Should Unvaccinated Kids Stay Home?

Jan 28, 2014

That depends on your priorities. But first, here's what's at issue:

If the health department's proposed immunization rule changes take effect, school kids who haven't been vaccinated against a vaccine-preventable disease (including the flu) would have to stay home until the outbreak is over. They'd be expected to get the seasonal flu vaccine starting as early as it's recommended by experts (six months) and up through 59 months (or five years old). And they'd have to get the HPV vaccine before entering ninth grade. You can read the full regulations here.

Flu vaccine-filled syringes ready for administering at a workplace vaccine clinic.
Credit Kristin Gourlay / RIPR

Kids could be exempted from the regulations with a doctor's note or if their parents sign a form that says their religious beliefs are in conflict.

As you might imagine, the proposals have drawn fire, including from the ACLU of Rhode Island. They expressed opposition to the proposals at a public hearing on January 16. You can read their objections here. One objection is to requiring the flu vaccine so young, in part because babies might have an allergy to eggs (which are a component of some vaccines) that hasn't shown up yet - and, therefore, how could a doctor have documented it? - and partly because parents should have the right to make medical decisions for their own children. The ACLU also argues that the flu vaccine isn't 100% effective. What's more, says the organization, keeping kids home from school during a flu outbreak would pose an economic hardship on many parents, and harm kids' progress in school.

If you keep an unvaccinated kid at home during a flu outbreak, you might prevent him from coming down with the flu. You might also prevent him from spreading it to others. Then again, you might not.

Further, the ACLU argues that excluding "middle and high school students who are unvaccinated against HPV is additionally inappropriate, because HPV is unlikely to spread in the school environment," as HPV typically spreads through sexual contact (and the assumption, I guess, is that middle schoolers aren't as likely to have sexual contact).

The health department's argument is that its job is to protect the entire community, and especially the most vulnerable among us. Widespread vaccines, such as for the flu, health department director Dr. Michael Fine has told me on many occasions, are our best bet for protecting ourselves against the flu. And by ourselves, he means not only those who are able to get the vaccine, but those who can't for medical reasons (such as people with compromised immune systems).

Here's something I don't think anyone can argue with: If you keep an unvaccinated kid at home during a flu outbreak, you might prevent him from coming down with the flu. You might also prevent him from spreading it to others. Then again, you might not.

Here's what the experts and the data say:

  • The CDC's Advisory Committee on Immunization Practices recommends that everyone ages six months and up be vaccinated against the flu, for instance.  That's because fFlu-related hospitalization and death rates are higher among infants and young children. During the H1N1 influenza outbreak of 2009-2010, about 300 kids are estimated to have died from the flu.
  • Based on my search of the Vaccine Adverse Event Reporting System (VAERS), there have been about 50 adverse reactions to the flu vaccine, ranging from a mild reaction to a life-threatening (such as an anaphylactic or allergic) reaction, among kids ages six months to five years old in the past 40 years.

Lots of ink has been used writing about the ethics of vaccination programs, mandates, and refusals. If you're interested in pondering those questions, here are a few links you might like to check out.

  • NYU bioethicist Art Caplan on the morality of influenza vaccine mandates. Caplan has even argued that those who don't vaccinate should be liable for putting others at risk.
  • The Hastings Center (one of the nation's oldest nonpartisan bioethics think tanks) has this review of the ethics of "non-pharmaceutical" interventions during a flu pandemic - things like quarantines, wearing masks, etc.
  • Lawrence Gostin is a public health law scholar at Georgetown. Here's his rundown of the ethical considerations at the intersection of public health and personal liberty. One key question: "How do we know when society should choose individual autonomy over the common good, or vice versa?"