The Washington PostDemocracy Dies in Darkness

The Health 202: States are largely silent on school mandates for the covid vaccine

with Paige Winfield Cunningham

Kids coming back to school this fall will need to be vaccinated against diphtheria, measles, pertussis, tetanus, mumps, rubella, chickenpox and polio. In 17 states and D.C., they need a hepatitis A vaccine. Hawaii, Rhode Island, Virginia and D.C. also require a vaccine against the human papillomavirus.

But there’s one glaring absence from this litany of required vaccinations: a coronavirus vaccine.

No state is requiring kids to get a shot against the coronavirus, whose threat to kids has been hotly debated even as it has killed more than 600,000 people in the United States, the vast majority of them older adults. Coronavirus vaccines have been authorized for emergency use in children 12 and older since May, and trials for younger children are ongoing.

States have remained largely silent on mandating coronavirus vaccines for schoolchildren as hospitals, nursing homes and businesses have ramped up vaccine mandates for workers in recent weeks. New York City will require all teachers to get vaccinated or undergo weekly testing but the city mandate does not extend to kids.

Experts say it’s not because the coronavirus is less of a threat than other diseases we routinely vaccinate against in schools, but instead a reflection of how divided the nation has become on the coronavirus.

Measles used to kill 500 Americans each year before vaccines were availably. That’s more than the roughly 400 children who have died of covid-19 since January 2020, but its in the same ballpark. Chickenpox used to kill around 100 people a year — far less than the toll from covid-19.

As school starts back up, most American kids remain unvaccinated.

Some 39 percent of adolescents between the ages of 16 and 17 and only 28 percent of kids between the ages of 12 and 15 are fully vaccinated from the coronavirus, according to CDC data. In comparison, the vaccination rate for seniors sits around 80 percent.

And there’s a committed share of families who don’t plan on getting a vaccine anytime soon: About one-quarter of parents who have a child between the ages of 12 and 17 say they will not vaccinate their kid. About 1 in 5 parents say they want to wait and see, a recent Kaiser Family Foundation poll found

Some public health experts say vaccine mandates are necessary.

Paul A. Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, says that the combination of the more contagious delta variant, the approach of colder weather in which respiratory viruses flourish, and under-vaccination of the American public could have disastrous outcomes.

He warned that schools could be more dangerous this winter than last winter, given the laws in some states banning them from requiring masks.

“It’s a situation ripe for outbreak,” Offit said. “One way to lessen or mitigate that disaster is to vaccinate.”

And while the coronavirus is far less deadly to children than adults, Offit points out that millions of children have been infected with the virus, tens of thousands have been hospitalized and roughly 1 in 1,000 infected kids suffer from a multisystem inflammatory syndrome that can have long-term consequences.

Offit argues school vaccine mandates are necessary to protect both children and adults.

“This affects everybody. This is not a personal choice. This is a choice that people are making for everybody, or in this case, which parents are making for their children, which affects everybody,” he said.

Deciding which vaccines to require usually happens at the state level.

In most states, the legislature determines what vaccines will be added to the school vaccine schedule. In some, state lawmakers have delegated that authority to the health department.

Public school districts do not have the authority to make their own vaccine mandates for students. And cities in general do not either, apart from New York. (A 2018 court decision determined that New York City officials could require the flu vaccine in daycares and preschools.)

Private schools have more leeway in mandating vaccines that aren’t part of the state requirements. At least two elite Connecticut boarding schools and a secular private school in Connecticut have notified families that being vaccinated against the coronavirus will be a condition of enrollment, the Connecticut Post reported.

School districts do however have more autonomy over masks, although some states, including Texas, have prohibited schools from requiring them. In other states, school mask mandates have sparked heated political debates.

But mandating the coronavirus vaccine in public schools would be politically tricky. 

The fact that the school vaccine requirements against the coronavirus would need to pass through the state legislature means many conservative-leaning states are unlikely to see them soon — if ever. 

“There’s less and less reason to think these mandates are even going to be possible in states that are not dominated by Democrats politically,” said Mark Navin, a professor of philosophy at Oakland University in Rochester, Mich. who has spent years researching the battles between anti- and pro-vaccine camps when it comes to childhood immunizations in school.

Even in politically blue states, lawmakers seem reluctant to take immediate action. Dorit Rubinstein Reiss, a public health law professor at the University of California Hastings College of the Law, says she thinks states are holding off on what could be a contentious political fight until they have full emergency use approval for children under the age of 12.

“Nobody is moving yet, and I think they will wait for vaccines to be approved for the full age group,” said Reiss.

Ahh, oof and ouch

AHH: Biden says federal workers must get vaccinated or face new restrictions.

Those who opt not to get vaccinated won't be fired, but they will be required to wear a mask at work, physically distance from other employees and visitors, and undergo weekly or twice-weekly testing. The directive, which applies to federal employees and contractors both in the United States and overseas, will affect more than 4 million Americans, The Post’s Annie Linskey, John Wagner and Seung Min Kim report.

“People are dying, and will die, who don’t have to die,” President Biden said on July 29, calling on unvaccinated Americans to get vaccinated against covid-19. (Video: The Washington Post)

“After months and months of cases going down, we’re seeing a spike in covid cases. ... Why? Because of this new form, this new variant called the delta variant,” Biden said in remarks at the White House in which he described the new restrictions.

In a separate push, the Treasury Department said Biden “is calling on state, territorial, and local governments to provide $100 payments for every newly vaccinated American, as an extra incentive to boost vaccination rates, protect communities, and save lives.”

OOF: An internal CDC document strikes an urgent tone on the ongoing threat of the coronavirus.

It warns that the delta variant of the coronavirus appears to cause more severe illness and spreads as easily as chickenpox, The Post’s Yasmeen Abutaleb, Carolyn Y. Johnson and Joel Achenbach report

The document, a slide presentation shared with the CDC and obtained by The Washington Post, argues that officials must “acknowledge the war has changed.”

In a phone briefing with reporters, CDC Director Rochelle Walensky on July 27 urged vaccinated people to wear masks indoors in some cases, including in schools. (Video: The Washington Post, Photo: Brendan McDermid/The Washington Post)

“It cites a combination of recently obtained, still-unpublished data from outbreak investigations and outside studies showing that vaccinated individuals infected with delta may be able to transmit the virus as easily as those who are unvaccinated. Vaccinated people infected with delta have measurable viral loads similar to those who are unvaccinated and infected with the variant,” our colleagues report.

That data played a key role in spurring the CDC to issue revised guidelines calling for use of masks indoors by both vaccinated and unvaccinated people in coronavirus hot spots.

“I finished reading it significantly more concerned than when I began,” Robert Wachter, chairman of the Department of Medicine at the University of California at San Francisco, wrote in an email to The Post.

OUCH: D.C. is reinstating indoor mask mandates starting Saturday.

The move comes as cases have risen sharply in the District in recent weeks. Earlier this week, the CDC asked people in localities with more than 50 new cases per 100,000 residents per week, including D.C., to wear masks again indoors.

The order, which will apply to both vaccinated and unvaccinated people over the age of 2, will allow an exception for eating indoors in a restaurant but not for exercising at a gym or working in an office building, The Post's Julie Zauzmer and Karina Elwood report.

D.C. joins a growing list of major metropolitan areas reestablishing indoor mask mandates. Sacramento County also issued an indoor mask mandate on Thursday. Los Angeles County reinstated its mandate earlier this month. New York City officials have said that they plan to release new guidance on indoor masking early next week.

More in coronavirus news

The FDA is letting a troubled vaccine factory restart production. 

The agency gave Emergent BioSolutions the green light to resume manufacturing the Johnson & Johnson coronavirus vaccine. The Baltimore facility was shut down in April by the Food and Drug Administration after contamination problems forced it to trash the equivalent of tens of millions of doses of the Johnson & Johnson vaccine.

“The company still does not have full FDA approval that would allow any bulk vaccine produced there to be distributed in the United States without additional reviews, but the company called the restart an important step toward getting the only domestic source of Johnson & Johnson’s single-shot vaccine back on track,” The Post’s Christopher Rowland reports

Elsewhere in health care

A Pfizer court case could have big implications for pharma marketing.

A federal case in the Southern District of New York could determine the future of a controversial practice on the part of drug companies.

Pfizer is seeking a judge’s permission to reimburse patient co-pays for heart medications that cost nearly a quarter of a million dollars per year, Kaiser Health News's Jay Hancock reports

If approved, the move would legitimize a practice over which the company has settled with the government for millions of dollars in the past: paying the patient portion for prohibitively expensive drugs, the price of which the company itself has set, and then collecting the Medicare co-pays at taxpayers' expense.

The company says it is just trying to help patients. Critics see it as an attempt to milk money from the public coffers. “If this is legal for Pfizer, Pfizer will not be the only pharmaceutical company to use this, and there will effectively be a gold rush,” government lawyer Jacob Lillywhite said in oral arguments last month.

If approved, the move would legitimize a practice over which the company has settled with the government for millions of dollars in the past: paying the patient portion for prohibitively expensive drugs, the price of which the company itself has set, thereby removing one of the only barriers to price hikes that come at the taxpayer's expense.

Sugar rush