Should Schools Require COVID Vaccine? Many experts say it is too early.

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(LA Johnson / NPR)

Vaccination of children aged 5 to 11 against COVID-19 is well advanced: the White House announced last week that about 10% of children in this age group have received their first vaccine.

California became the first state to announce that it will add this vaccine to its list of required vaccines for all school children. And a handful of districts in 14 states are taking similar steps, starting with mandates for student-athletes to participate in sports.

Because almost all children go to school, the vaccination warrants have been particularly effective against diseases such as smallpox, polio, pertussis and, more recently, chickenpox. But school mandates have also always led to a setback – and that has escalated to a new level in the 21st century.

“Vaccines have been controversial since the very first vaccine was developed against smallpox,” says Elena Conis, medical historian at the University of California at Berkeley. “And vaccination became more and more controversial when states began to make it mandatory. “

Here’s a whirlwind tour of the past, present and future of immunization mandates, with a few surprises along the way.

1. The first compulsory school vaccines date back more than 200 years

1796: English doctor Edward Jenner successfully vaccinates a child named James Phipps with pus taken from a cowpox pustule.  The principle dates back centuries to the traditional practice of smallpox in Central Asia, India, China and Africa.  1818: The first known school vaccine warrant comes from the King of Wittenberg, Germany.
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In 1818, the King of Wittenberg in east-central Germany issued what appears to have been the first compulsory school vaccination against smallpox. The king decreed: “No one should be received in a school, college or charity; be an apprentice linked to any trade; or hold a public office, which has not been vaccinated. In 1827, Boston became the first city in the United States to do the same. As the country became more urban in the late 19th century, the need for vaccines increased and smallpox death rates fell.

2. The first vaccine mandates gave birth to the first anti-vaccinators.

Since there have been vaccines, there have been people who oppose them (formerly known as "anti-vaccination"1885: Up to 100,000 people demonstrate against vaccination in Leicester, England.  They hang Edward Jenner in effigy.
(LA Johnson / NPR)

In 1882, the Anti-Vaccination League of America held its first meeting in New York. Among the false claims made by speakers at the meeting was the idea that smallpox is spread by dirt, not germs. Just as they do today, 19th century anti-vaccinations professed doubt in science, faith in religion, and zeal for personal freedom. They have made common cause with a range of other groups outside of the mainstream, such as temperance advocates, vegetarians, homeopaths, phrenologists and palm readers. They defended unfounded alternatives to vaccination, such as homeopathic remedies; and made false claims, such as the vaccines caused the eczema.

Conis points out that there were actual cases of vaccine injuries in the 19th century which contributed to doubts: called arm-to-arm, “where a person’s ampoule from the vaccination would be used to vaccinate the person. next. “And these two methods could sometimes transmit other infections, like tetanus and syphilis.”

3. The Supreme Court upheld school vaccination warrants a century ago.

Key U.S. Supreme Court decision on school vaccination warrants came in the 1922 case Zucht against the king. “The court was very clear: this is not a violation of liberty,” said James Hodge, Arizona State University law professor and member of the Network for Public Health Law. “It is not a constitutional question. States and localities can impose school vaccination requirements, period. And as a result, we’ve obviously seen over 80 years of schools doing just that thanks to state law. Hodge has been following legal challenges to COVID vaccine warrants.

4. The polio vaccine was not compulsory for years after its introduction in 1955.

1955: Jonas Salk introduces his polio vaccine after a field trial involving 2 million children, conducted in public schools.  But the first mass vaccination program in the United States had to be interrupted when a laboratory error caused the injection of a live virus into 200,000 children.  The "Cutting incident" leads to effective federal vaccine regulation, but mistrust persists.
(LA Johnson / NPR)

“When the polio vaccine was first approved, lots of people came and got it for themselves, for their children,” says Conis. “And it took several years before states even considered mandating this vaccine for children. “

5. Since 1979, Mississippi has prohibited religious and personal belief exemptions from school vaccination warrants, and the state has highest rate of childhood vaccinations in the USA

West Virginia has also allowed only medical exemptions since passing its first statewide mandatory vaccination law in 1905. California, Connecticut, Maine, and New York have Followed suit in the 2010s, eliminating non-medical exemptions in response to measles outbreaks that followed an increase in the number of people choosing not to be vaccinated.

6. In 1980, 28,000 students in New York City were expelled from school after failing to get the measles vaccine.

It was one thing to put state laws on the books requiring vaccinations; it was another thing for schools to enforce them. In 1977, during a measles outbreak in Los Angeles, it was estimated that only two-thirds of low-income children nationwide were actually vaccinated against the disease. Excluding children from school, as New York City did, was a last resort. Throughout the second half of the 20th century, epidemics in turn led to repressive measures on the one hand and public vaccination campaigns on the other.

7. The World Health Organization named “vaccine hesitancy” as one of the 10 most notable threats to global health – in 2019.

1998: Andrew Wakefield publishes a notoriously flawed article raising questions about a link between autism and the MMR vaccine.  2010: The article is withdrawn due to erroneous data and Wakefield, who also has undisclosed financial interests, is banned from practicing medicine.  Yet vaccine refusal is growing, in part thanks to misinformation and conspiracy theories.
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While opposition to vaccine warrants is as old as the warrants themselves, researchers agree that the 21st century movement has been different. This is in part because of the ease of spreading misinformation on social media. It is also partly because of the emotional weight of the opposition, argues Dorit Reiss, professor at Hastings College of Law at the University of California.

“Parents of autistic children have been drawn into the anti-vaccine movement. The anti-vaccine movement offered their support, offered them an explanation of how their children got autistic, offered them cures – bogus cures, but cures, ”Reiss says. “It created a very strong grassroots group of people who passionately believed it was vaccines. [that caused their children’s autism], and the movement has become more organized, more institutionalized.

8. Adding new vaccines to the list of school mandates has proven difficult in the 21st century.

All 50 states currently require schoolchildren to be vaccinated against polio, MMR (measles, mumps and rubella), Tdap (tetanus, diphtheria, pertussis) and chickenpox. Chickenpox (chickenpox) is the most recent, making the list in the early 2000s, according to the Immunization Action Coalition.

But only a handful of states require rotavirus, flu, or HPV vaccines for school. Due to its association with sexual activity, the HPV vaccine has been particularly controversial. “One of the last vaccines we tried to force on children was the HPV vaccine,” says Elena Conis at Berkeley. “It didn’t go so well. And we’re in a much more polarized time when it comes to immunization now than we did back then. “

9. In light of history, especially recent history, many public health experts and vaccine historians say it is not yet time to mandate school vaccines for COVID.

“I would say that in the next three to six months, encouraging a self-directed push to get people to immunize their children is probably what will help it not to be so ‘in line in the sand’,” says Dr Stella Safo. , founder of Just Equity for Health, a New York-based healthcare company focused on providing equitable care. “And then I think at the end of the day, just like we demanded that you have to be vaccinated against chickenpox before you can go to school, I think COVID will eventually be added to that portfolio.”

Coronavirus 2020 and vaccines in schools The COVID-19 pandemic is causing many children to miss basic vaccines.  And that stirs up anti-vaccination sentiment.
(LA Johnson / NPR)

“My view is always that terms are premature,” says Reiss. “But I want to be clear… I’m making my recommendation a bit from the Ivory Tower, and people on the ground can have a very different perspective.”

“I don’t think it would be a good time to [mandate the COVID vaccine at a state level], especially if we look at the context of the entire pandemic, ”says Dr. Thomas Dobbs, Mississippi public health official. “Patients trust their own doctors more than anyone else and especially where we are right now in the pandemic, this is the best place for this conversation.”

Copyright 2021 NPR. To learn more, visit https://www.npr.org.


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