Dr. Rosenthal is the editor in chief of Kaiser Health News. She was an emergency room physician before becoming a journalist.
The rapid spread of Omicron across the nation — and the finding that vaccines continue to provide strong protection against severe disease — brings Covid-19 one step closer, perhaps, to truly earning its place on the list of diseases that have been tamed by vaccines. These include polio, measles, mumps, rubella,and chickenpox, all of which most kids must generally be vaccinated against before they enter school or day care. Some states have announced Covid vaccine requirements for some students.
Unfortunately, not everyone agrees that vaccine mandates for children are the way forward. Senator Rand Paul, who has opposed vaccine mandates, called Omicron “nature’s vaccine.” Seventeen mostly Republican-led states have proactively banned, in some form, Covid vaccine requirements for students. This resistance to adopt mandates is a problem, especially as vaccination rates among kids ages 5 to 11 are still alarmingly low — under 15 percent in some states — even though children 5 and over have been eligible since last fall.
History holds lessons for why low vaccination rates for children are so risky and why we should strongly consider school mandates for the Covid vaccine.
In the United States, children generally must get a number of vaccines before they enter school in part because requirements are the best way to ensure an entire generation gets their shots.
Many of the diseases we no longer fear (thanks to vaccination) were terrifying for decades — sometimes centuries — especially when they arrived in a place that was immunologically “naïve,” showing up in bodies that hadn’t seen them before. That’s the devastating place we were with Covid-19 in early 2020.
When explorers brought diseases like measles, which had long been on the European continent, to Native populations of the New World, they killed up to an estimated 80 percent to 95 percent of the Indigenous population in repeated outbreaks over the next 100 to 150 years. When global travel become more available, the king and queen of Hawaii arrived in England in 1824 and both died there of measles. The virus came back to Hawaii in 1848 and started an epidemic that killed one quarter of the Native population by one estimate, then flared to create additional waves that killed more people in the following decades.
Even after vaccines were invented and diseases like measles and chickenpox were no longer common (and not medically dangerous for the average child), the United States continued to mandate school vaccination for different but important reasons.
We vaccinate against chickenpox and measles in part because they can be more deadly for adults, for the immunocompromised and for babies, whose immune systems are still developing. Like Covid.
We vaccinate against mumps, in itself usually a mild disease, because some who get it will suffer serious lasting effects, such as infertility in males who’ve passed puberty and hearing loss. You can draw parallels here with “long Covid,” and we still don’t know about the long-term effects of the coronavirus, which can inflame organs.
Also, kids with chickenpox require miserable prolonged isolation at home. And we vaccinate against this virus — and measles — because once there’s an outbreak at a school, it can cause significant disruption if vaccination rates are low, as contact tracing and other public health measures are put in place.
Just like the coronavirus now.
We could get lucky and achieve more widespread immunity for Covid-19 relatively quickly, after new waves become less and less overwhelming. But even if this does happen, many unvaccinated people will die or get seriously ill and some kids will miss school when they didn’t need to. New, potentially more dangerous strains have a better chance to emerge. Do we really want to roll the dice and not take full advantage of this very effective tool that we have at our disposal?
Which path do we want to take to put the pandemic behind us: the quicker, more certain one of mandatory vaccination or a potentially stuttering, drawn-out affair?
Unfortunately, the Covid vaccines landed at a time of deep national divides, when science has become politicized and mistrust of government is high. Even many parents who get their children required shots are balking at this one. States and school districts that have announced plans for school vaccination requirements already face backlash.
This is different from how the public reacted to the introduction of many childhood vaccines in the 20th century. People reacted enthusiastically to the availability in 1955 of the vaccine against polio, a disease that could have disastrous health consequences, but — like Covid — was asymptomatic or mild in a majority of people who were infected, particularly children. The hesitancy that did exist was not driven by the same intense partisanship and political division of today.
It may be that one of the keys to that era’s enthusiasm for a new shot was that Americans had lived through fearsome polio outbreaks and the attendant quarantines through much of the mid-20th century. By 1955, many Americans knew someone who had perished from polio or was left partly paralyzed. People have lived with Covid-19 for a relatively short amount of time.
Resistance to the Covid vaccine will perhaps dissipate once the Food and Drug Administration moves the shot for children from emergency use authorization to full approval and as waves of Covid affect more Americans.
Here’s how my thinking about another vaccine was affected a generation ago: My older child got chickenpox before the shot was available and spent hours in oatmeal baths covered with hundreds of itchy blisters. She couldn’t return to preschool (nor I to work) for 10 days, until her blisters scabbed over; some scars took years to fade.
So when the chickenpox vaccine came to market in 1995, I raced to get my 2-year-old the shot. He still got chickenpox, but a mild case, just like most breakthrough Covid: One evening while he was playing, I noticed two telltale blisters on his upper arm that disappeared within 24 hours. He didn’t miss a single play date.
Like many childhood vaccines, that shot protected him, our family, my work, our caregiver, his toddler classes, his grandmother and all the vulnerable people we had come in contact with at the market or on the subway. If we want to bring this pandemic to a rapid denouement, vaccinating schoolchildren can have the same ripple effect and may well be the best way to go.
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