Parents were fine with sweeping school vaccination mandates five decades ago — but COVID-19 may be a different story

The ongoing battles for COVID-19 vaccination in the United States are likely to get hotter when the Food and Drug Administration approves the urgent use of a vaccine for children ages 5 to 11, which is expected later in the fall.

California has announced it will require the primary school attendance vaccine when it receives full FDA approval after authorization for emergency use, and other states may follow suit. COVID-19 vaccination mandates in workplaces and colleges have created controversy, and the possibility that a mandate may apply to younger children is even more controversial.

Children are already required to get a host of other vaccines to go to school. School vaccination mandates have existed since the 1800s, and they became fixtures in all 50 states in the 1970s. Vaccination requirements are among those most effective means of combating infectious diseases, but they are currently under attack by small but vocal minorities of parents who consider them unacceptable intrusion into parental rights.

As a health historian studying development of vaccination policies, I see major differences between the current debates on COVID-19 vaccination and the public response to previous mandates.

Mandatory vaccination earlier

That first legal requirements for vaccination dates from the early 1800s, when horrific and deadly diseases routinely terrorized communities. A loose piece of patchwork of local and state laws was passed to stop epidemics of smallpox, the era’s only vaccine that can be prevented.

Vaccine mandates originally applied to the general population. But in the 1850s, when universal public education became more common, people recognized that schoolhouses were likely places of spread of disease. Some states and localities began to adopt laws linking school attendance to vaccination. The smallpox vaccine was crude by today’s standards, and concerns about its safety led to numerous lawsuits over mandates.

The U.S. Supreme Court approved mandatory vaccination in two rulings. The first, in 1905, confirmed that mandates are constitutional. The other, in 1922, specifically complied with school-based requirements. Despite these rulings, many states lacked a vaccination law for smallpox, and some states that did have one failed to enforce it consistently. Few states updated their laws as new vaccines became available.

School vaccination laws underwent a major overhaul that began in the 1960s, when health officials became frustrated with it Outbreaks of measles continued to occur in schools although a safe and effective vaccine had recently been licensed.

Many parents mistakenly thought that measles was an annoying but mild disease from which most children recovered quickly. In fact, it often caused serious complications, including potentially fatal pneumonia and swelling of the brain.

Encouraged by the Centers for Disease Control and Prevention, all states updated old laws or passed new ones that generally covered all seven childhood vaccines that had been developed at the time: diphtheria, pertussis, tetanus, polio, measles, mumps, and rubella. In 1968 only half of the states had school vaccination requirements; in 1981, all states did.

Extended claims, mid-20th century

What is most surprising about this large expansion of vaccination mandates is how little controversy it provoked.

The laws drew scattered court challenges, usually over the question of exceptions – which children, if any, should be allowed to opt out of it. These lawsuits were often brought by chiropractors and other proponents of alternative medicine. In most cases, the courts rejected these challenges.

There were scarce public protests. Unlike today’s vocal and well-networked anti-vaccination activists, organized resistance to vaccination remained on the fringes of the 1970s, the period in which these school vaccine mandates were largely passed. Unlike today, when fraudulent theories of vaccine-related harm – such as the discredited view that vaccines cause autism, circulate endlessly on social media, public discussion of the alleged or actual risks of vaccines was largely absent.

Throughout most of the 20th century, parents were less likely to ask questions pediatricians’ recommendations than they are today. In contrast to the authorized “patient / consumer” today, an attitude of “doctor at best” prevails. All of these factors contributed to overwhelmingly positive views on vaccination, with more than 90% of parents in a 1978 poll reporting it they would vaccinate their children, though there was no law requiring them to do so.

Widespread public support for vaccination made it easy to pass laws – but it required more than putting a law on the books to control disease. Vaccination rates continued to lag in the 1970s, not because of resistance, but because of complacency.

Thanks to the success of previous vaccination programs, most parents of young children lacked first-hand experience of suffering and death that diseases such as polio or pertussis had caused in earlier epochs. But public health officials acknowledged that these diseases were far from eradicated and would continue to threaten children unless higher vaccination levels were reached. Vaccines were already falling victim to their success. The better they worked, the more people thought they were no longer needed.

In response to this lack of urgency, The CDC launched a nationwide push in 1977 to help states enforce the laws they had recently enacted. Around the country, health officials worked with school districts to review student records and provide on-site vaccination programs. When pushing came to push, they would exclude unvaccinated children from school until they had completed the necessary shots.

The teaching was that it takes continuous effort and commitment to make a law successful – and constantly remind parents of the value of vaccines to keep schools and entire communities healthy.

Add COVID-19 to school vaccination list?

Five decades after school mandates became universal in the United States, support for them is generally still strong. But misinformation spread across the internet and social media has weakened the public consensus on the value of vaccination that made it possible to pass these laws.

COVID-19 vaccination has been politicized in an unprecedented way, with sharp party-political distinctions as to whether COVID-19 is really a threat, and about guidance of scientific experts can be trusted. The attention focused on COVID-19 vaccines has provided new opportunities for conspiracy theories against vaccination to reach a wide audience.

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Strong resistance to COVID-19 vaccination, driven by anti-government sentiment and misleading notions of freedom, could undermine support for time-tested school requirements that have protected communities for decades. Although vaccination of school-age children will be crucial in controlling COVID-19, lawmakers need to proceed with caution.


James Colgrove, Professor of Socio-Medical Sciences, Mailman School of Public Health; Dean of the Postbaccalaureate Premedical Program, Columbia School of General Studies, Columbia University

This article was republished from The conversation under a Creative Commons license. Read original article.

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