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The first vaccine mandate in U.S. schools was enacted in Massachusetts in the 1850s to prevent smallpox transmission. Klaus Vedfelt/Getty Images
  • As COVID-19 continues to spread across the globe, debates have emerged about whether or not the vaccines should be required to attend school for children who are old enough to get one.
  • The United States has a long history of requiring vaccines to enter school.
  • Experts say that while concerns around the use of COVID-19 vaccines in kids are understandable, they’ve been shown safe and effective in children ages 12 and up.

As the landscape of the COVID-19 pandemic continues to evolve with the Delta and Delta plus variant, debates have come up about whether COVID-19 vaccinations should be required to attend public schools in the fall.

Currently, the Pfizer-BioNTech vaccine is authorized for use in children and teens ages 12 and older.

Both Pfizer and Moderna are conducting vaccine trials in children between the ages of 6 months and 11 years old. Experts expect young children to have access to the COVID-19 vaccines by the fall or mid-winter.

Several states, including Florida, Alabama, Arizona, Indiana, Montana, Ohio, Arkansas, Oklahoma, and Utah have already enacted legislation to ban public schools and universities from requiring students to have a COVID-19 vaccine to attend classes.

But pediatricians and public health experts point out that several other routine vaccinations are already required in the United States for children to attend childcare or school.

“Vaccine mandates have been around for a while, and they work,” Angela Shen, ScD, MPH, visiting research scientist at the Vaccine Education Center at Children’s Hospital of Philadelphia and retired captain in the U.S. Public Health Services, told Healthline.

“In the United States, we have a long history of requiring certain shots in order to go back to school to control vaccine preventable diseases,” Shen added.

The first vaccine mandate in U.S. schools was enacted in Massachusetts in the 1850s to prevent smallpox transmission. By the 1900s, nearly half of all states had the same requirement.

“Initially when mandates were started, the idea was to prevent epidemic spread of diseases, and to essentially control epidemics,” Shen said. “Through the decades, it evolved to increasing vaccination coverage that was deemed important for public health in the absence of an epidemic.”

According to the Centers for Disease Control and Prevention (CDC), by 1963, 20 states, the District of Columbia, and Puerto Rico had mandates requiring a variety of vaccines to enter school. But enforcement was uneven.

By the late 1960s, there was a renewed focus on vaccinating school children because of measles outbreaks across the country.

“We knew that transmission in schools was a really big problem,” Shen said. “When we took a look at jurisdictions that were strictly enforcing mandates that excluded unvaccinated kids, it showed that mandates were really effective because the states that strictly enforced the school entry requirements had lower incident rates.”

In 1977, the U.S. federal government set up the Childhood Immunization Initiative aimed at increasing vaccination rates in children against the seven diseases for which vaccines are routinely given in childhood, including:

  • diphtheria
  • measles
  • mumps
  • pertussis
  • poliomyelitis
  • rubella
  • tetanus

This is when all 50 states widely adopted mandatory school vaccinations.

Today, all states, the District of Columbia, and U.S. territories have vaccination requirements for children to attend school and childcare facilities. State laws establish vaccination requirements, as well as mechanisms for enforcement and rules for exemption.

Most school requirements adhere to the CDC’s vaccine schedule for children, including vaccination against measles, meningitis, polio, chickenpox, whooping cough, and hepatitis. Some states also require vaccination against the human papillomavirus (HPV) and an annual flu shot.

Dr. Sara Siddiqui, a pediatrician at NYU Langone’s Hassenfeld Children’s Hospital, points to some of the many successes of vaccine requirements in schools.

“Vaccine mandates for attendance in school and daycare are necessary to protect all children from communicable diseases in childhood,” she said. “HIB and meningococcal meningitis are severe and fatal in children and are rare at this time due to requirement of vaccination.”

The pneumococcal vaccine Prevnar has also prevented countless hospitalizations in children under 3, she noted.

“Pneumococcal bacteria causes blood infections, pneumonia, and ear infections in children and was a common cause of hospitalization prior to 2000,” Siddiqui said. “Influenza vaccination helps to prevent hospitalization and severe disease in children every year.”

Experts say it’s understandable that parents may have concerns around the use of COVID-19 vaccines in children.

“Parents have a lot of questions,” Shen said. “They’re concerned about the speed at which the vaccine has been developed and the implications for their children relative to their potential risk.”

She advises parents to speak with their pediatrician about these concerns.

As a pediatrician herself, Siddiqui fields many of these questions on a daily basis.

When parents express concerns about the time in which the COVID-19 vaccine was developed, she explains that while the vaccine is new, the technology isn’t.

“The mRNA technology behind the COVID-19 vaccination has been studied for over a decade with the first SARS and MERS coronavirus outbreaks,” Siddiqui said. “At that time, scientists began to develop and study a vaccine for possible future use. Vaccine trials and testing was not modified or shortened in order to approve [the] COVID-19 vaccine, what was expedited was the time given between trials.”

Scientists also had a much larger study group than they typically would to test a vaccine, given the large amount of disease spread.

“Since initial release, millions and millions of doses have been given, and the COVID-19 vaccine is found to be safe and effective at preventing severe disease and hospitalization,” Siddiqui said.

And with the continued spread of COVID-19 in the United States and around the world, and the development of new variants, experts are urging parents to vaccinate children who are eligible.

“We are seeing an increased incidence of children having symptoms from COVID, suffering from long-term effects, and a rare but severe disease after being exposed to COVID-19 called Multi Inflammatory Syndrome in Children (MIS-C),” Siddiqui said.

“MIS-C occurs 4 to 6 weeks after a child is exposed to COVID-19 and can present with severe symptoms such as fever and vomiting, requiring hospitalization and aggressive treatment,” she explained.

“Vaccinating children against COVID-19 would help prevent disease spread, prevent severe illness, increase herd immunity, and prevent long-term complications in children,” Siddiqui said.