As the U.S. Food and Drug Administration debates granting emergency use authorization of a COVID-19 vaccine for children ages 5-11, school systems across the country are in various stages of planning for a potential rollout, including hosting vaccine clinics on campus, hiring additional staff, issuing communications to families, and handling parental permissions for students to get a shot.
An FDA panel met Tuesday and recommended a two-shot regime of the Pfizer-BioNTech COVID-19 vaccine for elementary-aged students. Each dose would be one-third the amount of an adult shot. If given approval, the Centers for Disease Control and Prevention will issue guidance for vaccine distribution, outreach and resources.
Under this timeline, vaccines for 5-11 year olds would likely be available within the first two weeks of November, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, on ABC’s This Week. Children could be fully immunized by the winter holidays if they follow the two-dose regime spaced 21 days apart. Pfizer's childhood COVID-19 vaccine has a 90.7% efficacy rate, according to documents submitted to the FDA.
Biotechnology company Moderna announced Monday its studies of a vaccine for 6-11 year olds show immune responses after two shots are high enough to likely prevent COVID-19, according to reporting by BioPharma Dive.
School leaders and parents have been anxiously awaiting the availability of a COVID-19 vaccine for younger children, as providing extra protection against the coronavirus for this age group will help bring more stability to in-person learning and reduce transmission rates in communities. Vaccines for children younger than 5, however, will likely not be available until early 2022.
"Once everyone becomes eligible, we hope that people will take advantage of that — parents, families — and get their students vaccinated, and then we will be able to achieve that herd immunity and we'll decrease the risk of transmission of this virus," said Linda Mendonca, president of the National Association of School Nurses.
Anticipating vaccine demands
Free childhood COVID-19 vaccines will be available at locations convenient to families, including doctors’ offices, hospitals, pharmacies, community health centers, and school- and community-based sites, the White House said in an Oct. 20 statement.
President Joe Biden’s administration also said there are enough vaccinations for the country’s 28 million children ages 5-11 years old. Students ages 12 and older are already eligible for a COVID-19 vaccination.
“The lives of our keiki are precious, and we are encouraged we may soon be able to protect them from COVID-19 through vaccination.”
Hawaii State Department of Health
School systems are gearing up for demand, even while they await final federal and state decisions and guidance. For example:
Officials with Chicago Public Schools told the Chicago Tribune the system plans to continue working with community partners to expand childhood vaccinations once they are approved. CPS currently works with partners to provide access to the vaccine through regional clinics, school-based health centers and school-based mobile events across the city. Those 12 years and older already eligible for a vaccine can make an appointment through the CPS website.
The Hawaii State Department of Health said in a statement it is working with vaccine providers in a wide range of locations, including schools, to make vaccines for younger students accessible. The department also said it is planning a comprehensive communication and outreach campaign to parents and guardians of children ages 5-11. “The lives of our keiki are precious, and we are encouraged we may soon be able to protect them from COVID-19 through vaccination,” the statement said.
The Los Angeles Unified School District, which now requires students ages 12 and older to have their second dose of the Pfizer vaccine by Dec. 19, is waiting on the FDA and CDC reviews to make a decision on vaccine mandates for students younger than 12. The district will also consult with the public health department and other medical institutions partners, according to its website.
The CDC said it plans to update a web page on how community partners, including schools, can support COVID-19 childhood vaccinations.
Mendonca said many school systems have the benefit of experience from coordinating or contributing to the vaccine rollout earlier this year for students ages 12 and older. “They have a system, if you will, in place. They kind of know what they need,” said Mendonca, adding logistics and communications will be different based on each school community’s needs.
The process for obtaining parental permissions for on-campus COVID-19 vaccinations may be the biggest difference between school-based support for vaccines for elementary-aged students compared to older students, Mendonca said.
School leaders will need to be aware of their state’s policy for age of consent and parental permissions. Some states may require in-person parental consent for the COVID-19 vaccine for younger students, while others may accept written permissions.
For example, a new state law in North Carolina requires a parent or legal guardian to give written consent for anyone under 18 to receive a vaccine that has emergency use authorization from the FDA, according to Kaiser Family Foundation, a nonprofit health information organization. In the District of Columbia, individual healthcare providers may set additional requirements, which could include having parents present for child inoculations.
Schools also will likely play a role in promoting vaccine confidence to families and addressing misinformation. A poll in September by KFF found while only 34% parents of children ages 5-11 plan to have eligible children vaccinated “right away,” that number was an increase from 26% who said in July they would get their child immediately immunized.
A collaborative effort
Schools can use Elementary and Secondary School Emergency Relief funds for COVID-19 prevention activities, including partnering with vaccine providers and creating incentives and initiatives to promote COVID-19 vaccinations, according to a "dear colleague" letter last summer from U.S. Secretary of Education Miguel Cardona.
Although the White House said it expects pediatric offices to play a critical role in vaccine distribution, it also said operations will lean on public-private partnerships to ensure supply, distribution and inoculations go smoothly.
Eric Vetere, safety and emergency manager for the San Bernardino City Unified School District in California, said some of the district’s 77 school sites and 11 administrative buildings may be used for vaccine clinics but the city’s health department is taking the lead on organizing the vaccine rollout.
The district also has contracted with AM LLC, a company that specializes in COVID-19 management, to hire COVID liaisons at each school to organize contact tracing, quarantines, pandemic communications and testing. The district is spending $12 million a year from federal relief funding for the support, Vetere said.
“I think the partnerships are important because it allows our personnel to just focus on educating our kids, which is their job, and then it allows our AM partners to focus just on COVID,” Vetere said.