The battle to curb the spread of Covid-19 in schools is quickly moving to football fields and basketball courts.
While much of the pandemic-fueled culture war has centered on mask-wearing requirements in classrooms, major U.S. school systems are beginning to require teen athletes, band members and even after-school program participants to get vaccinated.
Eligible kids in Los Angeles public schools need their second dose of Pfizer’s vaccine by Halloween to join in-person extracurricular activities, including sports and after-school programs. Students 12 years old and up in Washington, D.C., public schools must be fully vaccinated beginning Nov. 1 to participate in school athletics. New York City students in “high risk” public league sports and extracurriculars must also get shots, while Chicago Public Schools has announced an athlete vaccine-or-test requirement.
And in Hawaii, one of the first states to require vaccines for students in school-sanctioned sports, the state education department pushed back the start of its fall athletics season entirely so players could be inoculated by the end of September unless they qualify for a medical or religious exemption.
“This is the beginning of a movement,” Fairfax County Public Schools Superintendent Scott Brabrand said in an interview. The Virginia system in suburban Washington, D.C., is home to nearly 190,000 students and requires winter and spring athletes age 16 and older to get Covid-19 vaccinations by Nov. 8. Younger athletes must take regular virus tests if they’re unvaccinated (those in the fall sports season, however, aren’t subject to the requirement).
“I am convinced that more districts, more states and governors are going to realize that to preserve American public education in person, and to preserve the American athletic experience, we must have vaccinations for our students and our athletes,” he said.
Forty-five percent of 12- to 17-year-olds — approximately 10.7 million children — were fully vaccinated against Covid-19 by Sept. 29, according to an analysis of federal data from the American Academy of Pediatrics. That’s helped fuel a new wave of vaccine requirements for K-12 students, showcasing the latest option to help control the pandemic, especially among children most likely to share crowded locker rooms and stadiums.
The requirements carry out urgent requests to get teen athletes vaccinated from the Biden administration, the American Academy of Pediatrics and national sports medicine associations. They also demonstrate the lengths to which educators, as well as city and state leaders, are willing to go to incentivize older kids to get inoculated — dangling the potential of losing out on a favorite pastime to push vaccine-hesitant families.
“I am very supportive — both personally and as secretary of Health and Human Services — of a school district, of a local jurisdiction, of a governor that says, ‘It is time to keep our kids in school safe and we will therefore move towards requiring masks or vaccinations,’” HHS Secretary Xavier Becerra told the Senate’s education committee on Thursday.
School administrators say they’ve already seen scores of students held out of in-person classes after exposure to infected teammates. These worries underscore warnings from national health officials about close unmasked contact between the unvaccinated in high-risk sports such as football and wrestling — plus activities that involve heavy breathing, singing, shouting, playing instruments or exercising indoors.
“Students doing extracurricular activities that involve close contact with other individuals would be at a higher risk of potentially contracting Covid-19,” said Tina Tan, an infectious disease expert from Northwestern University’s Feinberg School of Medicine and former board member of the Infectious Diseases Society of America.
“If you say these kids need to be vaccinated before they can play, then this sort of sends a message to other kids in different extracurricular activities that this is something they might need to do,” she said.
Expanding vaccination requirements for athletes and other students elsewhere in the country may still take time.
While Pfizer and BioNTech recently submitted safety and efficacy data on their vaccine for children between 5 and 11 years old to the Food and Drug Administration, an agency decision is likely weeks away. That vaccine is fully approved for those aged 16 and older, and available under an emergency authorization in adolescents between the ages of 12 and 15. Even then, governors and lawmakers in 16 states have enacted some kind of ban on student Covid-19 vaccine mandates, according to the National Academy for State Health Policy, including jurisdictions that have resisted President Joe Biden’s efforts to expand federal vaccine requirements for adults.
“Unvaccinated teens are 10 times more likely to be hospitalized” from Covid-19 than those who are vaccinated, Education Secretary Miguel Cardona said during a panel hosted by the National Federation of State High School Associations in September. “If we [wouldn’t] send players into a football game without their helmet and pads, or a soccer game without their shin guards, why would we send them into competition without getting vaccinated?”
School reopening guidelines from the Centers for Disease Control and Prevention include a blunt warning: High-risk sports and extracurricular activities should be virtual or canceled in areas where the virus is spreading at high levels, unless all participants are fully vaccinated.
That guidance hasn’t stopped the fall season from kicking off. Ninety-three percent of U.S. counties were experiencing high Covid-19 community transmission by Friday, according to the CDC. Yet the approaching winter season and its indoor competitions, such as basketball, hockey and wrestling, has some school officials on high alert.
Adolescent vaccination rates are uneven at the local level. The AAP concluded that more than two-thirds of eligible children have received at least one dose of a Covid-19 vaccine in 10 states, while fewer than 50 percent of them have at least one dose in 21 states. The number of children receiving their first dose are also at the lowest levels seen since shots were made available for some of them.
New Covid-19 cases among children meanwhile remained “exceptionally high” through Sept. 23, according to the pediatrics organization. Severe illnesses and deaths are rare among children, but children’s hospital officials have warned the Biden administration about strained capacity in their facilities.
“The issue with adolescents in athletics is it’s hard to be distanced in many sports, wearing a mask can be difficult to do consistently in some sports, and in some sports it’s basically impossible to keep a mask on,” said Anne Liu, an infectious disease specialist at Stanford University.
In Baltimore City Public Schools, where all winter season athletes must be fully vaccinated by Nov. 1, the requirement is meant to buttress a school testing program that’s detected more than 250 cases in schools (out of approximately 88,000 students and staff) in the last 10 days.
“The major factor is we want our student-athletes to be safe,” said John Davis, Baltimore’s chief of schools, of the district’s sports vaccination requirement. “It’s 100 percent the right thing to do.”
Whether expanding vaccinations among schoolchildren is a good strategy in the fight against Covid-19, on the other hand, depends on the goals of the government and the public at large.
Global eradication of the virus is not on the table, said David Salmon of the Institute for Vaccine Safety at Johns Hopkins University. And cutting back Covid-19’s mortality rate and its strain on the health care system might not require high vaccination rates among children.
“But if you really want to control disease, then children are really important,” Salmon said. “They are beautiful, lovely little vectors for disease. If we’re not able to vaccinate children, we’re going to have a really hard time controlling Covid in the community.”