Can Schools Make a COVID-19 Vaccine Mandatory?

The Pfizer-BioNTech COVID-19 vaccine is available to all children 5 and up. The vaccine has full U.S. Food and Drug Administration (FDA) approval for use in those 16 and up and emergency use authorization (EUA) for ages 5 to 15. As school-age children have become eligible for vaccination, parents wonder if public school systems could make it mandatory for students to get vaccinated.

"Different schools will have different thresholds for creating mandates. There are some that have already talked about instituting mandates; others may wait," says Kawsar Talaat, MD, associate professor of international health at the Johns Hopkins Bloomberg School of Public Health.

American public schools require children to receive all of the routine vaccinations recommended by the American Academy of Pediatrics (AAP). However, parents who don't want their kids to adhere to these guidelines can seek special permission for an exemption. The question is whether that will be the case with the COVID-19 vaccine.

"The vaccines are safe, the vaccines are effective, and they are a good way to keep our kids healthy and to keep our kids in school," says Talaat. "Having said that, mandates do work, but they have a lot of pushback against them, so encouraging people and trying to get people to be vaccinated voluntarily might be a better way to do that."

Schools might consider several factors in determining whether or not children should be required to receive the COVID-19 vaccine to attend school.

Full FDA Approval

The Johnson & Johnson vaccine, along with the Pfizer-BioNTech vaccine for kids under 16, are being distributed "under an emergency use authorization [EUA], which is a much shorter process than what is required for a vaccine to be fully approved by the FDA," says Reagan Anderson, DO, FAOCD, FAAD, FASMS, MPH, and former combat physician.

The Moderna vaccine received FDA approval for people 18 years and up on January 31, 2022. Full FDA approval is a lengthy process that involves evaluating data from the vaccine manufacturer, including:

• Details about the manufacturing process
  
• Inspection of the vaccine facilities
• Preclinical and clinical data
• Vaccine testing results

This process usually takes years; however, the full approval of the Pfizer vaccine for 16 and older came less than a year after its EUA. It isn't clear whether a timeline for full FDA approval of a children's vaccine will follow a similar pattern.

"It requires so much work on behalf of the people who are applying as well as those who are reviewing," says Talaat. "I would expect that we are going to see it fully approved for 12- to 15-year-olds before it's approved for 5- to 11-year-olds, and as we work down in age."

The lack of full FDA approval doesn't mean the vaccine is unsafe by any measure, only that schools may have difficulty mandating something that hasn't yet received FDA approval like other required vaccinations.

The Risks of Kids Spreading COVID

Scientists now know that kids spread the virus the same as adults. That means they can spread COVID-19 in lots of circumstances, including:

• When they are asymptomatic
• When they have mild symptoms
• When they have non-specific symptoms
• When they don't know they are infected

When a community has higher rates of COVID-19 infection, it is more likely that COVID-19 will spread in local schools. Layered prevention strategies as recommended by the Centers for Disease Control and Prevention (CDC).

These measures, which include wearing masks, getting vaccinated, physical distancing, testing, and screening, all reduce the risk of COVID-19 transmission in schools. However, not all schools adhere to such guidelines.

The Risk of the Virus Compared to the Vaccine

Finally, one of the most prominent factors schools will have to consider when it comes to potential COVID vaccine requirements is the fact that kids are often mildly affected by the virus.

As of January 27, 2022, more than 11.4 million American children have been infected with COVID-19. Nearly one million of those cases occurred in the last week of January 2022. Since the pandemic began, children have made up 18.6% of cases.

Children accounted for 1.6% to 4.4% of hospitalizations among states reporting data. In addition, as of February 2022, 623 kids ages 5 to 18 and 287 kids under 5 have died from COVID-19.

"Yes, it's a generally mild disease in kids," says Talaat, "but it can be an incredibly serious disease in kids, and it can be a fatal disease in kids, and the best way to prevent that and to keep them healthy is by vaccinating them."

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.