To exempt or not to exempt: vaccines and student health

Classical utilitarian ethics—an ethical theory—dictates that the well-being of everyone is weighed equally in the pursuit of a morally-good life. Rapid developments in modern medicine and the raging COVID-19 pandemic have pushed policies governing vaccinations to the forefront of the battle over utilitarian ideals in modern American society. With state and local powers pushing for vaccine mandates, public distrust for vaccinations has grown. In order to protect their communities, state governments have required school children to be vaccinated against certain diseases since the 20th century. Yet vaccine exemption rates have only grown in school districts across the country. Who’s responsible for ensuring public health and safety in school children?

As students across the country shuffle into classrooms, COVID-19 vaccination requirements for schools remain a point of contention. This debate is not new. While vaccinations against a plethora of other diseases are required for enrollment in any California public school, each year a small but vocal community of people regularly seek vaccine exemptions for medical or ideological reasons. The responsibility to monitor these vaccine exemptions falls to state courts and medical boards, and the responsibility to ensure public safety via vaccinations is fraught with challenges.

“I do think that [the criteria for granting vaccine exemptions] resides in the hands of public health authorities and physicians,” said Dr. Katherine Herz, an attending hospitalist physician at the Children’s Hospital of Philadelphia in an interview with the Urban Legend. Herz explained that health decisions that affect only an individual child is a decision solely affecting the immediate family. “Vaccines are different,” said Herz. “When you vaccinate your child, that’s not just about your child’s health, it’s about your child’s friends’ and classmates’ health, and then their parents’ health. It’s about the health of everyone in their lives.”

Dr. Kim Newell Green, assistant clinical professor of pediatrics at the UCSF and immediate past president of the San Francisco Marin Medical Society, agrees. In the face of a pandemic or any severe disease, vaccinations become a tool that protects the larger community from serious harm. “We can keep people safe by having everyone who’s able to do so get vaccinated. That’s a public health question and not a question for an individual [or] an individual doctor,” said Newell Green.

Dr. Jeffrey Fineman, chief of pediatric critical care at UCSF Benioff Children’s Hospital, has witnessed firsthand the devastating effects of COVID-19 infection in unvaccinated kids. “[This] serious disease could have been significantly attenuated if they had been vaccinated,” said Fineman. “This was particularly true for our most vulnerable children with serious underlying disease[s].”

A critical issue during the pandemic has been the slow pace of vaccine development for children. “As a pediatrician, I do believe that vaccines should be developed for children in parallel [timing] with adults,” he said. Fineman believes that the lack of initial COVID-19 cases in children likely delayed the focus on vaccine development for children. “[This] represents a flaw in what otherwise was an incredible, historic campaign to develop safe, effective vaccinations in a very short period of time” Finerman said.

The battle against vaccination requirements has been shaped as a matter of individual freedoms and rights. “In America, we tend to focus so much on rights, to the exclusion of what those rights are meant to accomplish,” said Herz.

Newell Green believes that people should focus on more than just the individual. “As members of society, we have to be part of a larger societal discussion about how we protect each other,” said Newell Green.

Minimizing risks for school communities has been a crucial part of recovering from the COVID-19 pandemic. Maintaining safe school environments even outside of a pandemic requires certain public health rules. “Schools are not experts in health, so I think most schools do best when they listen to public health officials and do a reasonable job in partnering with public health agencies to follow mandates and be in conversation about how and why mandates may need to change,” said Newell Green. “Therefore, I think the school administration should be responsible for keeping schools safe.”

Just like other schools in California, and in line with utilitarian ethics, Urban follows California state mandates for vaccinations. In line with Newell Green’s belief, Head of School Dan Miller agrees that school administrations should be responsible for the school’s safety. “I believe state mandates are based on thoroughly vetted scientific evidence, and that the community health imperatives must sometimes infringe on individual freedoms.”