With the FDA’s authorization of the COVID-19 vaccine for children 5 years and older, now is the time to start considering the best path forward to protect Chicago’s children and their families.
As pediatricians in Chicago, we witness the burden of infectious diseases and understand the benefits of vaccines for individuals and for society. In order to keep children protected against disease and its harmful medical and social after-effects, we believe that COVID-19 vaccines should be required for children in all Chicago schools.
We urge schools to adopt policies that require COVID-19 vaccination.
This concept is not novel, as American schools have played an important role in public health for over 100 years. Schools have been legally allowed to require vaccinations for students beginning with the smallpox vaccine in the early 1900s. In the 1950s, public health officials partnered with schools to vaccinate children against polio. Today, school children must be vaccinated against previously eradicated illnesses, such as measles and polio, to help prevent resurgence.
The purposes of vaccines are to directly protect against severe illness in the recipient and to indirectly protect more vulnerable individuals in society, such as elderly and immunocompromised people. For example, the introduction of the pneumococcal conjugate vaccine for children in the U.S. reduced rates of pneumonia in elderly adults by nine-fold.
Closing health, education and social gaps
For COVID-19, the data is clear that the vaccines are safe and effective at reducing risks of severe illness and death. However, COVID-19 vaccination rates lag behind for people of color and in neighborhoods with lower socioeconomic status. In Chicago, Black and Latinx people have been disproportionately harmed by COVID-19 in terms of illness, hospitalization, and death. Historical mistreatment and racism today have led to distrust of the medical community; these factors have only worsened health inequities during the pandemic.
These disparities could widen further with the rollout of the COVID-19 vaccine in younger children. If current trends continue, children from families with more resources and from non-minority communities will get vaccinated at higher rates. Parents and guardians who may have been hesitant to be vaccinated themselves will also hesitate to vaccinate their children against COVID-19. Uniform requirements for vaccination of all students, however, would level the playing field and contribute to health equity across Chicago’s communities.
The data also show that the pandemic has wreaked havoc on children’s academic achievement. Hybrid learning during the pandemic was not as effective as full-time in-person learning. It was also unequally distributed in Illinois. The city of Chicago, like many in the United States, already struggled with disparities in educational outcomes for children along socioeconomic and racial/ethnic lines prior to the pandemic. Without a mandate, schools with lower vaccination rates will have more frequent cases and exposures, and thus affected students would be required to quarantine.
In general, missed in-person school days have the potential to lower academic achievement in unvaccinated student populations.
The argument for universal vaccination of school-aged children also holds true when considering mental health disorders, such as depression and anxiety. Pediatric emergency department visits for mental health emergencies, including suicide attempts, have risen dramatically during the pandemic. Children — from kindergarteners to high school seniors— who are forced to quarantine miss out on participation in social, athletic, and recreational activities that benefit their socio-emotional development. Higher vaccination rates have downstream effects of protecting children’s ability to learn and develop with healthy minds and bodies.
Public health leader
We acknowledge that the implementation of a widespread vaccination policy could be complex and controversial. Some families may not be ready to have their child vaccinated. The start date of any requirement needs to allow time for families to obtain information from their doctors and other community resources, as well as for access to appointments. As with all vaccines, exemptions should exist for a limited number of circumstances, such as medical conditions, with required documentation. Consequences, such as regular required COVID-19 testing each week, must be instituted for those who do not comply.
Chicago would not be alone in this endeavor, as the Los Angeles Unified School District planned to require COVID-19 vaccination for students once the vaccine is fully approved.
Chicago has the potential to be a public health leader in this effort nationally as well. From our standpoint as pediatricians and child health advocates, this is the time to begin planning for required protection for all of our city’s most valuable and vulnerable assets — our children.
Michael Bertenthal, MD is a pediatric resident physician at the University of Chicago Comer Children’s Hospital.
Anna Volerman, MD is a primary care doctor and Associate Professor of Internal Medicine and Pediatrics at the University of Chicago Medicine.
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