Schools are back in session. Kids are back in classrooms. And the highly contagious delta variant is along for the ride, causing COVID-19 cases among children to rise.
On Sept. 9, the Los Angeles board of education voted to mandate coronavirus vaccines for in-person students ages 12 and up in America’s second-largest school district. The move has been met with praise and criticism.
As part of Two Takes, a series examining opinions about key issues, U.S. News checked in with Dr. Paul Offit, director of the Vaccine Education Center and an attending physician in the division of infectious diseases at Children’s Hospital of Philadelphia, for his reaction.
Responses have been edited for length and clarity.
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Should K-12 schools mandate the coronavirus vaccine for all eligible students?
Yes. Much as we mandate vaccines for a variety of illnesses like measles or chickenpox or whooping cough in order for kids to attend school.
The coronavirus vaccine works and is safe to prevent a pandemic virus that in the past few weeks has caused more than 450,000 American children to become ill, and millions of children to suffer and more than 450 to die since the outbreak began.
We need to protect our children. Vaccines will do that.
We have an increased number of children in our hospital, consistent with the national average. We have children in the intensive care unit fighting for their lives with this virus – either because of the initial infection, which can cause severe pneumonia that can be severe and fatal, or this post-infectious inflammatory phenomenon called multisystem inflammatory syndrome in children (MIS-C), which can cause severe and occasionally fatal heart disease.
It’s really frustrating when it involves a child over 12 who could have been vaccinated and wasn’t. Last year, it was hard enough to watch the pandemic unfold. This year, it’s harder because what’s happening is preventable. It’s also difficult to see parents who aren’t vaccinated or other people in the home who could be vaccinated but aren’t.
People are essentially making the choice to put themselves and their children at risk. And we as health care providers see that risk. We have to see that risk. We are forced to see that risk.
Do you expect to see more schools mandating COVID vaccines for kids 12 and up?
It’s going to be dicey because some parents will push back. But it’s certainly the right thing to do. In a better world, we wouldn’t need vaccine mandates. Other countries don’t. Unfortunately, here in the U.S., we do. We’re a much more cynical, litigious society with rampant distrust of doctors and public health officials.
Any reasonable person who looks at the data would get a vaccine every time. How much more information do you need that this vaccine can keep you out of the hospital and prevent you from dying? Of the 670,000 Americans who have died of COVID-19, very few have been vaccinated.
What about COVID-19 vaccine side effects, such as myocarditis – or swelling of the heart muscle? Some experts have expressed concern about this risk in young people who get vaccinated.
COVID-19 is much more likely to cause myocarditis than the vaccine is – with heart muscle inflammation occurring in roughly 1 in 45 of those infected versus about 1 in 50,000 of those vaccinated. Also, myocarditis from the vaccine is generally short-lived and self-resolving. It’s not like the typical viral myocarditis, triggered by certain viruses that infect the heart and can cause some kids to go to the ICU or need a heart transplant. That’s a different story than this.
How do you counsel parents about whether or not to vaccinate their kids?
Any medical product that has a positive effect can also have a negative effect. Vaccines are no different. The influenza vaccine, for example, can cause Guillain-Barré syndrome – a rare neurological disease that can be quite severe and arises in about 1 per million people. The rotavirus vaccine – which I was fortunate to help develop – is a rare cause of intestinal blockage that occurs in approximately 1 in 70,000 recipients. But viral infections themselves also cause these negative effects – and much more commonly.
There are no risk-free choices. That is always true for any medical therapy. There are just choices to take different risks. Your job is to take the lesser risk.
So where do mandates come in?
The problem here – and the reason you need mandates – is it’s not a decision you’re making only for yourself. It’s a decision you’re making for others. It’s not your right to catch and transmit a potentially fatal infection any more than it is to run a stop sign because you felt like it.
I know we’re a country founded on individual rights and freedoms. And I know we don’t like the notion of a government agency or school district mandating that we get a biological agent injected into our arm against our will. But we’re not talking about compulsory vaccines required by law. With mandates, there’s an opt-out: You pay a fine, you don’t get to work where you want to work, your kid doesn’t get to go to school in person, you have to get tested bi-weekly.
I don’t think we should mandate the tetanus shot: If I step on a rusty nail and choose not to get vaccinated and get tetanus, that’s my right. No one’s going to catch tetanus from me. But COVID-19 is a highly contagious disease. Remember: There are many people in this country who can’t get the coronavirus vaccine – they depend on the people around them to protect them.
Right now, children younger than 12 can’t get vaccinated and they’re all coming together in one place – school – where the delta variant is highly transmissible. And we’re heading into winter, where generally these respiratory viruses thrive and spread. That’s not a good combination.