Education Week - October 20, 2021 - 6

Schools Helped Defeat Polio and Diphtheria.
Can They Do It With COVID?
By Andrew Ujifusa
As educators work to help vaccinate students
against COVID-19, the history of schools' involvement
with past inoculation efforts shows how
teachers, principals, and others in the K-12 world
can have a significant influence on the views of parents
and others.
But the current cultural atmosphere-rife with
partisan conflict and distrust in public institutions-
also has many public health experts worried that
what worked in the past faces a far higher lift in the
current pandemic.
In fights against diphtheria and polio in the 1920s
and 1950s, respectively, schools played a central role.
They hosted information sessions, coordinated with
local civic groups and the media, and commanded
trust in their communities. Experts saw the influence
of teachers, principals, superintendents, and other
educators not just as helpful, but crucial.
" Schools have been critical sites for where public
health officials for generations have thought about
the importance of high vaccination rates, " said Jason
Schwartz, an associate professor of public health at
Yale University who studies the history of medicine
and serves on a COVID-19 vaccine advisory group
for Connecticut Gov. Ned Lamont, a Democrat.
But a precipitous decline in trust in government
since the 1950s, skepticism or outright hostility toward
vaccines in recent decades, and a fragmented
media environment where a blizzard of influencers
and outlets compete for attention, are among the
potent forces that-separately and combined-have
changed the landscape for school leaders and others
now facing an unprecedented test of public health.
The time when schools as institutions participated
eagerly in nationwide trials to assess the viability
of newly developed vaccines also is long gone.
Students ages 12 and up are eligible to receive the
Pfizer-BioNTech COVID-19 vaccine, and emergency
authoritzation for that shot for children ages
5-11 is expected this fall. Different perceptions of
COVID-19's impact on children, compared to
widely feared diseases in the past, also play a role
in the current debate; vaccination rates for eligible
school-age children have lagged behind those of
adults, although vaccines for those children have
been authorized for less time.
Some recent polling has shown parents growing
more comfortable with having their younger
school-age children vaccinated, although other
survey data indicates there's a large share who oppose
the idea.
Schwartz said educators who know how to build
trust in local communities can still be valuable in
boosting vaccinations. But there's also concern
that current conditions will continue to make
things difficult.
In the era when the polio vaccine was developed,
and even before, " people generally trusted public
health officials. They trusted the government, the
pharmaceutical industry, " said Dr. Paul A. Offit,
the director of the vaccine education center at Children's
Hospital of Philadelphia. " It's a much more
cynical, much more litigious time. "
Court rulings and New York City schools served
a key role
The roots of requiring vaccines to attend schools
go back to the 19th century. In 1827, Boston required
students to show proof that they had received the
smallpox vaccine in order to attend public schools.
It is considered the first U.S. city to adopt such
a mandate. Smallpox vaccine requirements for
schools spread at roughly the same time that states
In this April 1955 file
photo, 1st and 2nd
graders are inoculated
against polio with the
Salk vaccine in Los
Angeles.
began adopting basic requirements for public education
services.
In a landmark 1905 ruling in Jacobson v. Massachu "
Schools
held
a great deal
of power in
communities,
especially in
the early 20th
century, as laws
mandating
attendance were
adopted and
strengthened
nationwide.
WILL SCHUPMANN
Doctoral student in sociology
at the University of California,
Los Angeles
setts, the U.S. Supreme Court upheld the right of the
state to implement penalties for those who did not
receive the smallpox vaccine. By 1915, according
to research by public health expert J.J. Hanlon, 21
states had adopted laws or rules empowering local
jurisdictions to implement vaccine mandates, while
nearly half the states had adopted vaccination requirements
for school attendance by the start of the
20th century, the CDC has reported.
And in its 1922 Zucht v. King ruling, the Supreme
Court upheld a San Antonio, Texas, ordinance requiring
all schools in the city to publish lists of teachers
and students and whether they had complied
with a mandate to get the smallpox vaccine.
But the year before that ruling, another significant
development took place in the history of schools and
vaccines when William Hallock Park led testing of
treatment that might confer immunity from diphtheria
on 50,000 students in New York City schools.
Although there was significant parent resistance to
the idea, Park's partnership with educators proved
crucial to the effort, which required parental consent.
Principals wrote letters to parents emphasizing the
importance. When teachers handed out permission
forms to students, it implied that they (and the schools)
backed the effort. Park said at the time that success or
failure " depends largely " on educators' backing.
" School officials' active support for the trial was
so valuable that Park reported obtaining consent
from three-fourths of the parents when principals
and teachers were enthusiastic about it, but only
one-fourth when they were not, " Will Schupmann,
a doctoral student in sociology at the University of
California, Los Angeles who has studied the history
of vaccines and schools, wrote in a 2018 analysis of
the diphtheria trial.
Such actions presaged schools' later involvement
in vaccination campaigns.
Broader circumstances helped the effort as well. It
was a time when signature Progressive Era reforms
impacted schooling. Educators, as well as doctors
employed by schools, helped diagnose student ail6
| EDUCATION WEEK | October 20, 2021 | www.edweek.org
ments, and schools were seen as crucial in the fight
against communicable diseases.
" Schools held a great deal of power in communities,
especially in the early 20th century, as laws
mandating attendance were adopted and strengthened
nationwide, " Schupmann wrote, even though
there was notable resistance to Park's work.
And the early 20th century was what Patrick Radden
Keefe has referred to in the book Empire of Pain
as " the golden age of American medicine ... when
the efficacy of medicine-and the credibility of the
medical profession-were greatly enhanced by new
scientific discoveries. "
How schools used obligation and partnerships
to promote the polio vaccine trial
Perhaps the most famous instance of schools' involvement
with vaccines is the case of the polio vaccine,
which underwent a trial involving more than
1.8 million children in 1954, and which eventually led
to a nationwide vaccination campaign. It's an often
cited example of how public health officials can successfully
cooperate with educators and the general
public.
Yet the success of that trial and the subsequent
ways in which schools aided polio vaccinations
doesn't necessarily translate into easy and relevant
lessons for educators today.
Researchers and others settled on schools as the
most logical and large-scale solution to put Dr. Jonas
Salk's new polio vaccine to the test. When the polio
vaccine trial got under way, schools worked with institutions
in several ways to promote the vaccine trial, and
also relied on the social respect for educators. And they
stressed how the trial represented a community effort.
The National Foundation for Infantile Paralysis,
which eventually became the March of Dimes, distributed
leaflets with information about the trial to parents,
a source that was especially important to parents
who consented to their children's participation. Since
it was established in 1938, the group had worked to find
a cure for and raise awareness about polio for more
than a dozen years before Salk developed the vaccine.
The foundation also pushed for the trial to take
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