Education Week - September 30, 2020 - 10

When There's a COVID-19 Vaccine, School
Employees Could Be Among the First to Get It
Schools also expected to play
a big role in mass inoculations
once a coronavirus vaccine is ready
When a COVID-19 vaccine is finalized and approved, schools will serve a
key role in administering it, and educators may be among those to receive the
earliest available doses, a new federal
plan says.
That plan positions U.S. schools,
which have experienced unprecedented disruption because of the
pandemic, as a crucial partner in one
of the largest public health operations
in recent memory.
Public health officials compared
the scale of the plan to the U.S. campaign to inoculate millions of children
for polio in the 1950s. More recently,
schools helped distribute millions of
vaccine doses for H1N1, also known as
swine flu, in 2009.
"In normal circumstances [school]
is where children and adolescents are
every day," said Suzanne Mackey,
policy director for the School-Based
Health Alliance, an organization that
advocates for medical care in school
settings. "It removes many barriers,"
such as transportation, for hard-toreach students, and families trust
schools as a place for their children to
receive care, she said.
And, even as some schools remain
in remote-learning mode, their experience in administering health screenings and more routine inoculations
makes them an effective partner, she
said. Schools often hold drive-through
clinics and pop-up events to provide
mandatory vaccines for illnesses like
measles.
But education and public health officials may face some hurdles before
children and their families are vaccinated for COVID-19 on a large scale.
A financial crisis has led to downsizing
of some school-based health centers,
public opinion polling shows concerns
about the safety of the vaccines, and
scientific trials have largely focused on
adults, who are more likely to grow severely ill from the virus than children.

A Federal Distribution Plan
Four pharmaceutical companies
have been cleared for large-scale U.S.
trials of potential COVID-19 vaccines.
The U.S. Department of Health and
Human Services released a plan Sept.
16 that outlines how it will quickly
work with states to distribute doses
when an effective vaccine is identified.
The 57-page plan leaves many
blanks for states to fill in. Testifying
before a Senate committee Sept. 23,
Robert Redfield, director of the Centers for Disease Control and Prevention, said he expects states to develop
their own plans by Oct. 16.

The national plan anticipates an unspecified lag time before production
will ramp up to the point that doses
will be broadly available to the general public. Depending on the specific
characteristics of the vaccine that is ultimately selected, initial doses will be
provided first to "critical populations,"
the plan says.
The first wave of critical populations,
which will be identified by the CDC's
Advisory Committee on Immunization Practices, may include people
with health vulnerabilities, the elderly,
and health care providers who work
with COVID-19 patients.

Educators on Priority List?
The second wave may include
people at increased risk of acquiring
or transmitting COVID-19, which
includes employees of schools, childcare centers, colleges, and universities,
the plan says.
That may help address concerns of
educators in some areas who've expressed hesitation about returning to
in-person learning while virus rates
remain high.
But a vaccine won't likely eliminate
all risk. Anthony Fauci, the nation's
chief epidemiologist, told a Senate
committee Sept. 23 that it's not yet
clear whether the eventual vaccine
will function like a polio vaccine, which
eliminates the risk of contracting the
illness, or like a flu vaccine, which reduces risk of severe illness but does not
necessarily eliminate it. Also unclear is
how long the effects of the vaccine will
last, whether multiple doses will be required, and whether booster shots will
be required in subsequent years.
There is still value in treating all the
adults in a school building, said Oscar
Alleyne, an epidemiologist who serves
as chief of programs and operations
for the National Association of County
and City Health Officials. But because
children can contract and spread the
virus without showing symptoms, it
will take a much higher rate of vaccination before schools will be able to
ease mitigation strategies, like wearing masks and spacing desks far apart.
"If you are in a setting where you
do not have enough individuals vaccinated ... there isn't really that great
protection that's going to be offered
if there are still asymptomatic and
presymptomatic individuals who are
spreading this disease," he said.
Public health officials generally say a
population reaches herd immunity, the
condition in which enough individuals
been vaccinated to limit community
spread of an illness, when 70 percent
to 80 percent of people have been inoculated, Alleyne said.

10 | EDUCATION WEEK | September 30, 2020 | www.edweek.org

Kirsty Wigglesworth/AP-File

By Evie Blad

A clinical research nurse prepares to
administer a COVID-19 vaccination to
a volunteer at a clinic in London.

But late-phase clinical trials have
focused on adults, leading a group of
pediatricians to publish a commentary
in the journal Clinical Infectious Diseases calling for increased attention
to the needs of children so that there
is not a delay identifying a dose that
meets their needs. One member of the
Food and Drug Administration's vaccine advisory panel told The New York
Times that trials for children may not
begin until the first doses of the adult
vaccine are administered.
Also of concern: Growing public
hesitancy about vaccines in general
and a polarized political climate may
lead some to resist receiving the inoculation. In a Sept. 20 Axios-Ipsos poll,
just 39 percent of respondents said
they are likely to get the first generation COVID-19 vaccine as soon as the
initial doses become available.
The federal plan focuses on providing the vaccine to "those who want it."
And, because the vaccine is still under
development, no state has said it will
be required for school attendance.

The Role of Schools
As enough vaccine becomes available for the general public, states and
local health officials should work with
a variety of organizations, including
schools, to provide it broadly as quickly
as possible, the federal plan says.
School buildings could serve as locations for pop-up clinics administered
by hospitals or other health-care providers. Or school-based health centers, which are full-service primary
care providers that serve students,
may alter their operations to quickly
vaccinate children with their parents'
consent.
"The opportunity is there because
most parts of the country are at least
in hybrid learning," said Viju Jacob, the

associate medical director for schoolbased health centers at Urban Health
Plan, a New York-based provider that
administers clinics in about 280 public
schools. "If, even conservatively, I get
30 percent of the population immunized at school, that's 30 percent that
I don't have to serve at an alternative
location."
In response to H1N1, the organization's school-based health centers
quickly shifted operations, developing one-page consent and information
sheets for parents, Jacob said. While
other countries may be more familiar
with "conveyor belt"-style mass vaccine delivery, it's less common in the
United States, he said, making public
education efforts important.
Another limitation: Some schoolbased health centers have shuttered
while school buildings are closed. And
some have closed permanently, said
Mackey, of the School-Based Health
Alliance. About half of the country's
3,000 school-based health centers are
operated by federally qualified health
centers, charitable medical providers that receive enhanced Medicaid
reimbursement rates for serving lowincome patients.
But the rest are operated by hospitals, school districts, and states, leaving
them vulnerable to cuts in operations
and personnel as the economy suffers.
In some places, that may mean experienced personnel won't be available
to provide school-based vaccine clinics. The School-Based Health Alliance
plans to survey its members to determine the size of the cutbacks.

Plans Not Finalized
So when will a final vaccine be identified, sending public health officials
scrambling to execute a massive campaign? The timing is still unclear.
Some public health officials reacted
with skepticism after President Donald Trump pledged a vaccine would be
ready around the Nov. 3 election.

Fauci told lawmakers recently that
U.S. authorities would likely know "by
the end of this year" if one of the vaccine candidates is safe and effective.
Even now, the federal government is
ramping up production of the finalists
so that initial doses can be provided
quickly after one is approved.
But it may be April 2021 before doses
are provided on a larger scale, Fauci
said.
Alleyne, of the National Association
of County and City Health Officials,
said local health officials want much
more communication with state and
federal health authorities so that they
can be prepared to play a role.
As a county epidemiologist in New
York during the H1N1 outbreak, Alleyne saw firsthand how complicated
it can be to quickly distribute a vaccine
at a large scale. In some cases, large
shipments were sent to dentists rather
than targeted health providers, like pediatricians and obstetricians. In some
cases, hospitals received double shipments after their initial orders were
long delayed.
"There are some of us who still have
PTSD from that," Alleyne said. "I literally was driving around my county with
dry ice units collecting vaccines from
hospitals. You know, horse trading."
And COVID-19 vaccine distribution may be more complicated. It may
require storage at lower temperatures
than other medications. Some finalists require multiple doses, which will
make administration more complicated.
Whatever the timeline, schools won't
be able to change their operations overnight, public health officials agreed. It
will still be necessary to track cases and
take precautions in response to rising
rates of the virus until the vaccine has
been distributed widely enough to
drive down community spread.
"It's a multipronged approach,"
Alleyne said. "Vaccines themselves
aren't going to be the panacea. It's a
mixture of all of the above."

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Education Week - September 30, 2020

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