What the history of student vaccination mandates means for school COVID vaccine rules

AILSA CHANG, HOST:

The vaccination of 5- to 11-year-olds against COVID-19 is well underway. California has become the first state to announce that it will add this vaccine to its list of shots that are required for all schoolchildren, and a handful of districts around the country are making similar moves. NPR's Anya Kamenetz reports that this kind of mandate goes back nearly two centuries, but it has always drawn pushback.

ANYA KAMENETZ, BYLINE: In 1827, Boston became the first city in the United States to require children entering school to be vaccinated; in this case, against smallpox. Inoculation was almost like a miracle. This was a disease that once killed nearly 1 out of 3 patients. But Elena Conis, a historian of medicine at the University of California, Berkeley, said...

ELENA CONIS: Vaccines have been controversial since the very first vaccine was developed against smallpox. And vaccination became increasingly problematic or increasingly controversial when states began to make it mandatory.

KAMENETZ: In the United States, early anti-vaccinationists, as they were known, brought multiple failed court challenges. In 1922, the Supreme Court specifically backed school-based mandates. In that case...

JAMES HODGE: The court made clear this is not a liberty violation, this is not a constitutional issue. States and localities can impose school vaccination requirements, period.

KAMENETZ: That's James Hodge, a professor of law at Arizona State University.

HODGE: And as a result, we saw, obviously, 80 plus more years of schools doing exactly that through state law.

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UNIDENTIFIED PERSON: Once the Public Health Service authorizes its release, the polio vaccine can begin to protect American youngsters. In 1955, over 10 million children received one or more injections of Salk vaccine, including this boy - the president's own grandson, David Eisenhower.

KAMENETZ: Just as this newsreel suggests...

CONIS: When the polio vaccine was first approved, loads and loads of people showed up to get it for themselves, for their children. And it was several years before states even considered mandates.

KAMENETZ: And once in place, Conis says, these mandates kept expanding.

CONIS: A number of states start introducing mandates, passing them. They apply to schoolchildren for polio, measles, smallpox, diphtheria, pertussis, tetanus.

KAMENETZ: If you're listening, you've probably had them all. Conis says that throughout the 19th and 20th centuries, schools have sometimes been lenient on vaccination requirements unless there's an outbreak. And in most times and places, religious exemptions are granted. But vaccine mandates still breed resistance, especially, she says...

CONIS: With the rise of the anti-authoritarian movements of the late '60s, 1970s. And so there is this whole ethos of questioning authority. And a number of people start asking this about vaccines - how do we know that they're safe?

KAMENETZ: Then came the 21st century.

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GUY RAZ: Britain's best-known medical journal, The Lancet, issued a rare public retraction this past week of a paper it published back in 1998 that linked autism to the MMR vaccine.

KAMENETZ: That's an NPR report on an infamous paper retracted a dozen years after it was published. But the vaccine resistance damage was done. Now, we're in the midst of a pandemic that has killed nearly 800,000 Americans so far. Political affiliation, plus plenty of disinformation, influences whether people follow public health advice by wearing a mask or taking a vaccine.

CONIS: Mandates have had a tendency, historically, to elicit pushback. And I don't think pushback is something we want or need right now.

KAMENETZ: At this point, the CDC and the president have yet to call for mandating COVID vaccines for schoolchildren, and experts like Conis say that's prudent given the lessons of history.

Anya Kamenetz, NPR News.

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