A vaccine against the coronavirus that causes COVID-19 could be broadly available by late spring, and to some teachers in schools even sooner. But schools are already grappling with the problem of how to convince families to get their children immunized—not just against COVID-19, but other childhood diseases already at risk of dangerous outbreaks.
While the coronavirus pandemic has heightened schools' focus on infection spread and containment, educators can take a key leadership role in preventing new outbreaks by encouraging existing childhood immunizations and laying the groundwork for a future COVID-19 vaccine.
Regularly scheduled childhood immunizations are down--way down--since the pandemic started last spring, and disease experts warn that a host of childhood diseases, some more infectious and deadly to children than COVID-19, have fallen below the threshold for the protection of herd immunity. The Centers for Disease Control and Prevention reported in May that the number of measles immunizations given each week crashed from more than 2,000 before March to less than 300 through April. And this month, the Blue Cross Blue Shield Association of America, one of the nation's largest health insurance providers, reported that from January through September, childhood immunizations for DTaP (diptheria, tetanus, and acellular pertussis) and MMR (measles, mumps, and rubella) had dropped 26 percent, while polio vaccine administrations were down 16 percent compared to 2019. The health group noted that those immunization rates were below the herd immunity threshold for the diseases covered in both MMR and DTaP for both 2019 and 2020 and were close to the threshold for polio.
Vaccination rates in the United States are high and stable compared to other countries, but "they tend to be geographically clumpy, so that people who decline the vaccination tend to live in the same neighborhoods. And that makes them vulnerable," said Gretchen Chapman, a Rutgers University psychologist who studies how people make health decisions.
Experience from prior and ongoing outbreaks of measles and whooping cough suggest school leaders should not rely on legal requirements to ensure their students get immunized. The United States saw measles outbreaks confirmed in 31 states last year, with 1,282 cases—the highest number of cases since 1992 and a more than 10-fold jump in only two years. It prompted state legislatures to tighten personal belief waivers in state laws that let families opt out of vaccines for nonmedical and nonreligious reasons.
But studies found these legal changes may not have changed behavior. For example, when states stopped allowing waivers for immunizations based on personal or philosophical beliefs, there was a rise in the number of waivers requested for religious or medical reasons, and the overall numbers of those opting out of vaccines didn't change much. Saad Omer, professor of infectious diseases at the Yale School of Medicine and of epidemiology at the Yale School of Public Health, and colleagues found that while state vaccination mandates were associated with higher vaccination rates, social norms seemed to drive people's decisions to immunize their children more than legal requirements did. For existing vaccines, it's proven very difficult to change people's thoughts and feelings about whether vaccines are safe and beneficial. However, for a newly developed vaccine, providing information can help.
"This is an excellent opportunity to improve scientific literacy ... to talk to the students about, how did vaccines get developed? How do we know that they're effective? ... What does it mean that a vaccine is 95 percent effective?" Chapman said. "These are important concepts, and this might be an opportunity to help them understand how the process works."
Some studies have found that when schools and pediatricians alerted parents early and reminded them often about vaccine requirements, more parents got their children immunized and fewer requested vaccine waivers.
According to an analysis by Noel Brewer, a University of North Carolina psychologist who studies health decisions, and his colleagues, the most effective strategies encourage families without trying to change what they think, and most of these interventions fall most squarely in schools' wheelhouse:
That last may be both more difficult and more critical during the pandemic. Both the CDC and the Blue Cross study note that parents reported being concerned about bringing their children to a doctor's office for a flu shot or other immunization because of the risk of exposure to COVID-19. Many work- and school-based immunization clinics were cancelled or postponed during closures.
"People are more scared about infectious diseases in general right now, but you know, the countervailing forces are that given that there's a pandemic going on, it's a little bit harder to get [an immunization] and ... people may feel a little bit more reluctant about walking into a pharmacy or a doctor's office," Chapman said. Even schools that are operating remotely may benefit from providing an on-site immunization drive for students who are not up to date on vaccinations. When the Gardasil vaccine against the human papilloma virus was released, studies found parents were more likely to accept it for their children if pediatricians simply announced it as part of the normal schedule of vaccines, rather than asking parents if they wanted to add it.
"We still legally have to get the parents to sign the consent form, but we could do it in a participant way," Chapman said. "You know, 'Our school is doing COVID vaccinations on Thursday and Friday of this week, your child will receive a vaccine at school that day. Please sign and return this consent form by Wednesday.' That kind of message communicates this is a standard of care. Everyone's doing it; it's our standard policy. And of course, parents can contact the principal if they have questions and can decline to sign the consent form."
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