Advisors at the U.S. Centers for Disease Control and Prevention voted last week to recommend that all children receive the COVID-19 vaccine, a move that does not change California’s list of vaccines required for children to attend school.
Adding the COVID-19 vaccine to CDC-recommended vaccines for children is not a mandate for states’ school attendance requirements. Any additions to California’s list must be made by the state legislature or state department of public health. In the past 12 months, the Newsom administration and the Legislature have separately tried to mandate that children go to school with the COVID-19 vaccine, and both have failed.
People involved in those efforts said they don’t expect the Legislature to reconsider the mandate for children next year, barring a large increase in hospitalizations or deaths.
“Our goal should be to increase vaccination coverage,” said Sen. Richard Pan, a Sacramento Democrat pediatrician whose bill last session mandated school-age vaccinations, with only a medical exemption. “We have work to do to make sure people have access to the vaccine, and we’re educating them.”
Since the federal government approved vaccines for children on an emergency use basis, children have received the COVID-19 vaccine at much lower rates than adults. So far, 67% of 12- to 17-year-olds have received the first round of the vaccine, 38% of 5- to 11-year-olds have received the first round, and 5% of children under 5 have received the shot, according to state data.
The state Department of Public Health declined to say whether it plans to add the vaccine to the required list. Instead, the agency referred to its previous statement in an April email: “…upon full FDA approval, CDPH will consider the recommendations of the Advisory Committee on Immunization Practices of the United States Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians before by considering a school vaccine requirement.”
The role of the Centers for Disease Control
It suggests that children 6 months of age and older be vaccinated against COVID-19 with injections approved by the US Food and Drug Administration or approved for emergency use.
“This is a step in the right direction to protect public health, but I understand there are many concerns about vaccines in general and the COVID-19 vaccine,” said Dr. Alice Kuo, professor and head of the Division of Pediatrics/Preventive Medicine. at UCLA. “It’s one step at a time.
Dr. Naomi Bardach, a professor of pediatrics at the UCSF School of Medicine, said the CDC recommendation is a sign that COVID-19 is here to stay. She said adding the vaccine to the pediatric schedule also normalizes the vaccine because pediatricians’ offices, which already use the CDC list as a guide, will dispense the COVID-19 vaccine into patient care.
Under state law, children must receive a series of shots for 10 diseases in order to attend child care centers, family child care homes, preschool and kindergarten through 12th grade. If children are not vaccinated or behind the state schedule, they may be suspended from school until they receive the shot.
Infants receive their first vaccine before they are one hour old, and injections continue until adolescence. Most vaccines recommended by the Centers for Disease Control are required by California for school attendance. These are: diphtheria, hepatitis B, hemophilic influenza type b, measles, mumps, pertussis (whooping cough), poliomyelitis, rubella, tetanus and varicella (chicken pox).
Prior to 2016, parents had the option of opting out of vaccinations for their children through a personal exemption. Senator Pan authored a controversial bill that removed the personal belief exemption for vaccines on the state list, leaving only medical exemptions that must be signed off by a doctor. At that time, about 3% of new kindergartners entered school with a personal exemption for some or all vaccines.
The law only applied to vaccines already on the list for children. Any new vaccines added to the list in the future by the state Department of Public Health would offer personal belief and medical exemption options. If the Legislature were to vote to add a vaccine to the list, lawmakers would choose which exemptions to offer.
Vaccination rates against these childhood diseases have fallen during the pandemic. In August, the Department of Public Health reported that 1 in 8 children were not up-to-date on vaccinations due to missing routine doctor visits over the past few years.
A failed effort
In October 2021, Governor Gavin Newsom said his administration would require a school-based COVID-19 vaccine for students 12 and older once the U.S. Food and Drug Administration fully approves vaccines for children. At the time, the mandate was set to go into effect in July 2022. As the Department of Public Health implemented the plan, the requirement would allow parents to refuse the vaccine for their children based on personal beliefs or medical exemptions.
In January 2022, Pan created the COVID-19 Vaccine Bill to go even further and eliminate the personal belief exemption.
In April, lacking the votes needed to pass the bill, Pan withdrew it, saying the vaccine needed to be more affordable for families and that vaccination rates needed to be higher before the mandate would succeed. On the same day, the Department of Public Health postponed until July 2023 its plan to require students to receive the COVID-19 vaccine.
On Monday, Pan said he doesn’t expect the Legislature to react to the mandate idea any differently than it did last year. Pan will not direct the effort if it is as marked in November.
Pan said if a state is considering adding a vaccine to the list, it needs to take into account all recent developments regarding the vaccine and revaccination, such as how often it will be needed. If it is required more than once as a non-mandatory flu vaccine for school attendance, it could be a burden for schools. Pan said the Legislature has focused on vaccines that children receive as a series and then don’t have to take again, such as measles and chicken pox.
“It will depend on how it develops and what the overall load is,” Pan said.
Last year, Pan established the Vaccine Legislative Task Force, which has proposed a number of bills related to COVID-19 and vaccines. Most of them failed, including proposed mandates for all employees and children to be vaccinated in order to work or attend school, as well as a bill that would allow minors to get the vaccine without parental consent.
“It’s been a rough year for vaccine legislation in the Legislature,” said Sen. Scott Wiener, a San Francisco Democrat who authored the juvenile vaccination bill and is a member of the task force. “I don’t know if that dynamic will change by next year, but it’s something to think about because it should be part of the regular schedule for school kids.”
Another member of the vaccine task force, San Diego Assemblywoman Akilah Weber, said she is not considering legislation to mandate the vaccine.
“At this time, I am not involved in any legislation that would mandate vaccination, but I am actively involved in education and outreach and providing community outreach for more parents to get their children vaccinated,” Weber said in an email.
In the past, proposed vaccine-related legislation has drawn protesters to the capital en masse. They disrupted hearings, shouted at lawmakers and even attacked them. During one memorable protest, what appeared to be a menstrual cup filled with blood was thrown over the railing of the gallery one floor below in the Senate.
If the administration or the Legislature re-enforces the vaccination requirement, critics are already planning to push back. They argue that it should be a family decision and that it raises questions about the number of breakthrough cases — where a vaccinated person tests positive for the coronavirus — effectiveness and safety for children.
“Anti-vaxxers are very organized and very vocal, even if they don’t represent the majority,” said Senator Wiener. “But that’s the dynamic we have to deal with, and that’s true of a lot of political issues and policy questions.”