When this news came out, many parents were understandably unsure about what this meant. Will their child be required to get the COVID vaccine in order to attend school? Will COVID boosters be an annual requirement for kids? As the CDC notes, these are simply recommendations—only states have the power to mandate vaccines for school or otherwise. Still, many questions still linger. We reached out to experts to help us unpack this news and to help us understand how child immunization schedules work and what the purpose is.
Why are Childhood Vaccine Schedules Important?
The CDC’s job is to keep track of infectious diseases and make determinations about what vaccines are important for children to receive. “The current childhood vaccine schedule has been carefully crafted and extensively studied,” says Rebekah Diamond, MD, assistant professor of pediatrics at Columbia University, and author of the book Parent Like A Pediatrician. Dr. Diamond emphasizes that the vaccines the CDC recommends for children are the safest and most effective way to protect your child from serious illness. “We know vaccine uptake leads to happy, healthy children through data,” she describes. “As a pediatrician, I’ve also seen it firsthand—treating a devastating disease or even witnessing childhood death from vaccine-preventable disease.” The CDC’s vaccine schedule also provides guidance for states and institutions like schools, explains Nehali Patel, MD, an associate faculty member at the Infectious Disease Clinic at St. Jude Children’s Research Hospital. “Childhood vaccination schedules are the guidepost for all providers to refer to when offering routine vaccinations,” Dr. Patel describes. “They are also the main resource for parents and schools to see what is recommended for each age group and special circumstance.” Additionally, Dr. Patel says these recommendations offer key guidelines regarding the number of vaccines in a series to offer, what ages children should start receiving these vaccines, how to space the vaccines out, and how to vaccinate children who have chronic conditions or are immunocompromised.
How the COVID Vaccine Fits Into Immunization Schedules
It’s not clear yet how the COVID vaccines will fit into the vaccine schedule. The CDC isn’t releasing guidelines about this until early in 2023. Officials attribute the decline to COVID-related disruptions in the vaccine schedule. The CDC is concerned declining vaccination numbers could eventually impact the protection of students from these diseases. “I’ll be waiting like all other parents and even pediatricians to see what the official recommendation is,” Dr. Diamond says. But if she were to make a prediction, she expects the CDC will recommend infants and children receive the primary series for the COVID vaccines and it’s likely a yearly booster will be recommended as well. Dr. Patel has a similar prediction: she also expects that a primary series of the COVID vaccine will be recommended, along with a yearly booster. As for how the primary series will work, Dr. Patel expects the recommendations will be similar to what it is now for children. “The Pfizer vaccine will require three doses for 1st time recipients who are under 5 years old,” Dr. Patel describes. “The Moderna will require 2 doses.” After that, she expects there will be seasonal COVID boosters, similar to the flu shot, updated yearly to target circulating COVID variants.
COVID Vaccinations Lag for Children
To date, COVID vaccination has lagged in children, especially young children. According to the Academy of American Pediatrics (AAP), as of October 26, 2022, 58% of 12-17 year olds have received two doses of a COVID vaccine, and 31% of 5-11 year-olds have received two doses. The vaccine uptake for 6 months to 4 years old is even lower—only 9% of kids in this age group have received even one COVID vaccine. Katelyn Jetelina, PhD, an epidemiologist and founder of Your Local Epidemiologist, shares some thoughts on why this may be happening. “First, I think this has to do with the lagged clinical trials and honestly waiting too long,” she said. “So, many children were already infected by the time vaccinations were available that many parents don’t see the benefit.” Additionally, compared to adults, children tend to fare better when it comes to COVID infections, which likely has led to a lack of urgency for parents, she says. “However, comparing children to adults is inherently flawed, as kids aren’t supposed to be hospitalized (or die),” Dr. Jetelina emphasizes. This type of messaging hasn’t reached parents with enough clarity, she says. Finally, Dr. Jetelina thinks there are still quite a few hesitant parents and even hesitant pediatricians. There’s hope, though, she says. “Vaccine confidence takes time, and I think over time this gap will eventually close,” Dr. Jetelina describes. “Parents just want to do the best thing for their kids and it takes time to be convincing.”
Some Vaccines Required For Schools
Every state is different but all states in the U.S. require at least some of the CDC-recommended vaccines for school entry—and they have done so long before COVID vaccines came on the scene. According to the Pew Research Center, all states require vaccines against diphtheria, tetanus, pertussis, polio, chickenpox, measles, and rubella. Every state besides Iowa also requires the mumps vaccine. Some daycares and preschools require flu shots. Mandates for vaccines like hepatitis A and B also vary from state to state. Not only do the CDC recommendations help schools decide what vaccines to require, but their recommendations have an important role to play when it comes to vaccine access for kids, Dr. Jetelina points out. CDC vaccine recommendations are added to the Vaccines for Children program, she says. When this happens, the federal government is required to pay for vaccines for children who don’t have health insurance. “This is incredibly important for health equity in the United States,” Dr. Jetelina commented.
