by Tina Manzer
Giving vaccinations to children in school, aka “school-located vaccination” (SLV), has had a long and effective history. It begins in Massachusetts in 1827, when the first “no child left unvaccinated” act (against smallpox) became law for Boston schools. Smallpox was highly contagious; a devastating disease that killed, on average, three out of every 10 people who got it.
The U.S. struggled to maintain and distribute a vaccine during most of the 19th century. In 1875, during a smallpox outbreak in New York City, the first recorded SLV occurred.
American schoolchildren continued to receive routine smallpox vaccinations until 1972, when the disease was deemed eradicated in the U.S.
In the 1950s, the polio vaccine was successfully distributed in schools across the country. Compared to the scar-inducing smallpox vaccine delivered by “jet injector,” the oral polio vaccine in individual sugar cubes was a delight.
SLV was also used to combat rubella in 1969, and then chickenpox and H1N1 (swine flu) in 2009. In the 1990s, schools became catch-up clinics for hepatitis B, and during the 2012-2013 school year in rural Kentucky, HPV vaccines were administered in schools.
Children are immunized to protect the school community but also to protect the broader community from the spread of preventable disease, says Laurie Combe, president of the National Association of School Nurses (NASN). “The school really has a huge role to play in the health of the broader community.”
Right now, COVID-19 vaccine availability to children is still a long way off. Guidance from the National Academies of Science, Engineering and Medicine (NASEM) has prioritized healthcare workers, older adults and those with comorbid conditions as the first groups to have access to a vaccine. K-12 teachers and school staff are included in phase two, and children are part of phase three. That, of course, could change.
Vaccinations for children during this school year are doubtful, believes Dr. Mario Ramirez, a physician and former acting director for the federal Office of Pandemic and Emerging Threats. In an article in news resource Education Dive, he noted that today’s schools have a host of challenges to overcome in the meantime. Here are just a few of them.
Declining support for immunizations
Widespread public support for childhood vaccines helped prevent measles and polio from spreading in the U.S., but the number of Americans who consider vaccines important has dropped 10 percent since 2001. According to a December 2019 Gallup survey, 84 percent of Americans say it is extremely or very important that parents vaccinate their children, down from 94 percent in 2001.
“The only group that has maintained its 2001 level of support for vaccines is highly educated Americans, those with postgraduate degrees,” reports Gallup. “The perception of the importance of vaccinations declined by at least 5 percentage points among all other education subgroups.”
Some people are opposed to vaccines because they believe them to be more dangerous than the diseases they prevent. It’s hard to change their minds. For example, “Vaccines cause autism,” a claim made in the late 1990s, has since been debunked by the CDC and other respected health organizations. Even so, 10 percent of U.S. adults still believe vaccines cause autism in children, according to the Gallup poll. Forty-Five percent do not think vaccines cause autism, up a little from the 41 percent who said the same thing almost five years ago.
And most people have forgotten the horror of vaccine-preventable diseases like smallpox and the measles. They’ve been in our collective rearview mirror for so many years that they believe we are no longer vulnerable to them.
In terms of the COVID vaccine, “Public interest was really high six months ago, and then came all the political infighting tied to the presidential campaign and concerns about the safety profiles,” said Dr. Ramirez. “Many of them were rooted in conjecture, but they drove down confidence in the vaccine.”
A December 9 survey from The Associated Press-NORC Center for Public Affairs Research shows that about one-quarter of U.S. adults aren’t sure if they want to get vaccinated against the coronavirus. Roughly another quarter says they won’t.
The Pfizer vaccine calls for ultracold storage (minus-70 Celsius), making it difficult for schools to become valid distribution points unless they are equipped with special freezers. “I don’t think anyone sees that as possible,” noted Ramirez, but stay tuned: ultracold freezers are available and being moved where they’re needed. The Riverside Health system in Virginia ordered one for each of its five hospitals, reports The Washington Post, and the state of Maine has purchased one for its public health emergency warehouse that can store more than 200,000 doses.
Pfizer’s special GPS-tracked, suitcase-sized shippers can store vials up to 15 days, said the article, but the ultracold storage specifications must be followed to a “T.” The 50 pounds of dry ice pellets in them must be refreshed upon arrival and then every five days, and to maintain the minus-70 temperature, the container cannot be opened more than twice a day. “The vials can stay at refrigerator temperature for five days before their contents degrade,” noted the article.
The nationwide school-nurse shortage
Twenty-five percent of schools in the U.S. have no school nurse, and other schools depend on part-timers who split their hours among several schools, according to research from the National Association of School Nurses (NASN). Fewer than 40 percent of schools have a full-time employee.
But the Charleston County School District in South Carolina added to its school nursing staff this year so there is at least one full-time nurse at each school. Also added was an immunization coordinator. The changes have more to do with a federal Vaccines for Children grant the school system received, but according to Ellen Nitz, its director of nursing services, COVID-19 tipped the scale in favor of increasing the district’s number of nurses.
“I think it’s going to be all hands on deck for our healthcare providers, including my school nurses,” she told Education Dive. “We could step into the public health role and be able to assist by providing those vaccines to those who need them.”
All hands on deck
Nitz raises an interesting point. Given the past successes of SLV, couldn’t it help to speed up the current U.S. vaccine rollout? School buildings have the space and capacity for mass vaccinations in gymnasiums, cafeterias and libraries. In the past, many schools have provided space for hospitals and other health-care providers to hold pop-up clinics and store vaccines in a controlled environment. What’s more, school nurses often have pre-established relationships with families in their community, which helps with the vaccine trust issue. They also have relationships with local and state public health departments, other nurses, emergency planning authorities, and local healthcare providers.
“The school and public health partnership is a familiar model for the delivery of healthcare in many communities,” notes NASN. In rural communities especially, schools are often more accessible than healthcare facilities.
According to NASN’s school-located position statement, “reaching high vaccination coverage of school-age children and their families, as outlined in Healthy People 2020 (U.S. Department of Health and Human Services 2017) is an important public health objective … Health care providers must continue to improve access to and acceptance of vaccination providers in nontraditional health care settings. School-located vaccination can augment other emerging alternative vaccination sites.”
“Schools touch so many more people compared to any other public institution,” says Ramirez.
As of January 5, information about vaccination sites and vaccine availability is still unclear. Many of the draft vaccination plans that states submitted to the federal government in October mention the need for mass-vaccination sites, but offer few, if any, details, reports fact-checking resource PolitiFact. Some plans refer to the locations of mass vaccinations for H1N1 in 2009. Wyoming used national parks, Indian Health Services, prisons and an Air Force base. Wisconsin’s plan floats the idea of using schools.
“In New York City, Health Commissioner Dr. Dave Chokshi said schools will host temporary vaccination clinics staffed by city employees, including those from the local health department, and volunteers,” said Politifact.
When schools are called upon, I hope they’re given time to prepare.