One of the most popular myths during the COVID-19 pandemic is the idea that our children are all but immune to the COVID-19 virus. But that could not be further from the truth. Hundreds of children have died from COVID-19 during the pandemic, and many more were hospitalized.
Yes, the numbers are certainly higher in adults but compared to other risks to children COVID-19 is up there. Children just don’t die very often in modern days, thankfully, but still, COVID-19 has been among the top 15 causes of deaths for them. COVID-19 is not as dangerous to children as it is to adults – but it’s highly dangerous to them compared to other risks children today face. And this does not even count the many, many children – over 140,000 – who lost a caregiver to COVID-19.
As an academic who has studied the regulation of public health, specifically vaccines, I hope and expect the Advisory Committee of Immunization Practice (ACIP) at the CDC to recommend COVID-19 vaccines for children 5-11 during their upcoming meeting on November 2-3. Recently, FDA authorized the vaccine for emergency use in children after its own advisory committee recommended it, and hopefully, the CDC will add its recommendations.
For me, the decision is also personal. I look forward to vaccinating my six- and eleven-year-old sons as soon as I can. I know parents in states where schools are prohibited from requiring masks who are waiting for the vaccines even more eagerly than I am. There is no question in my mind that the vaccines’ rare risks do not outweigh their benefits for children – just as for adults.
At the same time, however, I hope policymakers do not mandate vaccines for children in the near future.
It is, in my assessment, constitutional for states to require COVID-19 vaccines for children in school. There is a strong jurisprudence supporting school immunization mandates, and I think it will cover these vaccines as well. That is because school is a shared environment, and vaccine mandates in school do double duty: they protect children by incentivizing parents who are hesitant to vaccinate, and they protect other children – and the community – by increasing vaccines rates.
Most likely, courts will not usually overturn policy makers’ choice on this. It is also probably legal: although there is an open legal question on whether you can mandate vaccines under an Emergency Use Authorization, there is a good argument you can. Schools with high COVID-19 vaccination rates will make everyone safer from COVID-19, and I understand the temptation to reach for mandates. But I still think it’s premature, at this point, for three reasons.
First, vaccine hesitancy for a new vaccine is natural. More so for a vaccine developed fast, as COVID-19 vaccines were. Even if the data is strong, some people will take time to accept the decision. Misinformation makes it worse, and the fact remains that many of us are vulnerable to misinformation because the COVID-19 pandemic has been so traumatic. If possible, working through hesitancy with compassion and patience is a better choice.
In some contexts, that’s not viable. With delta raging, mandates are the least bad option in many places. We need as much safety as we can get in the healthcare sector, for vulnerable patients and workers. We need safety when the public interacts with first responders since they often are close to vulnerable people. We need safety in nursing homes. In all those places, we should mandate COVID-19 vaccines now. In other places, it’s a closer call: private business owners need to balance the need to provide a safe workplace and the safety of consumers with hesitancy, the reasons for hesitancy, and the best ways to increase rates.
In schools, teachers should be vaccinated. But requiring vaccines from children – though beneficial – may not be as urgent. Vaccine mandates can increase safety, but it’s not clear how much. After all, some parents will vaccinate anyway. Some children may be still immune from previous infection. And if everyone else is vaccinated, and the risk to children is lower, the additional benefit from a mandate may not outweigh the potential harms of losing education for children who will be kept out of school because their parents are not ready to vaccinate. Giving parents more time to build confidence and get answers before mandating makes sense when the risk is lower.
Although the state of California announced a mandate, it is, essentially, doing just that. California said its mandate would not be operational until the vaccines are licensed for 12 and up. Right now, they’re only under emergency use authorization for that age group. That’s not going to happen for a few months at least. Pfizer has not yet applied for full licensure for that group – and it is probably the closest – and once it applies, reviewing the materials would take the FDA weeks to months. And for now, California’s mandate will have an open exemption when it becomes operational. Both these things give parents time to adjust.
Some districts in California – like the Los Angeles district- moved to immediately mandate. That’s trickier.
And ironically, in the states where the risk is higher for children – where there are laws banning schools from using masks to increase safety, for example – the political climate makes mandates a non-starter, even though the objective justification would be higher.
Second, I think a mandate will inflict pain on families that have already had a horrible pandemic. The pandemic has been traumatic for many families. Homeschooling is not always easy; not all families have enough rooms or computers for all children who need them, not all families have sustainable internet, and younger children find online schooling hard – and need more supervision (all else being equal). Some families lost loved ones. Some families lost their income. Some of these families, frightened, angry, hurt will be the ones most hesitant to vaccinate.
Forcing them to choose between schooling their child and taking a vaccine they are afraid of is adding pain on top of trauma. It is hard for them and the child. Vaccine mandates can always be hard on families who have been scared by anti-vaccine misinformation. Usually, that pain loses in the balance, compared to the need to make schools and children safer. But on the background of a traumatic pandemic, the level of harm may be greater than in usual times.
And finally, I am concerned about pushing families into the arms of the anti-vaccine movement. Some families who vaccinate routinely against other diseases have been affected by misinformation about COVID-19 and the vaccines. A mandate may lead them to team up with anti-vaccine groups and make them vulnerable to other claims those groups make more broadly.
For all those reasons, even though I think a mandate is legal, I hope that policymakers hold off and give people time. Maybe down the line we will need – or choose – to mandate covid-19 vaccines. But I think it’s not time yet.
Dorit R. Reiss
Dorit R. Reiss is a professor of law at the University of California, Hastings College of the Law who specializes in vaccines law and policy, including exemption laws and tort liability related to non-vaccination. She published law review articles, peer-reviewed articles and blog posts on legal issues related to vaccines.