The Washington State Board of Health unanimously rejected a measure that would have prevented the board from ever requiring a vaccine under an emergency use authorization from the Food and Drug Administration or a product that has not completed Phase 3 clinical trials.
In December, Xavier Figueroa, on behalf of Informed Choice WA, submitted a petition asking the State Board of Health to adopt such a rule. The petition was in response to the board convening a technical advisory group, which will evaluate whether to add the COVID-19 vaccine to the list of required immunizations for children to attend public and private schools.
The board received more than 1,000 pages of public comments and dozens of live comments during Wednesday’s virtual meeting, primarily from concerned residents and parents who oppose vaccine mandates for their children.
Some health board members were wary of how the rule proposed by the Informed Choice petition might limit future boards, should they need to act quickly to protect the public.
Dr. Thomas Pendergrass, vice-chairman of the board, said he did not want to commit a future board to such stringent demands. He recalled when the polio vaccines were voluntary but then mandated in public schools to prevent the spread of the disease.
“While I share the concern that we should be very much thoughtful, studious and strict in our engagement in looking at any (vaccine) requirement for school entry, I think this is one where they’re asking for us to make decisions for future boards that I don’t support,” Pendergrass said.
While the Board of Health rejected this petition, board members acknowledged the flood of public comments opposed to vaccine mandates and said the technical advisory group assembled to look at the COVID-19 vaccine would have to answer many of the questions raised on Wednesday.
Last fall, the Board of Health assembled a technical advisory group, which will begin meeting to discuss the possibility of adding the COVID-19 vaccine to the list of required vaccines for children attending school or child care in the state. The technical advisory group is composed of health care, public health and education representatives, as well as parents and other state residents.
That group is very early in its process; it has planned meetings through March of this year. Even if that group brings a recommendation to include the COVID-19 vaccine for children on the list of state-mandated vaccinations, the health board will have the final say.
They have said “no” to recommendations before, Pendergrass noted on Wednesday.
“The other reassurance I want to give to the public is there have been recommendations for vaccines in the near-past that were turned down. For example, we do not require the meningococcal vaccine for every student who enters K-12,” Pendergrass said.
Pendergrass also pointed out that before the board even assembled a group to study the COVID-19 vaccine, two requirements must be met: First, a process must exist for opting out. Second, the vaccine must be accessible and have no cost barrier.
With the exception of the measles, mumps and rubella vaccine, all required vaccines in Washington’s schools have medical, religious or philosophical exemptions available to families.
The Legislature would have to make a change to state law, as it did with the MMR vaccine, to remove exemption possibilities.
How the vaccine could be mandated
The technical advisory group will use nine criteria established by the Board of Health that a vaccine must meet to be considered for inclusion on the list of required vaccines.
These criteria focus on vaccine effectiveness, disease burden and implementation.
One factor the group will consider is if the vaccine is recommended by the Advisory Committee on Immunization Practices and included on its recommended immunization schedule.
The ACIP currently recommends COVID vaccines for children 5 and older, but it is not officially on the immunization schedule for school-aged children.
Board members noted that the process is quite long to get a vaccine added to the list of required immunizations for school-aged children and teens.
Pendergrass pointed out that thousands of children are still being followed post-vaccination and data continues to be collected on the Pfizer vaccine. The fact that the COVID vaccine for children is under an Emergency Use Authorization and not fully approved is something the technical advisory group will have to consider.
It is possible that later this year Pfizer could apply for full approval for its vaccine for children, as it has for its vaccine for people 16 and older. In August, the FDA granted Pfizer full approval, more than eight months after it was approved for emergency use.
Some experts believe it is only a matter of time until the Pfizer vaccine for children is also fully approved.
“We’re not seeing any new and surprising adverse events that we didn’t know about, so I’d imagine that’d be coming soon,” said Dr. Gretchen LaSalle, MultiCare Rockwood family physician and 2020 vaccine science fellow.
The technical advisory group will likely meet from January to March. It will then bring a recommendation to the board to add the COVID-19 vaccine to the list of required vaccines in the state – or not. Ultimately, the board will get the final say, regardless of the group’s recommendation.
Board chairman Keith Grellner said that when the technical advisory group has a recommendation, the board will host a meeting with limited other topics in an effort to have a robust discussion with additional input from the community.
“That will be in the future; we don’t know how long it will take the technical advisory group to do their work,” Grellner said.
Cases, hospitalizations increasing among children
While COVID has affected kids and teens less severely than older and higher-risk adults, both COVID cases and hospitalizations of children and teens are increasing, data from the Department of Health show.
Public health officials and physicians continue to stress that the benefits of COVID vaccination outweigh the very rare risks of side effects from the vaccine. Outcomes such as myocarditis or pericarditis are more frequent in children and teens who contract COVID than in those who are vaccinated.
The message that the virus is less severe in children has been a disservice over time, LaSalle said.
“Kids definitely do fare better than adults or older adults who get COVID, but it’s still something that has killed children,” she said. “It’s killed more children in two years than we’ve seen in two years of flu season.”
In two flu seasons from 2017 to 2019, 898 children and teens from birth to 17 years old died from the flu nationwide. Since the pandemic began, 1,090 children and teens have died from the virus nationwide, according to data from the Centers for Disease Control and Prevention.
The potential impacts of COVID for a child, from multi-inflammatory syndrome to continued symptoms associated with long COVID, are all risks parents take when they do not vaccinate their children, LaSalle said. Additionally, children and teens also have the ability to spread the virus and infect to more vulnerable community members.
“It’s about families, neighbors and communities, and the ability to get back to normal living,” LaSalle said.
As of last week, nearly 190,000 kids ages 5 to 11 statewide have received a first dose, and more than 130,000 kids in this age group are fully vaccinated. More than half of this age group is not vaccinated statewide, however.
For those ages 12 to 15 , just 56% statewide have received one dose, and a little more than half of this age group is fully vaccinated.
In Spokane County, vaccine uptake among teenagers remains lower than statewide averages. About 44% of 12- to 17-year-olds in Spokane County have received at least one dose of a COVID vaccine.
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