Worried in part over ‘outrage component,’ a Washington advisory group did not recommend required COVID-19 vaccines for kids. So what’s next?

After extensive meetings and an onslaught of data presentations, a state advisory group voted late last month to not recommend adding the COVID-19 vaccine to the list of required immunizations for school entry beginning this fall.

The technical advisory group was tasked with evaluating the COVID-19 vaccine against nine criteria used by the State Board of Health, which will ultimately make the final decision.

The group was split on its final recommendation vote: Six members voted “yes” to recommend requiring the COVID-19 vaccine in schools; seven members voted “no”; and four voted that they were “unsure.”

The group’s recommendation now goes to the board of health, which will most likely take it up at its April 13 board meeting.

The State Board of Health has the final say on whether the COVID-19 vaccine will be required in schools and child care settings, but the board has never gone against a technical advisory group’s recommendation.

The split decision

The group of stakeholders, from pediatricians to community organizers, educators and public health experts, overwhelmingly backed the safety and science of the COVID-19 vaccine for children and supported about half of the criteria necessary to add a vaccine to the list of required immunizations.

The advisory group supported criteria that say the vaccine is recommended by federal agencies, effective, safe and able to prevent disease and transmission.

The other criteria brought up real challenges, however.

The advisory group was split on the cost effectiveness, burdens to community members, school districts and the health care system, and its acceptability to the medical community and public.

A nationwide survey from the Kaiser Family Foundation found that two-third of parents think schools should not require the COVID-19 vaccine for children and teens. Advisory group members were concerned that because all school-mandated vaccines in Washington state come with exemptions, a mandate might not compel enough additional families to get their children vaccinated, opting for exemptions instead, thus minimizing the potential benefit.

If the COVID vaccine were required, advisory group members questioned how well Washington families could access the vaccine or, if they wanted an exemption, a provider to grant one.

An informal statewide survey found that some Washington families would face structural barriers to complying with a COVID-19 vaccine requirement, whether that be transportation, coordinating time off work or finding a provider to authorize an exemption.

If families do not have an exemption or verification of the vaccines needed to attend school or child care, those children and teens are not allowed to be in school, a significant potential consequence that the group acknowledged would disproportionately impact families with limited access to the health care system to begin with.

Currently, 35% of 5- to 11-year-olds have initiated vaccination in Washington state. For 12- to 15-year-olds, that figure is 59%, and so far, 67% of 16- and 17-year-olds have received at least one dose of the Pfizer vaccine in the state.

Ultimately, the advisory group had questions about how much a vaccine requirement would result in bolstering those vaccine percentages and at what cost, especially with some public outrage over mask mandates in schools leading some districts to ditch their masks prematurely last month (only to rescind their resolutions after their funding was threatened).

The politicization of the pandemic had an impact on the group’s final recommendation.

“This is not as straightforward as some additions in the past and without the outrage component, it might have been an easier answer than without it, but that combination is something of concern,” Dr. Tom Pendergrass, who helped lead the advisory group and also sits on the Board of Health, said after the group’s final vote. “The overall vote was near equal, which is not a surprise given all the discussions we’ve had.”

What’s ahead

The board of health will take public comment on adding the COVID-19 vaccine to the state immunization schedule at its April 13 meeting, in addition to hearing why the technical advisory group decided to not recommend adding the COVID-19 vaccine to the immunization schedule.

The board could choose to agree with the technical advisory group and not require it, or go against the technical advisory group and add it to the list anyway, requiring it for the 2022-23 school year.

Beyond those two options, the board could also look further ahead to future school years, instead of requiring the COVID-19 vaccine this fall.

Keith Grellner, the chairman of the State Board of Health, said the process is a public one. He encouraged members of the public to go to use the board’s website at sboh.wa.gov to learn more about the process, as well as submit public comment.

“We are aware of social media and other platforms that are not getting their information from there and spreading mis- or disinformation, and I’d encourage the public to not make decisions or assumptions based on other people’s information but to go to our webpage and get the information,” Grellner said.

Some medical groups, including the Washington State Association of Local Public Health Officials, have asked the Board of Health to only include a vaccine on the state’s immunization schedule once it’s fully approved by the Food and Drug Administration.

The COVID-19 vaccine for children and teens is at different stages of the federal use and approval processes.

The Pfizer vaccine for teens 16 and older has received full approval from the FDA, but for children under 5, there is no vaccine available at all.

The COVID vaccine for 12- to 15-year-olds is being considered for full approval, but remains under emergency use. Similarly, the vaccine for 5- to 11-year-olds is also authorized for emergency use currently.

Those interested in submitting public comment about the COVID-19 vaccine requirement in schools can email the Board of Health or send letters. Additionally, public testimony and comments will be taken at the April 13 meeting. Go to sboh.wa.gov/i-want-to/contact-board-member to learn more.