Student Well-Being Q&A

Why School Vaccinations Are So Fraught, According to an Infectious Disease Specialist

By Elizabeth Heubeck — August 11, 2023 4 min read
Students make their way into Angeline Academy of Innovation for the first day of classes on Aug. 10, 2023 in Land O' Lakes, Fla.
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School vaccination requirements have a long history in the United States. Starting in 1827, school-age children in Boston had to show proof of smallpox vaccination in order to attend school, a policy that took hold in other states beginning in the 1850s. In 1922, a landmark decision by the U.S. Supreme Court held that public schools could exclude students who were unvaccinated from attending.

Given their lengthy history, it would seem that back-to-school vaccinations have become a routine practice, whether required or not. But factors like emerging and mutating virus strains, vaccine resistance, and shortages of health professionals who can effectively educate families on their importance and track students’ vaccination status create a fluid set of circumstances that requires constant vigilance.

To learn more about the protections and pitfalls associated with vaccinations as students return to school, Education Week spoke with Sean O’Leary, professor of pediatrics-infectious diseases at the University of Colorado Anschutz Medical Campus and chair of the Committee on Infectious Diseases for the American Academy of Pediatrics.

The interview has been edited for length and clarity.

The COVID-19 vaccine this February was added to the Center for Disease Control and Prevention’s recommended childhood immunization schedule. But the vaccine is banned from being included in school mandates in at least 20 states. Thoughts?

Sean O'Leary

COVID-19 got politicized in the [United States] very early on in the pandemic. Part of it was due to the misinformation and disinformation engines fueled by myths circulating online that revved up before the vaccine was made available to the public. Those [bans] are political maneuvers that are not using a public health lens. But vaccine resistance isn’t new. There was resistance to the flu vaccine well before COVID vaccine resistance.

Can you elaborate on this?

Emotional resistance to flu vaccines predates COVID. About 50 to 60 percent of children get the flu vaccine compared to most other recommended [childhood] vaccines, whose rates are well north of 90 percent. There are a lot of myths around the flu vaccine: that it can give you the flu, that it doesn’t work. These [myths] have circulated for decades. Some of them have some basis in truth. The flu vaccine, in a good year, is about 50 percent effective. It’s not a perfect vaccine, but it’s a good one. It allows us to prevent thousands of hospitalizations and deaths. So on an individual level, you can get vaccinated and still get the flu, although in general it will be a milder case. Even though the flu vaccine is recommended, historically it hasn’t been required in schools.

There’s a new [COVID] vaccine coming out soon to target the XBB variants most commonly circulating now. Should parents wait for this new vaccine or go ahead with the existing one?

Yes, we’re waiting for a new, updated [COVID-19] vaccine and we’re hearing that it will be available later in September or October. For kids with high-risk conditions, they need to stay up to date on their [COVID] vaccines no matter what. For healthy school-age kids, it wouldn’t be unreasonable to wait for the new product to come out. But if it’s a matter of parents thinking, ‘We’re going to be busy later, we might not have time to get it,’ then we advise them to get what’s available now.

The national measles, mumps, and rubella vaccination rate among kindergarten students recently fell below the target of 95 percent, the level needed to prevent community transmission. Why?

Issues with these vaccination rates [for which the most recent data applies to the end of the 2020-21 school year] are really multifactorial. There was an initial hit from the pandemic, with people not going to the doctor. During the pandemic, [pediatric] clinics limited their hours for well visits. So we’ve been playing catch up.

As recently as 2019, we’ve seen how outbreaks of infectious diseases like measles, previously eliminated as a public health threat, can occur—especially in communities with high percentages of unvaccinated residents. Thoughts on this?

We’re probably in a worse position now [than in the 2019 outbreak]. What protected us from a nationwide outbreak in 2019 was the high vaccination rates in surrounding communities and an effective public health response. A lot of us [public health professionals] are concerned about an outbreak of measles, a highly contagious disease. Making sure kids are up to date on routine vaccines and flu vaccines is critical.

What’s the best way for schools to ensure that their students are getting recommended and required vaccines?

For schools, consistent positive messages is key; so is having everyone [on staff] on the same page regarding the importance of childhood vaccines for keeping kids in school and protecting entire communities.

Who should be responsible for vaccine messaging and tracking within schools?

School nurses are very knowledgeable about vaccines, and often lead the charge. If you have a full-time nurse in a school, it tends to have a higher vaccination rate than those that don’t. School nurses are powerful messengers. But unfortunately, school nurses are very underfunded. Many schools don’t have them. A lot of folks who end up handling [vaccination] records aren’t necessarily medical professionals.

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