed with at least some people who will make decisions about immunizations based on ideology and not on science.
Kennedy, himself a prominent vaccine skeptic, described his rationale for overhauling the advisory group in an opinion piece for the Wall Street Journal. The action, he wrote, aims to restore public trust in the government’s health agencies.
“The problem isn’t necessarily that ACIP members are corrupt. Most likely, they aim to serve the public interest as they understand it,” he wrote in the newspaper. “The problem is their immersion in a system of industry-aligned incentives and paradigms that enforce a narrow pro-industry orthodoxy.”
Kennedy has shown he is willing to overturn established ACIP recommendations. Shortly before overhauling the vaccine-advisory committee, Kennedy announced on social media that the CDC no longer recommends COVID-19 vaccines for pregnant women and children. The American Academy of Pediatrics and several other leading health organizations are now suing the secretary for making “unilateral, unscientific changes to federal vaccine policy,” the AAP said in a statement.
The fear among many public-health experts is that the newly reconstituted ACIP will alter the childhood vaccine schedule, the timeline for what vaccines people should receive at different ages. Kennedy has on multiple occasions challenged the childhood vaccine schedule, including issuing a report in May that questioned the necessity of school vaccination mandates. The report was widely criticized for citing studies that didn’t exist. The newly configured ACIP said in June during its first meeting that the group plans to review the current vaccine schedule.
How do federal vaccine recommendations affect schools?
So, how might the new look of this advisory group affect schools?
There are a couple of ways primarily having to do with potential changes to the vaccine schedule, said James Hodge, a law professor at Arizona State University’s Sandra Day O’Connor College of Law. He also directs the university’s Center for Public Health Law and Policy.
First, many state school vaccine mandates don’t outline a specific list of immunizations that students must receive to attend school, Hodge said. Instead, the laws say that children must receive the vaccines recommended by the CDC.
That’s because states aren’t in the business of approving new vaccines, so they rely on the federal government to determine what is safe and effective, said Hodge.
“That’s where things get dicey,” he said. “If ACIP starts pulling the plug on vaccines that it had previously accepted, and states’ laws are tied to what ACIP says on this, that’s not good. A simple legislative or regulatory fix could certainly fix it. But they’re going to have to act. They’re going to have to do more than just accept whatever the federal government says.”
Although states set their own vaccine policies, the federal government has a few levers it can pull to influence those measures, Hodge said. It could, for example, de-authorize a vaccine and threaten to withhold public-health funds from states to compel them to drop certain vaccines from school mandates, Hodge said.
In addition, students from low-income families often rely on programs like Medicaid, and federal and state partnerships like the Vaccines for Children Program, to get low-cost or free immunizations. But those programs can only administer vaccines recommended by the CDC, Hodge said. That means schools that serve large populations of students from low-income families will have to figure out what to do if those kids can’t get state-mandated vaccines.
Even when students are granted exemptions from vaccines, many states require unvaccinated students to stay home from school if there are outbreaks of certain diseases, like measles, spreading in the school, said Hodge.
What can schools do to help?
Although schools don’t have much power to influence federal vaccine recommendations, they can take some steps to encourage families to get their children immunized, said Nelson.
“School nurses work really hard to get good information out there to provide education to parents,” she said. “We also have schools, that for various reasons, don’t necessarily exclude children ... because they’re not up to date on their vaccines. That’s something we can do in schools—we can really pay attention to that and allocate the resources needed.”
That may mean allocating additional staff time or resources to help check students’ vaccine records at the beginning of the school year and having a plan for reaching out to families who are out of compliance, Nelson said. This has become a bigger issue for schools because childhood vaccination rates have been declining since the pandemic.
Nelson and other public-health experts worry that giving anti-vaccination advocates a platform like ACIP will only confuse parents and other adults and lead to greater vaccine hesitancy.
“It’s just increasing vaccine skepticism because it’s confusing the public, it’s confusing the practitioners,” said Tina Tan, a pediatric infectious disease physician at the Ann & Robert Lurie Children’s Hospital in Chicago and a professor at the Northwestern University Feinberg School of Medicine.
Some of the common anti-vaccination claims that Tan hears are: “‘They’re not worth getting, or it’s better to get the natural disease than to get a vaccine.’ It’s just stuff that we have proven, time and time and time again, that the vaccines that we use are safe and very effective.”
The vaccine-preventable diseases have very series health consequences, said Tan.
Measles—for which cases are on the rise in the United States, including a large outbreak in Texas—can cause deafness, blindness, and even lead to permanent neurologic deficits, she said. Pertussis, or whooping cough, can get so bad it causes rib fractures and eardrum ruptures, in addition to long-term respiratory issues.
“Medicine is not politics,” Tan said. “And everything now has become politicized.”
