Mandatory Vaccines in Schools: Should We Add COVID to the List?

The British philosopher John Stuart Mill famously said: “He who knows only his own side of the case, knows little of that.” With this in mind, let’s consider the case for mandatory COVID vaccination in schools.

Across the United States, vaccinations (or exemptions) are required against numerous diseases before a child can be enrolled in public schools. Given that COVID-19 is more dangerous than some of those diseases, and we’re in the middle of a worldwide pandemic, it seems like a logical decision to add COVID-19 vaccination to the list. In other words, if you’re willing to give your child the chicken pox vaccine to go to school, when chicken pox is considered less dangerous and less prevalent than COVID, then why not the COVID vaccine?

It’s a fair question. Before answering, let me state that I’ve had two doses of Moderna vaccine, I own stock in Moderna and Pfizer, I’ve worked for Big Pharma, I’ve founded a drug development startup, and I think the development of these COVID vaccines has been fabulous. In other words, I’m not anti-vaccine, and I’m not anti-pharma.

Mandatory School Vaccines. Historically, there has been some opposition to mandatory vaccination policies in the public schools, but existing mandatory vaccination policies have generally had widespread support. In all 50 states and DC, the DTaP (diphtheria, tetanus, and pertussis), chicken pox, and polio vaccines are required for kindergarten entry. All of these states also require the MMR vaccine (measles, mumps, and rubella), with the exception of Iowa, which requires measles and mumps vaccines. Vaccines for other diseases such as Hepatitis A and Hepatitis B are required in some states.

Vaccine Exemptions. All states have exemptions from vaccine requirements based on medical grounds, and most of the states allow exemptions based on religious grounds. People who get exemptions based on religious or medical grounds are provided some level of privacy and generally are not treated differently than everyone else on the basis of their vaccine status. In other words, students with vaccine exemptions are not forced to maintain social distancing, wear a mask, or subject themselves to frequent testing that is not performed on their vaccinated counterparts.

Effectiveness of the Mandated Vaccines. Let’s examine the effectiveness of these mandatory vaccines. Of the mandated vaccines, the diphtheria and tetanus vaccines have excellent effectiveness according to CDC. A complete DTaP vaccine series has a clinical efficacy of greater than 99% for tetanus and 97% for diphtheria. A recommended complete series is five doses for children. The pertussis vaccine is far less effective, and wears off quickly. As an aside, I would argue against making pertussis vaccination mandatory, but since it comes standard as part of the DTaP vaccine, most people will get it anyway.

According to CDC, completion of a three dose vaccine series for polio gives protection greater than 99% which lasts for many years.

What about measles and mumps? According to CDC: “People who receive MMR vaccination according to the U.S. vaccination schedule are usually considered protected for life against measles and rubella. While MMR provides effective protection against mumps for most people, immunity against mumps may decrease over time and some people may no longer be protected against mumps later in life.” Two doses of MMR vaccine were found to be 97% effective against measles and 88% effective against mumps.

What about natural immunity? According to CDC, you don’t need the MMR vaccine if you have laboratory confirmation of past infection or had blood tests that show you are immune to measles, mumps, and rubella. In other words, if you have natural immunity, you don’t need the vaccine.

According to CDC, two doses of the varicella (chicken pox) vaccine provides at least 90% relative immunity for chicken pox, and the immunity is sustained for at least 10 years. Those with past history of chicken pox infection do not need to take the vaccine.

Prerequisites of Mandatory Vaccine Policies. For all of these mandated vaccines, the following rules generally apply:

1. A complete series of vaccinations provides at least 90% efficacy against at least one disease (if a single vaccine covers multiple diseases) for a period of at least ten years.

2. People who receive medical or religious exemptions from vaccination are not treated as second-class citizens.

3. Where appropriate, people with natural immunity by virtue of confirmed previous infection do not need to take the vaccine.

Mandatory COVID Vaccine Policies Fail These Tests. These three rules do not apply for COVID and most mandatory COVID vaccine policies.

First, the COVID vaccines are nowhere near as effective as the above-mentioned required vaccines. I believe the case for mandatory vaccines against a highly infectious disease is largely dependent on (i) the relative protection provided by the vaccine, (ii) the duration of protection, and (iii) the threat posed by a disease. A vaccine that provides lifelong 90% relative protection is entirely different than a vaccine that provides 60% relative protection for a year. The best of the COVID vaccines originally showed 95% effectiveness against COVID for at least several months, but the effectiveness numbers have dropped over time as immunity wanes and virus variants have emerged. For example, the Pfizer vaccine, which is the most widely administered COVID vaccine, appears to have decreased to roughly 50% effectiveness against infection by the end of the summer.

The duration of effectiveness is uncertain, but numerous studies have shown that the effectiveness wanes over time, which is why there is an understandable clamor for booster shots. Unlike the vaccines mandated in schools, which generally provide at least 90% protection for at least ten years, the actual effectiveness of the COVID vaccines might be roughly 60% for a year (and I’m probably being generous with both the effectiveness and duration in that estimate), which is roughly comparable to flu vaccines. Moreover, it is unknown how well the current COVID vaccines will perform against future COVID variants.

Therefore, a simple answer to the question asking why COVID-19 vaccines should not be added to the list of required school vaccines is that those previously mandated vaccines work extremely well against the targeted disease (and any variants), and they work extremely well for a long time. That’s just not the case with the COVID vaccines.

Second, people who receive medical or religious exemptions from standard public school mandatory vaccination are not treated as second-class citizens. If your child has a medical exemption for traditional vaccines, they don’t have to wear a mask every day, or sit in a corner, or get tested weekly for the disease. In other words, the exemptions don’t come with what amounts to punishments. This is not the case with COVID vaccine exemptions. For example, at universities with mandatory COVID vaccine policies, students with exemptions can be subject to additional testing requirements and/or masking requirements and/or social distancing requirements and/or quarantine requirements in the event the student has contact with infected people.

Third, for these other mandated vaccines, at least where relevant, natural immunity is recognized. If a person has had chicken pox, or mumps, or measles, that individual is not required to get that particular vaccine. An exemption for natural immunity is rarely provided in mandatory COVID vaccination policies in the US. For example, among the legions of American universities with mandatory COVID vaccination policies, I have not yet seen one policy which recognizes natural immunity, in spite of the prevailing science showing that natural immunity is as good or better than vaccine-derived immunity. The goal is immunity, not vaccination, so ignoring natural immunity is illogical.

Finally, it’s worth pointing out that the side effect profile of COVID vaccines, particularly the mRNA vaccines, appears to be somewhat worse than other vaccines.

In summary, the conditions are vastly different for mandatory COVID vaccinations than for other mandatory vaccinations, providing plenty of reasons why a parent might be far more willing to vaccinate his or her child against polio or chicken pox, for example, than against COVID.

Flu Vaccine and COVID vaccine. By some distance, the closest parallels to COVID vaccines are flu vaccines (which notably, are typically called flu shots, with the implication that the term “vaccine” is reserved for immunity shots that provide lasting protection). Similarities include a rapidly mutating virus, a highly transmissible disease, and a vaccine with perhaps 60% effectiveness for a year. Moreover, COVID and the flu appear to be responsible for similar numbers of fatalities among school-aged children (with some evidence that the flu is deadlier for children between the ages of 1 and 4) and death rates after hospitalization are comparable.

For those who have long-argued in support of mandatory vaccines for influenza and are now supporting mandatory COVID vaccination, I disagree with you, but support your intellectual consistency.

Obviously, flu vaccines are not typically mandated in schools, and when they have been advocated, groups such as the ACLU have vigorously opposed mandatory flu vaccines. For example, in 2014, the Rhode Island chapter of the ACLU fought against mandatory flu vaccinations for children up to five years old in order for the children to enter school or daycare programs, stating that: “The vaccination of children against illness is a laudable goal, and the ACLU appreciates that there are some illnesses and some situations that may warrant imposition of mandatory vaccinations. However, mandatory vaccinations must be reserved only for those diseases where the vaccine has an undeniable preventative effect on the illness, where the illness is easily transmitted by the individuals and in the situations under consideration.” By those guidelines, the ACLU would be against mandatory COVID vaccines in schools.

Here is what a 2009 ACLU press release said about mandatory flu vaccines for (adult) health care workers: “’The goal of protecting New Yorkers from the effects of the flu is undeniably important, as is the interest of ensuring that our doctors and nurses are healthy enough to work. But individuals have a constitutional right to bodily autonomy,’ said NYCLU Executive Director Donna Lieberman. ‘Forcing competent adults to choose between getting the flu vaccine and getting fired is coercive, invasive and unjustifiably intrudes upon their fundamental rights.’”

Presumably just a few years later in the Age of COVID, individuals still “have a constitutional right to bodily autonomy” and “mandatory vaccinations must be reserved only for those diseases where the vaccine has an undeniable preventative effect on the illness, where the illness is easily transmitted by the individuals and in the situations under consideration”. Thus the ACLU must now be leading the fight against mandatory COVID vaccines in schools, right?

Unfortunately, politics trumps logic and intellectual consistency. David Cole, the group’s national legal director, and Daniel Mach, director of the ACLU’s program on freedom of religion and belief, recently wrote an op-ed in the New York Times in support of COVID vaccine mandates, arguing that COVID vaccine mandates actually protected civil liberties. According to these ACLU leaders: “Vaccines are a justifiable intrusion on autonomy and bodily integrity.”

As tempting as it is to consider the odds that the ACLU would express the same position today if Trump had been re-elected and was pushing for COVID vaccine mandates (a billion to one?), perhaps a better and more general question is why the ACLU’s previously stated, well-reasoned objections to mandatory flu vaccines do not apply to COVID vaccines, particularly given the: (i) significant side effect profile of COVID vaccines and the attendant mathematical certainty of harming many children who will not benefit from COVID vaccines, (ii) the prevalence of widespread natural immunity, (iii) the extremely low COVID fatality rate among schoolchildren, (iv) the inability of COVID vaccines to halt infection or transmission, (v) the short duration of vaccine effectiveness, (vi) the low rate of transmission to staff in primary schools in Denmark in the absence of vaccines and masks, and (vii) the likely imminent approval of antivirals from Merck and Pfizer that will reduce the death rate among vulnerable populations infected with COVID?