Education Week - October 20, 2021 - 7

the 1960s. The measles vaccine and the public's reaction
to it demonstrate how the public's response
to vaccinations can be difficult to predict.
Not all diseases and vaccines spur the same
reaction among parents
The first measles vaccines were approved in the
U.S. in 1963. Yet many parents at the time and in
subsequent years were less eager to have their children
vaccinated against measles than they were
nearly a decade earlier, when the polio vaccine became
broadly available.
" Measles was seen as part of childhood, and not
as dangerous " as polio, even though measles did
(and still does) have serious effects on children,
Schupmann said. " It didn't have the same fear
associated with it as polio did. As a result, public
health officials had a more difficult time encouraging
vaccine uptake. "
To a certain extent, that matches reactions among
some parents who believe their children don't have
a huge need for the COVID-19 vaccine, and indeed
might be harmed by it.
Yet measles outbreaks continued to present a seriplace
in schools with strong public-health infrastructure
already in place, as well as in communities
that had already indicated an interest in being
part of a trial.
Schools collaborated with county health officers,
parent-teacher associations, and politicians,
among others, to promote the effort. A famous
picture features a teacher in her classroom near a
blackboard with the message: " We are among the
first children ever to be given Polio shots. So we are
really making History today. " Trailers in theaters
promoted the effort.
And consent forms sent to parents were framed by
schools as a " request to participate. " That language
underscored the idea that people were taking part
in a positive endeavor with broad benefits, rather
than an unwelcome imposition. In addition, experts
found that schools often relied not so much on direct
coercion as a " pervasive sense of obligation " among
parents, according to a study by Schupmann.
A December 1954 study of parents in Virginia
schools that participated in the polio vaccine trial
found that among mothers who attended " orientation "
sessions at schools about the trial, 75 percent
subsequently gave consent for their children to participate,
while only 41 percent of mothers who did
not attend those sessions gave consent.
" Schools, in that era, were both a focal point in
generating the knowledge that the vaccine worked,
and sites for where the vaccine was made available
following its approval, " said Schwartz.
Media organizations often played a major role in
promoting the trial, both as local institutions as well
as in their coverage. When Randall Kerr became
the first child to get the vaccine as part of the trial
at a school in McLean, Va., in April 1954, his picture
was featured prominently in newspapers across the
country. Media outlets and others also promoted
the children who participated in the trial as " polio
pioneers, " as well as touting the vaccine's efficacy.
" The press reported some controversy over the use
of the Salk vaccine, but was preponderantly favorable, "
three researchers reported in the 1954 study.
Parents' willingness to have their children participate
was also correlated with their educational
attainment. The same Virginia study found that
consenting mothers were much more likely to have
attended college than those who withheld consent.
Factors that affected the polio vaccine trial are
different today
All of that aside, some long-standing factors that
contributed to polio vaccination efforts, and corresponding
community trust in them, might have less
relevance for schools' efforts to increase COVID-19
vaccinations.
The National Foundation for Infantile Paralysis,
over many years, used its network of local chapters
to generate energy, excitement, and donations
through tactics like the nationwide " Mothers'
March. " Celebrities and cultural icons ranging
from Helen Hayes to Mickey Mouse were enlisted
to promote the work, a strategy that continued
after the vaccine trial to highlight polio inoculations
through public figures like Elvis Presley. And
the foundation had the prominent backing of
President Franklin D. Roosevelt, himself a victim
of polio.
No such time and preparation has been afforded
to groups fighting the pandemic today, although celebrities
have participated in efforts to promote the
COVID-19 vaccine.
Another factor in earlier efforts was parents'
acute fear of polio's impact on children in particular.
The disease inspired enough dread for parents
to keep their children indoors and away from
facilities like swimming pools and playgrounds.
A polio outbreak also closed Chicago schools in
1937. The fact that COVID-19 has largely affected
adults, especially the elderly, has created a different
environment for parents when weighing the
risks of the virus.
Still, the media environment in previous eras was
not wholly free of misleading or baseless claims
about the vaccine.
In April 1954, the national columnist and broadcaster
Walter Winchell warned his audience that the
polio vaccine undergoing a trial might be a " killer, "
and that it had killed several monkeys. Winchell was
misleading his audience.
Nevertheless, fearful that the message would disrupt
the trial, Salk-with the help of his local newspaper,
the Pittsburgh Post-Gazette-immediately
rebutted Winchell's claim, which did not ultimately
halt or dramatically affect the trial and subsequent
vaccination campaigns.
In the 1950s, the anti-vaccine movement was at
a relatively low ebb, and did not have the weight it
does today. And though Winchell was influential,
" social media and the internet can help theories,
hypotheses, and doubts find a sympathetic audience
far more quickly " now than during the polio
era, Schwartz said.
That's not to say the rollout of the polio vaccine
proceeded without problems, or tragedy. In the
" Cutter Incident " in 1955, 10 children died and
hundreds suffered paralysis after receiving a defective
version of the vaccine. That ultimately did not
scuttle the inoculation campaign itself, although it
had long-term consequences concerning vaccine
production and lawsuits.
The CDC has noted that despite state vaccine
mandates, enforcement of them was " uneven " in
In this July 29, 1962 file
photo, a family is given
the Sabin oral polio
vaccine in Richardson,
Texas.
ous health risk in places like Los Angeles for years
after the first vaccines came out. And the different
approaches between neighboring school communities
in various states could lead to very different
consequences.
The city of Texarkana, which straddles the Arkan "
Schools,
in that
era, were both
a focal point in
generating the
knowledge that
the vaccine
worked, and sites
for where the
vaccine was
made available
following its
approval.
JASON SCHWARTZ
Associate professor of public
health at Yale University
sas-Texas border, experienced a measles outbreak
for several months beginning in 1970. Experts who
studied the disease there in children ages 1-9 found
that in Texarkana, Ark., the rate of infection was far
lower than in Texarkana, Texas; roughly 95 percent
of cases were in Texas. They estimated that 99 percent
of children on the Arkansas side-where there
had been robust measles-vaccination campaigns for
children in school and preschool-had been vaccinated,
compared to 57 percent on the Texas side,
where no such efforts had taken place.
In response to such outbreaks and lagging vaccination
rates, states, with the support of the federal
government's 1977 Childhood Immunization Initiative,
pushed to dramatically expand vaccinations for
students for measles and several other communicable
diseases, in conjunction with mandates tied
to school attendance.
But vaccine hesitancy and refusal continue to
keep measles outbreaks as a notable problem for
public health.
Schupmann also noted that health officials have
pushed to vaccinate students against rubella with the
specific purpose of protecting not just those children,
but pregnant women. Congenital rubella syndrome
can result in serious birth defects among infants, as
well as miscarriages and stillbirths.
In the same way, COVID-19 vaccinations among
students are promoted in large part to help protect
vulnerable adults, in addition to children themselves.
Offit said long-standing and broad school vaccine
mandates in states like Mississippi, which for
decades has not allowed for religious or philosophical
exemptions, have shown that " you can compel
people to do the right thing. "
Whether that carries over to COVID-19 vaccine
mandates is very much an open question. Mississippi
Gov. Tate Reeves, a Republican, has indicated his opposition
to mandating the COVID-19 vaccine for students
(at least until it progresses beyond emergency
use authorization) in his state, which in September became
the state with the highest COVID-19 death rate.
At the same time, Schwartz said vaccine-education
efforts by school nurses as well as other staff
have proven crucial to sowing support and reducing
resistance to the vaccines, well in advance of official
vaccine approvals and subsequent mandates. In
short, the influence educators have demonstrated in
the past might not have vanished completely.
" It's those sorts of one-on-one, trusted sources
of information that have been shown to be a really
important way for people who have concerns or
anxieties about vaccines [to] have those concerns
addressed, " he said.
EDUCATION WEEK | October 20, 2021 | www.edweek.org | 7
Ferd Kaufman/AP
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Education Week - October 20, 2021

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