The next vaccine exemption debate: ‘My child, my choice’

The options for Americans who refuse to get vaccinated are rapidly shrinking. President Biden’s blanket COVID-19 vaccine mandate for federal workers or contractors and companies with over 100 employees means that vaccination is required for over 100 million people.  Only some workers under the mandate have the alternative of weekly testing — the rest, face seeking alternative employment if they do not take the jab. Over two-thirds of unvaccinated Americans have indicated that they would quit their job rather than be vaccinated, although many more are submitting to vaccination than expected. 

Exemptions based on religion and health have been ubiquitous. However, no religious entity in the U.S. has provided any written doctrine that mandates against vaccination. The Roman Catholic Church went so far as to label the choice to be vaccinated “an act of love”.   

Health-based exemptions to vaccination have also proven to be long on emotion but short on substance, with few medical conditions in existence that would prevent a person from vaccination.  

The next exemption war is poised to begin in the very near future. 

Pfizer recently reported the effectiveness of their vaccine for children 5 to 11 years of age, and has applied for FDA emergency use authorization, with plans already under way by the Biden administration to vaccinate these children. This would make around 28 million children in the population eligible for COVID-19 vaccination.   

Children in this age group are typically in grades K-6. Parents and guardians of this cohort have say over their children’s health, which means that “my child, my choice” will be the mantra for those who oppose vaccination. As such, areas with low vaccination rates among adults will likely have low vaccination rates among their children. This will effectively creating uneven vaccination coverage not only across school districts, but even within classrooms. 

Given that many K-12 schools mandate vaccines against diseases like measles, mumps and other infectious diseases, it is reasonable that the COVID-19 vaccines will be added to this list once they gain full FDA approval for this age cohort. California became the first state to make this announcement; it will not be the last. 

Even in areas with high vaccination rates, a small fraction of students is likely to remain unvaccinated in every school. Local herd immunity may protect the school community, although breakthrough infections among the most vulnerable, like older teachers, may still occur. 

One issue of concern is that younger people have been at greater risk of myocarditis following their second mRNA vaccine dose. To put this into perspective, the risk of myocarditis for children who become infected is 37 times higher than for those uninfected. Moreover, the reduced vaccine dose should mitigate some of these effects. Nonetheless, this condition will require monitoring. 

As the footprint of vaccine-eligible people continues to grow, so will the number of people seeking exemptions and ways to avoid vaccination.  

Vaccine exemptions provide reasons to avoid vaccination, yet human nature is such that the desire to avoid vaccination often precedes the reason rather than follows it. Whether the reason is medical, religious or personal, simply saying “no” to a vaccine without a justifiable reason during a pandemic is problematic for community health.   

The population health risks associated with the vaccines is exceedingly small. Ironically, those who still refuse vaccination are also willing to seek off-the-shelf and sometimes dangerous remedies when not taken appropriately, like Ivermectin, for which no reliable studies have been reported to establish its clinical benefits against COVID-19.   

The takeaway from avoiding vaccination is that there is nothing rational about such decisions. Unfortunately, with 5- to 11-years-olds soon to be eligible for vaccination, some of them will be subject to the same irrational thinking of their parents or guardians.  

The good news is that even if just 40 percent of those 5= to 11-year-olds are vaccinated, then over 11 million additional people in the population will be protected, increasing the population vaccination rate by 3 percent.   

In a pandemic like this, every person vaccinated counts, effectively moving us closer to a safer environment for all.  

Sheldon H. Jacobson, Ph.D., is a founder professor of Computer Science and the Carle Illinois College of Medicine at the University of Illinois at Urbana-Champaign. He applies his expertise in data-driven risk-based decision-making to evaluate and inform public health policy. Follow him on Twitter: @shjanalytics

This piece has been updated.