When the school board in Wappingers Falls, New York convened its regularly scheduled Zoom meeting in mid-October, the agenda included a hotly contentious vote. The board’s Legislative Action Committee had drafted a letter addressed to Governor Kathy Hochul “strongly objecting” to any legislation that would require students to be vaccinated against COVID-19. Members of the school board in Wappingers – a town of 6,000 in Duchess county – were intent on heading off a pair of bill proposals in the New York Legislature that seek to include COVID-19 on the list of diseases children must be inoculated against before enrolling in school. Before the vote, a school-board secretary read comments from parents in support of the letter.
“It is criminal to inject children with a vaccine that’s still in testing mode,” wrote one parent. “We will absolutely be pulling our child out of the district if this vaccine is mandated,” wrote the mother of another student. A third seemed to level a threat: “Vaccine manufacturers may have immunity from liability for adverse effects … are you sure those who comprise the school board are so immune?”
Almost all of the commenters said they would not be vaccinating their children, occasionally bolstering their arguments with dubious information about side effects. (Later, school-board member Keri Cahill falsely claimed the COVID-19 vaccine approved for children is different than other vaccines required by schools because it caused “death and injury to the young population.”) All told, the secretary read 22 comments from parents who wanted the board to send the letter to Hochul and just one parent who opposed it. Despite the lopsided tally, the Wappingers board ultimately voted 6-3 against, justifying their decision by saying preemptively advising the governor on a matter of public health was outside of the board’s purview.
Ten days after the Wappingers school-board vote, the FDA approved emergency use of Pfizer-BioNTech’s vaccine in school-age children, stoking debates about school-vaccine requirements across the nation. In Seattle, the school board is considering a resolution to push for a statewide mandate, and Maine’s CDC is weighing a statewide requirement. California is the only state in the country to have instituted a mandate (pending full FDA approval) for K–12 students, but school boards there are already toying with the idea of defying Governor Gavin Newsom’s order. Illinois governor J.B. Pritzker issued an executive order in August requiring all students in higher education to be vaccinated.
But the number of states enacting school requirements pales in comparison with those that have preemptively banned mandates. Florida became the 17th state to prohibit any legislation that would mandate school vaccinations against COVID after lawmakers in Tallahassee voted in favor of a measure on Wednesday, according to the National Academy for State Health Policy.
The debate over mandates is heating up just as the number of cases, including pediatric ones, across the country rise: The latest report from the American Academy of Pediatrics showed a 22 percent increase in cases nationwide from two weeks earlier. Children are far less likely to be hospitalized because of COVID-19 than adults, and just over 700 people under the age of 18 have died from the disease in the U.S. Though studies conducted early in the pandemic suggested children might not be infected or spread the disease as easily as adults, more recent studies say otherwise.
State laws regarding school-vaccination requirements vary. Alabama, for example, is the only state that doesn’t require vaccination against hepatitis B. Six states and New York City require students to be vaccinated for influenza. (A 2014 study found that flu-vaccine requirements might have helped increase vaccination rates and decreased morbidity in Connecticut.) All states allow medical exemptions to vaccination and 44 allow religious exemptions.
Historically, school-vaccination requirements have played a vital role in stemming public-health crises, systematically nudging parents who had been hesitant, skeptical, or negligent. And for as long as mandates have existed, anti-vaxxers have strongly opposed them: The Anti-Vaccination Society of America held its first meeting in New York in 1882. But most school-vaccine requirements were instituted years after the vaccines were fully approved, allowing time for the general public to become more comfortable with them.
As far as a COVID vaccine goes, an October poll by the Kaiser Family Foundation found that parents of 5- to 11-year-olds were evenly divided into three groups: one-third were eager to vaccinate their children; one-third were hesitant and wanted more time to see how the vaccine worked; and one-third were flatly opposed to vaccinating their children. Those numbers are why some public-health experts say that pursuing a mandate before a COVID-19 vaccine receives full FDA approval may do more harm than good.
“From a public-health perspective, I do think that premature discussion and preparation of legislation for vaccine mandates for schoolchildren could result in a backlash,” said Dr. William Moss, executive director of the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health. While COVID-19 can pose a threat to children, it doesn’t rise to the level of smallpox, polio, or diphtheria. Further, phase-three trials of Pfizer’s vaccine for 5- to 11-year-olds were relatively small and more time might be needed to build trust among wary parents, according to Moss.
“I don’t think it’s unreasonable for parents to want to wait for information in that age group,” Moss said, while noting that it’s possible that the risk of serious side effects like myocarditis may actually prove to be lower in children and teenagers than adults. “I see mandates two or three years from now. This virus is still going to be around then, but maybe it will be less politicized and polarized and COVID-19 vaccines can be added quietly to the list of currently required vaccines for schoolchildren.”
That didn’t stop New York assemblymember Jeffrey Dinowitz and State Senator Brad Hoylman from introducing school-mandate bills in their respective chambers. Dinowitz and Hoylman are used to taking on anti-vaxxers. In 2019, following measles outbreaks mostly concentrated in Orthodox Jewish communities, Dinowitz and Hoylman led a controversial campaign to repeal religious and philosophical exemptions for schoolkids. Then-Governor Andrew Cuomo signed their legislation into law, which, according to Dinowitz, caused vaccination rates to go up in schools.
Their COVID-vaccination bills won’t go to a vote until the FDA fully licenses a vaccine for children. Even then, any sort of mandate will likely be difficult to pass. “I do think the opponents of vaccinations, anti-vaxxers, while small in number, are very loud,” said Dinowitz. “Elected officials get nervous about that.”