States Consider Role of COVID-19 Vaccination for School Enrollment

June 23, 2021 | Andy Baker-White, Maggie Davis, Lauren Ewing

medical-gloved-hand-holding-syringe-vaccine-ampoule_1200x740.jpgThis week might have marked the beginning of summer, but many policymakers and health officials have their eye on the upcoming school year and what that might mean in terms of getting students vaccinated against COVID-19. According to a recent CDC Morbidity and Mortality Weekly Report, COVID-19 related hospitalizations among adolescents increased in March and April 2021, potentially related to increased circulation of new COVID-19 variants, changes in physical distancing, and a larger number of children returning to school or other in-person indoor activities. This increase indicates an urgent need for vaccination against COVID-19, which is currently authorized for use in youth as young as 12.

Expanding vaccination efforts is a cornerstone function of public health. Community outreach and education efforts are a common method for increasing vaccination rates, including outreach to personal physicians to counsel their patients about vaccines. Recommendations from a personal physician that is able to listen to concerns and answer questions from patients and parents helps them make informed decisions. In addition to community outreach efforts, some states are providing incentives like Ohio’s “Vax-a-Million” lottery or considering requirements for employment or school enrollment.

More than a century ago, the U.S. Supreme Court in Jacobson v. Massachusetts upheld the authority of states to pass laws requiring vaccinations in certain contexts. Today, to help prevent the spread of preventable disease, all 50 states and D.C. require children to receive a series of vaccinations before they enroll in school. Some states also require university and college students to receive certain vaccines before enrollment (e.g., meningococcal and hepatitis B). Exemptions to required vaccines are provided when they are medically necessary, and all but six states (California, Connecticut, Maine, Mississippi, New York, and West Virginia) also allow non-medical exemptions based on religious or personal beliefs. The current COVID-19 vaccines have been authorized by the FDA but have not been licensed under the biological license application (BLA) process. A state most likely can statutorily require vaccination from an authorized but not approved vaccine, although this issue has yet to be considered by the courts.

Currently, hundreds of colleges and universities across 35 states and D.C. are requesting their students and staff be fully vaccinated against COVID-19 before returning to campus, with some schools requesting that students and staff receive their second shot by August 1. As many as seven out of 10 college students believe COVID-19 vaccination should be required for students and staff to return to campus.

ASTHO has identified over 30 bills introduced across 26 states which would limit the ability to require COVID-19 vaccination as a condition of enrollment. Some of the bills have broad limits on any vaccine requirement for school enrollment. For example, in West Virginia HB 2289 would have eliminated the state’s existing vaccination requirements for enrolling in school or a state regulated child care-centers. Other bills focus on the COVID-19 vaccine by explicitly prohibiting schools, colleges, and/or universities from requiring the vaccine for enrollment or broadly prohibiting all government entities, agencies, and employees, in which educational institutions may be included, from establishing pre-enrollment COVID-19 vaccine requirements. Still, other bills would establish COVID-19 vaccine enrollment requirements for post-secondary education students.

At least four states (Alabama, Arkansas, Tennessee, and Utah) enacted laws that prohibit governmental entities from requiring a person to receive a COVID-19 vaccine as a condition of receiving services, which include state operated or funded institutions of education. For example, Arkansas enacted HB 1547 which prohibits a government entity from requiring the COVID-19 vaccine within two years of the vaccine’s approval by the FDA. Currently, all the COVID-19 vaccines are authorized by the FDA but have yet to receive BLA approval. Specifically, the bill prevents schools from requiring COVID-19 immunization or proof of vaccination status. However, if a new COVID-19 variant emerges before the two year mark that is more likely to affect children, then government officials will meet and determine if and what action should be taken. In Utah, a new law (HB 308) prohibits a governmental entity, defined to include institutions of higher education, from directly or indirectly requiring an individual receive a COVID-19 vaccine that is authorized by the FDA but has not received BLA approval. The Utah law make an exception for certain healthcare facilities.

Other states considered bills that specifically prevented educational institutions from requiring the COVID-19 vaccine. For example, Alabama passed SB 267, which prohibits educational institutions from adding additional vaccination requirements for enrollment after Jan. 1, 2021. Essentially this bill precludes the addition of a COVID-19 vaccination requirement since no schools in the state required the vaccine before Jan. 1, 2021.

States such as Iowa are considering bills that would prevent specific types of post-secondary education from requiring the COVID-19 vaccine. Iowa’s HF 330 would prohibit an educational institution that provides clinical experience to require a COVID-19 vaccination. This legislation covers staff, students, and interns participating in clinical education like what is provided at nursing schools, teaching hospitals, and university systems connected to medical schools.

Similarly, states are considering bills that affect only certain levels of education. Some states like Alaska’s HB 175 would specifically prohibit the University of Alaska to require COVID-19 vaccinations for their students and staff. In Arizona, a set of bills (HB 2897 and SB 1825) were introduced to prohibit the Arizona Board of Regents and any university under the board’s jurisdiction from requiring university faculty, staff, and students to receive the COVID-19 vaccine. Another set of bills in Wisconsin (AB 347 and SB 375) would not only prohibit the University of Wisconsin system from requiring students receive a COVID-19 vaccine but would also disallow student COVID-19 testing requirements. Finally, bills in Washington state (SB 5144) and New Jersey (A 5611) prohibiting any college or university from requiring students to receive the COVID-19 vaccine were also introduced this year.

Conversely, some states are considering legislation that would add a requirement that students receive the COVID-19 vaccine. For example, New York (A 7829) would add the COVID-19 vaccine to the existing required vaccinations for college students in the state. Massachusetts recently introduced SD 2608, which would direct community colleges to “require COVID-19 vaccine immunization for all students and employees on every campus enrolled in on-campus learning.”

With new school years beginning in a few months and the eventual approval of the COVID-19 vaccine for children under the age of 12, more policymakers will soon consider and decide whether to include the vaccine in school enrollment requirements. ASTHO will continue monitoring these considerations and decisions and inform its members of this critical public health issue.