With the FDA’s approval of the COVID-19 vaccine for children ages 5 and older, now is the time to think about the best way forward to protect the children of Chicago and their families.
As pediatricians in Chicago, we witness the burden of infectious diseases and understand the benefits of vaccines for individuals and for society. To protect children from disease and its harmful medical and social consequences, we believe that COVID-19 vaccines should be mandatory for children in all schools in Chicago.
We urge schools to adopt policies requiring vaccination against COVID-19.
This concept is not new, as American schools have played an important role in public health for more than 100 years. Schools were legally allowed to require vaccinations for students starting the smallpox vaccine in the early 20th century. In the 1950s, public health officials worked with schools to vaccinate children against polio. Today, schoolchildren must be vaccinated against previously eradicated diseases, such as measles and polio, to prevent a relapse.
The purpose of vaccines is direct protection against serious diseases in the recipient and indirect protection of more vulnerable people in society, such as the elderly and immunocompromised people. For example, the introduction of the pneumococcal conjugate vaccine to children in the US reduced the rate of pneumonia in older adults by a factor of nine.
Closing health, education and social gaps
For COVID-19, the data is clear that the vaccines are safe and effective in reducing the risk of serious illness and death. However, vaccination rates against COVID-19 are lagging behind among people of color and in neighborhoods of lower socioeconomic status. In Chicago, black and Latinx people have been disproportionately affected by COVID-19 in terms of illness, hospitalization and death. Historical abuse and racism have led to distrust of the medical community today; these factors have only exacerbated health inequalities during the pandemic.
These differences could become even greater with the rollout of the COVID-19 vaccine in younger children. If current trends continue, children from wealthier families and from non-minority communities will be vaccinated at higher rates. Parents and guardians who may have been hesitant to get themselves vaccinated will also be hesitant to vaccinate their children against COVID-19. However, uniform vaccination requirements for all students would level the playing field and contribute to health equity in Chicago’s communities.
The data also shows that the pandemic has wreaked havoc on children’s academic performance. Hybrid learning during the pandemic was not as effective as full-time face-to-face learning. It was also unevenly distributed in Illinois. Before the pandemic, the city of Chicago, like many others in the United States, struggled with inequalities in children’s educational outcomes along socioeconomic and racial/ethnic lines. Without a mandate, schools with lower vaccination rates are more likely to have cases and exposures, and so affected students should be quarantined.
In general, missed personal school days have the potential to reduce academic performance in unvaccinated student populations.
The argument for universal vaccination of school-age children also applies when it comes to psychological disorders, such as depression and anxiety. Visits to the pediatric emergency department for mental health emergencies, including suicide attempts, have risen dramatically during the pandemic. Children — from preschool to high school students — who are forced to go into quarantine lack participation in social, athletic and recreational activities that benefit their social-emotional development. Higher vaccination rates have downstream effects of protecting children’s ability to learn and develop with a healthy mind and body.
Public Health Leader
We recognize that implementing a widespread vaccination policy can be complex and controversial. Some families may not be ready to have their child vaccinated. The start date of a requirement should give families time to obtain information from their physicians and other community resources, as well as access appointments. As with all vaccines, there should be exceptions for a limited number of circumstances, such as medical conditions, with required documentation. For those who do not follow the rules, consequences, such as mandatory weekly COVID-19 testing, must be put in place.
Chicago wouldn’t be alone in this pursuit, as the Los Angeles Unified School District planned to require COVID-19 vaccination for students once the vaccine is fully approved.
Chicago has the potential to become a public health leader on a national level as well. From our point of view as pediatricians and child health advocates, now is the time to begin planning for the protection required for all of our city’s most valuable and vulnerable assets: our children.
Michael Bertenthal, MD is a pediatric physician at the University of Chicago’s Comer Children’s Hospital.
Anna Volerman, MD is a family physician and associate professor of internal medicine and pediatrics at the University of Chicago Medicine.
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