For the latest edition of Two Takes, a series examining opinions on key issues, Dr. Vinay Prasad weighs in on the debate over whether schools should mandate coronavirus vaccines for students ages 12 and up. His commentary comes on the heels of one such move by a major U.S. school district. Prasad is a hematologist-oncologist and associate professor of epidemiology and biostatistics at the University of California–San Francisco, and author of “Malignant: How Bad Policy and Bad Evidence Harm People With Cancer.”
The Los Angeles Unified School District has issued a bold vaccine mandate for its 600,000-plus school kids. All eligible children 12 and up who don’t have qualified exemptions must get two doses of the coronavirus shot, and if they don’t, they will no longer be allowed to attend in-person classes. There are many things we can do to improve vaccine uptake and ease vaccine hesitancy, and I am a firm supporter of encouraging and persuading adults to get vaccinated, but forcing kids to get the two-dose vaccine regimen – and taking away school if they don’t comply – is bad policy.
First, questions remain around giving adolescents two doses of the coronavirus vaccine – and it largely boils down to the rare risk of myocarditis, in which the heart muscle becomes inflamed. (Most cases of myocarditis appear to occur after dose two.)
Although the U.S. Food and Drug Administration has permitted giving everyone ages 12 to 15 two doses of Pfizer’s mRNA vaccine under an emergency use authorization, some of our peer nations have chosen a different path. While the vaccine is approved for this age group in the United Kingdom, the U.K.’s vaccine advisers initially recommended against vaccinating healthy kids ages 12 to 15 because the “marginal” benefit of vaccinating this age group came at the rare price of myocarditis. (They did, however, advise that kids in this age group with underlying health conditions be vaccinated.)
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A U.K. oversight body has since decided to recommend one dose of the vaccine for healthy kids ages 12 to 15 to prevent disruption to school, but said it was a “difficult decision” and should not be seen as a “silver bullet.” According to Reuters, “second doses would not be offered to the age group until at least spring as they wait for more data from around the world.” Norway has taken a similar stance and only offers one dose, for now, to kids 12 to 15 (though Canada and other nations follow the two-dose regimen like the U.S.).
In an effort to minimize the risk of myocarditis – and help young people build stronger immunity against COVID-19 – Norway also advises spacing out the doses for kids 16 to 17 anywhere from eight to 12 weeks, versus the U.S. standard of three weeks. Notably, LA’s mandate is written in such a way that many kids can allow no more than four weeks between the first and second dose in order to comply.
Scott Gottlieb, a former FDA commissioner and current Pfizer board member, argues that parents should have some say in the matter. Recently on CBS’ “Face the Nation,” Gottlieb noted that parents should have “some latitude” on how to vaccinate kids. He also explained that this is not a “binary decision:” Parents could opt for their kids to get one dose for now, or one dose for kids who have recovered from COVID-19. Above all, it’s a decision that should be personalized and made in lockstep with a pediatrician. I support Gottlieb’s position, and advise all parents to discuss vaccinating their child (ages 12 and up) with a physician they trust.
And in the case of the Los Angeles school district mandate, the punishment does not fit the crime. Taking kids who decline vaccination and preventing them from getting an in-person education is a draconian penalty. The Los Angeles school district, the second largest in the U.S., has already failed children by closing in-person schools for months on end, a move taken by schools around the nation throughout the pandemic. With this new vaccine mandate, LA is poised to push some kids – those who don’t comply or whose parents don’t permit them to comply – out of school for even longer.
Prolonged school closures have massive negative effects on children, robbing them of education, the last tattered rung left in the ladder of American opportunity. Diminished education can impact career attainment, happiness, marriage and net worth, which itself is a powerful determinant of crime, poverty and longevity. This stick is too sharp.
Children who choose not to be vaccinated may not be allowed to make the choice for themselves. For many, it is made by parents who are subject to a constant deluge of misinformation. Decades of policies that have furthered income inequality and political polarization set the stage for vaccine hesitancy, which can vary by wealth and race. Instead of treating the root problems – wealth inequality, political polarization, tribalism – we further perpetuate inequality by depriving these children of in-person learning. We cannot punish a child for the sins of the parent, and we cannot punish a child for a parent who is the byproduct of a society that is fractured and impaired.
Some argue that mandating the coronavirus vaccine is the same as requiring other childhood vaccinations to attend school. In my view, it isn’t. There is more uncertainty around its benefits and harms at school age and could factor into why some peer nations are making different policy choices. And, this decision comes after nearly a year without in-person schooling, making the punishment even worse.
LA is making a bold public statement, and the move will be cheered by many. Other school districts may even take similar steps. But the reality is they are overstepping the certainty of the science, and they are taking out our collective rage and frustration – that this pandemic has not yet ended – on children. It is a shameful policy, and I condemn it.
