Polio, chickenpox, measles, and now covid. Time to review the history of the school immunization mandate

© Provided by Kaiser Health News

The rapid spread of omicron across the country — and the realization that vaccines continue to provide strong protection against severe disease — means that covid-19 is, perhaps, one step away from earning its place on the list of diseases that have been dominated by vaccines. These include polio, measles, mumps, rubella, and chickenpox, which most children should be vaccinated against before starting school. some states have announced the mandatory covid vaccines for some schoolchildren.

But not everyone agrees that the obligation to vaccinate children is the way forward. Senator Rand Paul, who has opposed vaccination mandates, called omicron the “nature’s vaccine”. Seventeen states, mostly led by Republicans, they have bannedin some way, the requirement to be vaccinated against covid for students.

Resistance to adopting these types of mandates has profound repercussions, especially as vaccination rates among children ages 5-11 continue to be alarmingly low—below 15% in some states— despite the fact that children 5 years and older can be vaccinated since last fall.

History teaches us why low vaccination rates among children pose a huge risk, and why authorities should consider making the covid vaccine mandatory in schools.

In the United States, children generally must receive a series of vaccinations before entering the school system. These requirements help ensure that an entire generation gets their shots against diseases that feared them for decades—even centuries—until the vaccines did their job.

These diseases were even more terrifying in immunologically “naive” places, appearing in bodies that had never suffered from them. That is the devastating place we found ourselves with covid-19 in early 2020.

When explorers brought diseases such as measles, which had long circulated on the European continent, to the native populations of the New World, it is estimated that he died 80% or 95% of the indigenous population in repeated outbreaks over the next 100 to 150 years.

When it became easier to travel around the world, the king and queen of Hawaii came to England in 1824 and both died of measles there. The virus returned to Hawaii in 1848 with an epidemic that killed a quarter of the native population, according to one estimate, and then flared up to create additional waves that killed more people in subsequent decades.

Even after vaccines were developed and diseases like measles and chicken pox were no longer common (and not medically dangerous for most children), the United States continued to mandate vaccinations in schools for different but important reasons.

We vaccinate against chickenpox and the measles in part because these diseases can be more deadly for adults, for the immunocompromised, and for babies, whose immune systems are still developing. Just like covid.

We vaccinate against mumps, which in itself is usually a mild disease, because some of those who contract it suffer severe complications, such as hearing loss or infertility in boys who have passed puberty. A parallel can be drawn with “persistent covid”, and we still don’t know the long-term effects of covid, which can inflame organs.

In addition, children with chickenpox must endure prolonged and harsh isolation at home. And we vaccinate against the chickenpox virus—and measles—because an outbreak in a school it can cause significant disruption if vaccination rates are low, triggering actions such as contact tracing and other public health measures.

Just like today with covid.

We might be lucky and achieve widespread immunity to covid relatively quickly, if the new waves are less and less overwhelming. But even if that happens, many unvaccinated people will die or become seriously ill, and some children will have to miss school. New, potentially more dangerous strains could emerge. Do we really want to take that risk and not take full advantage of this powerful tool that we have at our disposal?

Which path do we want to take to leave the pandemic behind: the faster and safer path of mandatory vaccination or the path of remaining in a state of prolonged doubt?

Unfortunately, the Covid vaccines came at a time of deep national divisions, when science had become politicized and mistrust of government was high. Even the parents who vaccinate their children to go to school have been reluctant to covid vaccines. States and school districts that have announced plans to require COVID vaccination in schools already face negative reactions.

Very different from the way the public reacted to the introduction of childhood vaccinations in the 20th century. People enthusiastically welcomed the availability, in 1955, of the vaccine against polio, a disease that could have disastrous health consequences, but, like covid, was asymptomatic or mild in most infected people, especially children. The doubts that existed then were not motivated by intense partisanship or political division.

One of the explanations for the enthusiasm of that time for a new vaccine was the good memory of the Americans, who they had experienced fearsome outbreaks of polio and the consequent quarantines for much of the middle of the 20th century. In 1955, many Americans knew someone who had died of polio or was left partially paralyzed. People have lived with covid for a relatively short period of time.

Resistance to the covid vaccine may disappear when the Food and Drug Administration (FDA) changes the childhood vaccine from emergency use authorization to full approval and when waves of covid affect more Americans.

This is how my thinking about another vaccine was affected a generation ago: My oldest daughter contracted chickenpox before the vaccine was available and spent hours in oatmeal baths covered in itchy hundreds of blisters. She couldn’t go back to preschool (and I couldn’t go to work) for 10 days, until the blisters scabbed over. Some scars took years to fade. So when the chickenpox vaccine hit the market in 1995, I rushed to get my 2-year-old son vaccinated. He still had chickenpox, but a mild case, like most covid cases: One afternoon while playing, I noticed two telltale blisters on my upper arm that disappeared within 24 hours. He didn’t miss any playdates with his friends.

Like many childhood vaccinations, that injection protected him, our family, my job, our caregiver, his classmates, his grandmother, and all the vulnerable people we had come into contact with in the market or on the subway. If we want to bring this pandemic to a quick end, vaccinating schoolchildren may have the same ripple effect and may be the best remedy.

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