As state departments of health begin to unroll plans for the mass vaccination of children schools are now requested to assist with these large scale efforts. With very little information or knowledge regarding the implications of administering vaccines school superintendents are placed in a difficult leadership position. Do we agree to use public schools as conduits for widespread delivery of the N1H1 vaccination or do we proceed with caution and possibly remove our schools from this process given certain unknown risk factors for children?
As a school superintendent I accept the responsibility for the critical role that we play in providing for the health, safety, and welfare of children. On the surface, vaccinating children appears to be a move in the right direction regarding the health and safety of school-age children. But on balance the wholesale endorsement of providing schools as the vehicle for the delivery of vaccinations is filled with unanswered questions and perhaps even difficult ethical choices.
Schools are being directed to complete interest surveys at present with the assumption that we are the logical institutions for the efficient delivery of mass vaccinations for children. Prior to signing on to this effort it may be prudent for us to consider the unintended consequences of placing the imprimatur of the schools on this unprecedented effort. The risks appear to be minimal but many consequences may need to be considered prior to participating in the delivery of vaccinations.
Even if a school only provides a place and time for vaccination of children the perception is that the school approves and by extension endorses the vaccination. Having the imprint of the school is powerful psychologically as parents or guardians may feel a subtle pressure to have their child included. The fact that it is endorsed by school officials is a powerful psychological one and may persuade many uninformed guardians of children to sign on to the process.
The vaccine is designed for “healthy children ages 2 – 18” according to the Center for Disease Control. What parameters define a seemingly “healthy” child? Public schools experience tremendous variation in physical disabilities in their school populations. It is assumed that children with identified or pre-existing health conditions would likely be excluded. But what of young children with yet-to-be-identified developmental health conditions? The under-identified population of children with bronchial or other health related conditions are a large concern for us in public education. We currently struggle to provide health-related services to an increasing number of children with specific acute needs and the implications of administering relatively untested vaccinations across a wide spectrum of young children is a chilling prospect.
Parental notification and ensuing permission has not been addressed. How and what do we communicate regarding a mass inoculation in public schools? Does this form of communication originate with school officials (who are not experts in disease control and mitigation) and what advice to we provide to parents? Do permission forms that a school may distribute to parents pass legal muster? Who assumes the responsibility for any vaccination that may prove faulty or even lethal to a young child?
From a logistical perspective it may not be ideal for vaccinations to be administered during the school day or even in a school setting for very young children. The negative psychological results can place fear in a child regarding the vaccination and children receiving such vaccinations may present illness or sickness associated with a vaccination. A degree of Mass Sociogenic Illness (MSI) can be attributed by extension to the receipt of the vaccination. This is a social phenomenon patients experience when they believe they have been exposed to a virus and may experience symptoms triggered by a psychological response.
Of the entire spectrum of children present in public schools do we administer these vaccinations to our pre-school populations? The vaccine is supposed to be made available to children as young as two. Who makes this judgment call on behalf of the state government? What assurances are in place that guarantee the supply of vaccinations are entirely safe for very young children?
The argument for public schools in the mass vaccination of children presents many challenges for administrators who want to be good sheppards of the public trust. Yet the ethical decision to allow schools to participate is filled with emotional and behavioral challenges. I suggest a cautious approach to the endorsement of schools in the process for mass vaccination of children and recognize that public schools have much at stake in sharing the risks associated with this public safety effort. These type of decisions are not easy for school leaders and more support is needed from health experts before we proceed. What do you think?
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