Pre-Collegiate Global Health Review
Evaluating a Secondary Education COVID-19 Vaccine Mandate
Avaneesh Babu, Broad Run High School & Academies of Loudoun, Leesburg, Virginia, USA
In a polarizing political climate that turned public health into a partisan battlefield, governments around the world are considering a COVID-19 vaccine mandate for children 12 through 18. With vaccine trials in children ages 12-15 resulting in 100% efficacy against symptomatic COVID-19, the answer is not completely reliant on medical utility but also includes personal belief and the boundaries between government power and citizens' rights (Pfizer, 2021).
The experts on this matter cite changing political zeitgeist as a reason for this development. In a 1978 poll, more than 90% of American parents stated that they would vaccinate their children despite no law requiring them to do so (Colgrove, 2006). At this point, vaccines were less developed than what we see today, but their effects were more noticeable in local communities, social circles, and the world stage. Whooping cough, a condition with over 260,000 cases in 1934, went down to a mere 1,010 with the introduction of a combined diphtheria, tetanus, and pertussis (DTP) vaccine (Center for Disease Control and Prevention, 1997). Families with children felt safer because they were being guarded against these deadly diseases and thus believed that the “doctor knows best.”
But now, we are decades removed from directly seeing these effects. This could, in part, be responsible for the belief that COVID-19 doesn’t meet the threshold to mandate a vaccine. Individuals believe that doing so sets a dangerous precedent of increased government involvement in private citizens’ affairs without a reason. Some cite the example of how ex-President Donald Trump declared a national emergency over immigration at the southern border to bypass legislation and free up spending for a wall (a campaign promise) as an example of such an executive overreach without a reasonable warrant (Moorthy, 2020a). The problem, they argue, is that the WHO does not create unchanging guidelines of what criteria mark a national emergency, and further that there are no laws requiring national leaders to comply with those guidelines (Moorthy, 2020b). Opponents to vaccine mandates also cite that children do not spread COVID-19 easily and thus do not constitute a valid vector for the virus. A French analysis of hospital admission indicated that almost half of total juvenile COVID-19 cases may be asymptomatic (Poline et al., 2020), and in a study published in Nature tracking ten million positive asymptomatic cases and their close contacts, there were zero instances of case spread (Cao et al., 2020). This could potentially indicate that most children don’t spread the virus enough to meet the threshold for a mandate.
However, new information regarding the latest strain of COVID-19, the Omicron variant, may change that view. As of January 1st, 2022, Omicron has had an unprecedented impact on children. From ages 12-15, the case spike was roughly 152% of the last one in September 2021, and from ages 16-17, it was roughly 160% of the last case spike in January 2021 (Center for Disease Control and Prevention, 2022). Furthermore, allowing children to go to school and other social areas without vaccinations may result in the creation of more dangerous variants. In a study analyzing the UK B.1.1.7 COVID-19 variant originating in the United Kingdom, the conclusion was that its higher transmission rate may be “largely attributable to an increase in transmission to and among school-age children” (Oosterhout et al., 2021). More and more of these variants are expected in the coming years, as COVID-19 is a virus that is highly susceptible to gene mutations, and “geographic separation tends to result in genetically distinct variants” (Bollinger and Ray, 2022).
Figure 1: Simulation of COVID-19 case numbers with new variants, and its effect in the context of childhood vaccination. Figure developed by averaging multiple models from the COVID-19 Scenario Modeling Hub (Nature, 2021).
If studies suggest that children are a vector for COVID-19 and could spread dangerous variants, meeting a plausible scientific threshold for a vaccine mandate, why might an objector be against one? According to experts in human behavior and interaction, the cause may be social. Anthropologist Elisa Janine Sobo, the author of Dynamics of Human Biodiversity, found that parents at a California school used vaccine refusal to build relationships with their community (Mendenhall, 2021a). It was seen as a bonding tool between neighbors and friends. Sociologist Jennifer Reich, a researcher at the University of Colorado at Denver, found that mothers who refused some vaccines gained approval from social networks through “informational, emotional, and appraisal” support (Mendenhall, 2021b). Parents in predominantly unvaccinated communities may feel pressured to refuse this vaccine mandate to feel accepted.
Another possible reason for refusal could be the effort involved in vaccination versus claiming an exemption, be it religious or philosophical. In an analysis determining whether the processes involved in claiming an exemption to state immunization had a role in the number of exemptions filed, the results showed that there was an “inverse correlation” between the complexity of an exemption process (paperwork, average time, etc.), and the number of exemptions filed (Rota et al., 2019). This means that the easier it was to attain an exemption, the more people got one as an alternative to getting a vaccine, which requires an appointment, scheduling, and traveling to and from the site.
As stated earlier, this hesitancy to take the COVID-19 vaccine can create a net negative effect in the world of public health. These children can possibly spread more dangerous variants like the UK B.1.1.7 variant which can cause the hospitalization of hundreds of thousands of people. Furthermore, the negative connotation associated with vaccination has ill effects on other, non-mandated vaccines. In an analysis of Germans who participated in a simulation where a vaccination became compulsory, the negative view of that vaccine impacted a participant’s willingness to take another recommended but non-compulsory inoculation (Betsch and Böhm, 2015). This could result in the proliferation of more preventable diseases and viruses.
In countries around the world, a vaccine mandate represents not only a dilemma in medicine but also in social understanding. Nations are plagued by polarization and partisan decision-making, and this divisive political climate may influence public opinions about vaccine mandates. However, during times of crisis, legislators must reach across the aisle and look towards science to come to a compromise to help our world as a whole through a secondary education vaccine mandate.
Betsch , C., Böhm, R. (2015, August 21). Detrimental effects of introducing partial compulsory vaccination: Experimental evidence. European journal of public health. Retrieved February 7, 2022, from https://pubmed.ncbi.nlm.nih.gov/26297722/
Bollinger, R., Ray, S. (2022, January 14). Covid variants: What you should know. Johns Hopkins Medicine. Retrieved January 21, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/a-new-strain-of-coronavirus-what-you-should-know
Cao, S., Gan, Y., Wang, C., Bachmann, M., Wei, S., Gong, J., Huang, Y., Wang, T., Li, L., Lu, K., Jiang, H., Gong, Y., Xu, H., Shen, X., Tian, Q., Lv, C., Song, F., Yin, X., & Lu, Z. (2020, November 20). Post-lockdown SARS-COV-2 nucleic acid screening in nearly ten million residents of Wuhan, China. Nature News. Retrieved January 21, 2022, from https://www.nature.com/articles/s41467-020-19802-w
Centers for Disease Control and Prevention. (1997, March 28). Pertussis vaccination: Use of acellular pertussis vaccines among infants and young children recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention. Retrieved January 21, 2022, from https://www.cdc.gov/mmwr/preview/mmwrhtml/00048610.htm
Centers for Disease Control and Prevention. (2022). CDC Covid Data tracker. Centers for Disease Control and Prevention. Retrieved January 21, 2022, from https://covid.cdc.gov/covid-data-tracker/#demographicsovertime
Colgrove, J. K. (2006). State of immunity: The politics of vaccination in twentieth-century America. University of California Press.
Mendenhall, E. (2021, November 24). We need school-age vaccine mandates to end the covid pandemic. Scientific American. Retrieved January 21, 2022, from https://www.scientificamerican.com/article/we-need-school-age-vaccine-mandates-to-end-the-covid-pandemic/
Moorthy, G. (2021, December 7). Compulsory covid-19 vaccination? : Only as a policy of last resort. Voices in Bioethics. Retrieved January 21, 2022, from https://journals.library.columbia.edu/index.php/bioethics/article/view/7301
Oosterhout, C. van, Hall, N., Ly, H., & Tyler, K. M. (2021, January 25). Covid-19 evolution during the pandemic – implications of new SARS-COV-2 variants on disease control and public health policies. Taylor & Francis. Retrieved January 21, 2022, from https://www.tandfonline.com/doi/full/10.1080/21505594.2021.1877066
Pfizer. (2021, March 31). BioNTech announce positive topline results of pivotal COVID-19 vaccine study in adolescents. Retrieved January 20, 2022, from https://www.pfizer.com/news/press-release/press-release-detail/pfizer-biontech-announce-positive-topline-results-pivotal
Poline, J., Gaschignard, J., Leblanc, C., Madhi, F., Foucaud, E., Nattes, E., Faye, A., Bonacorsi, S., Mariani, P., Varon, E., Smati-Lafarge, M., Caseris, M., Basmaci, R., Lachaume, N., & Ouldali, N. (2021). Systematic Severe Acute Respiratory Syndrome Coronavirus 2 Screening at Hospital Admission in Children: A French Prospective Multicenter Study. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 72(12), 2215–2217. Retrieved January 21, 2022, from https://doi.org/10.1093/cid/ciaa1044
Rota, J. S., Salmon, D. A., Rodewald, L. E., Chen, R. T., Hibbs, B. F., & Gangarosa, E. J. (2001, April). Processes for obtaining nonmedical exemptions to state immunization laws. American journal of public health. Retrieved January 21, 2022, from https://pubmed.ncbi.nlm.nih.gov/11291383/
Article Thumbnail: Mages, E. (2021, October). The Washingtonian. https://www.washingtonian.com/2022/01/13/january-23-anti-vaccine-mandate-march-dc/
Figure 1: Nature. (2021, December 16). How COVID vaccines shaped 2021 in eight powerful charts. Nature. https://www.nature.com/articles/d41586-021-03686-x