Efforts to curtail the spread of COVID-19 now center on vaccinating against the coronavirus, but the drive has led to heated debates in schools and districts nationwide.
a social and behavioral scientist and health communication scholar at the Johns Hopkins Bloomberg School of Public Health on Wednesday will release a free series on how educators can train leaders, teachers and parents to become 鈥渧accine ambassadors鈥� to communicate better with parents and community members who have concerns about vaccinating children. Education Week spoke with Limaye about schools鈥� role in vaccinating students and staff.
The interview is edited for length and clarity.
We鈥檝e now had COVID-19 vaccinations available for those 12 and up since last May and 5-11 children since November. Where are we, nationwide, in getting all school-age children vaccinated?
It鈥檚 really varying across the states. So, for example, in Northern Virginia where I live, it has been amazing how many people have done it; more than 50 percent of kiddos between the ages of 5 and 12 have gotten the vaccine. But if you look at it from a nationwide perspective 鈥� it鈥檚 only been about 20 percent so far of 5- to 11-year-olds have gotten at least one dose. In this area, we had to wait to get our kids in 鈥� but then I talked to other parents in Oklahoma and they鈥檙e like, there鈥檚 no line, no one is bringing their kids. So the problem is that it鈥檚 been very uneven. And there are a lot of parents who are like, I got the vaccine, but I don鈥檛 feel comfortable with my kid getting it.
Why have vaccinated parents been slow to get their children immunized?
The reason that we鈥檙e essentially hearing鈥攁nd parents have been very upfront about this鈥攊s that at this point, like if you are an adult, you have tons and tons of data that you can look upon for people that have gotten the vaccine. Millions of people have gotten it with very, very few issues. With kiddos, the data that came out when [the Food and Drug Administration] approved [Pfizer vaccines for 5- to 11-year-olds] in November, the trials had only included something like 2,000 to 3,000 children. So, from my perspective, can we give parents just a minute? You know, let鈥檚 let them talk to other parents. Let鈥檚 give them a second.
I think the other issue that we were seeing with kiddos specifically in that age range is just, most kids aren鈥檛 having really severe COVID. So then the question really was well, if most kids aren鈥檛 going to get hospitalized or aren鈥檛 going to have major issues, why should I get my kid vaccinated?
Over the last three weeks, there鈥檚 been a record increase in pediatric hospitalizations. So, I think parents are starting to see that, oh, people should stop calling the [omicron] variant mild. It鈥檚 mild when you鈥檙e comparing it to delta hospitalizations [overall], but this is really the first time that we鈥檝e seen hospitalizations at the numbers that we have in this age group specifically. That鈥檚 really concerning.
But my bigger question as a parent with two kids under age of 11 is, what about the long-term effects of this? We鈥檙e starting to hear this from doctors that it鈥檚 not just about hospitalizations, that it鈥檚 more that we don鈥檛 know the long-term effects of long COVID in brain development of children.
How much of a role do schools really play in whether or not parents decide to vaccinate their children?
69传媒 are probably one of the most critical places where people are getting advice for [child] development in general. Yes, people go to their pediatricians about what they should be doing, but schools play a really important role because it鈥檚 also a congregate setting. You have children together 鈥� and so we鈥檙e starting to see more and more teachers get engaged in this space鈥攁nd not only teachers, but school nurses and just other parents that can talk about the importance of vaccination. 鈥�
HPV [the human papilloma virus vaccine] is a perfect example: A lot of parents didn鈥檛 really listen to pediatricians. They were really just talking to other parents to figure out whether or not they should get their kid the HPV vaccine. And I don鈥檛 think it鈥檚 any different here either. So I think it鈥檚 such a natural place to make sure that these conversations that parents are having with one another are based on evidence, and that correct information is really being communicated.
Our biggest concern, from a public health perspective, is that an increase in concern related to the COVID vaccine may spill over to other vaccines. Pre-COVID, the biggest issue that parents had with regards to vaccination was related to the measles vaccine, because there was a study that showed that there was a link between autism and measles鈥攅ven though the study was retracted and the person that wrote it lost his medical license. But that rumor has persisted, and so talking to parents, [the measles vaccine] would be the one that people were most hesitant with regards to routine vaccination. 鈥� Now the concern is, if people are in general more distrustful of the government, which I think we are seeing, how is that now going to impact all these other vaccines we recommend?
Should schools provide vaccines on site, or is it better for them to play a less-direct role?
When you look at other vaccine programs in schools, we know that by offering them in schools, it really removes a lot of barriers for parents: making an appointment, taking time off work, just being able to manage everything.
What are the most common mistakes you see school and district leaders making when talking to parents about vaccinations?
The first one is being dismissive. The second is automatically rejecting when people bring up misinformation, just essentially saying, 鈥渘o you鈥檙e wrong,鈥� which has not been helpful in any way, shape or form. For example, when I talk to people that are hesitant, often they鈥檙e just like, 鈥淚 don鈥檛 want the vaccine because there鈥檚 a microchip in the vaccine.鈥� Now, there鈥檚 no microchip in the vaccine. 鈥� But it鈥檚 important for me to not be dismissive of that [concern] and not correct that misconception 鈥� without really being careful about how you respond. If you put someone on the defensive鈥攚hich I think is what ends up happening in a lot of these conversations鈥攖here鈥檚 no way then that this person is going to engage with you.
The third mistake is using authority. I think sometimes school nurses or teachers will think, 鈥淚f I say it, they鈥檙e going to do it.鈥� But it鈥檚 really important that it鈥檚 a shared decisionmaking conversation.
Are there strategies for better communication about vaccines?
There are all these different techniques that have been tried and effective in the vaccine space, that we鈥檙e actually teaching again to individuals who are not in public health, like 鈥減resumptive communication鈥� and 鈥減re-bunking.鈥�
In presumptive communication, you structure your conversation in a way that assumes that vaccination is the default or the norm. So if I鈥檓 having a conversation with you and you have a 10-year-old 鈥� I would say, 鈥楬ey, your son is 10. When are you gonna sign the person up for the vaccine?鈥� We鈥檝e seen a lot of success in this, for example when doctors say that the normal behavior is that you get your child the vaccine.
Another technique is called pre-bunking. One of the major issues that we鈥檙e seeing is that parents, administrators, nurses are confronted by so much misinformation. So essentially think of pre-bunking as a way to give yourself a vaccine to identify and reject misinformation. You teach how to look for telltale signs that something that you鈥檙e reading is actually not based in evidence. That has been really critical because there鈥檚 a lot of information out there and people have a hard time discerning what is real and what鈥檚 not real.
Many districts are also debating whether or not to require vaccines of their employees or students. Are mandates effective or not in getting people fully vaccinated?
We do know that mandates work, particularly at the school level. If you look across different districts that have mandates, they have really helped keep community transmission [of the coronavirus] down. 鈥� And so, mandates have been very effective with regards to keeping kids safe and also keeping kids in schools 鈥� because if teachers aren鈥檛 also vaccinated and a teacher gets [COVID-19], that leads to a staffing shortage. Just in the last two weeks there are states where schools are shutting down because everyone is out with COVID.
With dominant variants like delta and omicron causing more breakthrough infections among people who are fully vaccinated, how should school leaders think about whether to shorten quarantine and isolation limits, as the CDC recently has suggested?
The reason that [schools] are able to do [shorter quarantine periods for vaccinated people] is, if you鈥檝e been vaccinated and you get a breakthrough infection, we have seen consistently that you have a shorter infectious period. If you鈥檙e not vaccinated, you鈥檙e more likely to do something called viral shedding through your nasal mucus 鈥� and you may still have COVID viral shedding 10 days after you got infected. If you are vaccinated and you get infected, the viral shedding is shorter, the symptoms are also shorter and also tend to be less severe, so you鈥檙e just less likely to transmit it.
