When California Gov. Gavin Newsom, a Democrat, announced a first-in-the-nation statewide mandate for students to be vaccinated against COVID-19, it set off conversations about whether other states will soon follow.
One key detail in California’s new rule, issued Friday: Families can more easily opt their children out of its COVID-19 vaccine requirement than existing state rules that require vaccines for routine illnesses, like measles, as a condition of school attendance.
Another catch: The COVID-19 vaccine mandate won’t kick in right away. Rather, age groups will be phased in as vaccines win full approval from the Food and Drug Administration, which means the requirement would not be in place for older students until around July 2022, after the current school year is over.
Here’s what school leaders should know about what’s happening in California—and what it says about the debates ahead.
In student vaccine requirements, details matter
Newsom pitched his new mandate as adding COVID-19 to the list of routine vaccinations students must get under state law, but it will function a bit differently, potentially leading to higher opt-out rates.
As Education Week reported recently, California has one of the strongest pre-pandemic school vaccine laws in the country. After years of amendments by state lawmakers, in part triggered by a 2015 measles outbreak linked to Disneyland, the state does not provide religious or “philosophical” waivers from requirements for vaccines including measles, mumps, and rubella.
Aside from vaccines explicitly listed in state law, California code allows state and school officials to require other vaccines for other diseases, following recommendations from federal agencies. But those requirements must allow “personal belief exemptions.”
So, unless the state’s legislature votes to include COVID-19 in the state vaccine law, families will be able to bypass the rule for broad ideological reasons.
That may be a concern in some communities, where vaccine skepticism is higher. In the affluent Bay Area community of Marin County, for example, as many as 7.6 percent of families claimed personal belief exemptions from routine shots— more than twice the state average—before lawmakers eliminated the option in 2015.
Nationwide, rates of COVID-19 vaccination for teenagers have lagged behind other age groups, and some parents have expressed hesitation. In an August poll by the Kaiser Family Foundation, 23 percent of parents of children ages 12-15, who are currently eligible for the vaccine, said they would “wait and see” before getting them vaccinated. Twenty percent said they would “definitely not” get their children vaccinated for COVID-19.
Those parents may be more likely to take advantage of loopholes in state vaccine requirements.
As we reported recently, many states prohibit schools from setting such vaccine requirements for COVID-19 specifically.
And routine school vaccination laws vary: Fifteen states allow parents to opt their children out of the mandates for philosophical reasons, according to the National Conference of State Legislatures. That process is sometimes as easy as signing a piece of paper without listing any specific ideological objection. Forty-four states allow exemptions for religious reasons, which can be broadly applied.
In the states with more restrictive current laws, like California, the strength of new COVID-19 mandates may depend on the latitude state leaders have to add new diseases to the list of covered illnesses.
Full FDA approval may trigger more student vaccine mandates
Initially, the three COVID-19 vaccines in use in the United States were administered under an emergency use authorization from the Food and Drug Administration.
When the agency granted full approval to the Pfizer-BioNTech vaccine for patients ages 16 and older in August, it set off a domino effect of vaccine mandates for workers around the country.
Some public health officials have suggested full approval of vaccines for younger children may set off a similar reaction. And some governors have suggested they won’t even consider adding COVID-19 to school vaccine requirements until that full approval is in place for all age groups.
Students as young as 12 can voluntarily receive the vaccine under the emergency use authorization. And the FDA is expected to grant a similar authorization for children as young as 5 in the next month or two.
California’s mandate is conditional on full approval for two age cohorts. Both private and public students in 7th through 12th grades will be required to get the vaccine the semester after it wins full approval for their age group. Students in kindergarten through 6th grade will follow when federal authorizers grant full approval for their age group later.
Practically speaking, that means the new rule won’t likely take full effect until the 2022-23 school year.
How quickly students are vaccinated in other states may depend on if leaders wait for full approval and how soon after any future mandates take effect.
Many states won’t follow California’s lead
As debates over school mask mandates have demonstrated, state leaders have very different viewpoints on the risk posed by COVID-19 and whether to prioritize collective health requirements or personal freedom in setting policy.
It’s likely that student vaccination mandates will also vary from state to state.
Some states have already banned student COVID-19 vaccine mandates, or required full FDA approval before they can be implemented. Others may leave it up to individual school systems to set student vaccination policies, following the lead of districts like Los Angeles that already require the COVID-19 vaccine for older students, or others that have made it a condition of playing school sports.
In a sign that California may have more of an appetite for broad statewide orders, Newsom recently survived a recall attempt that was pitched in part as a referendum onhis virus response.
Dr. Bob Wachter, chair of the University of California, San Francisco’s department of medicine, quickly noted the connection after Newsom’s announcement Friday.