On May 19, 1955, 22,561 New York City first and second graders received Jonas Salk’s novel vaccine against poliomyelitis while at school, marking the start of the city’s mass vaccination campaign. Describing the scene at P.S. 33, the New York Times reported, “Seizing proffered lollipops the children raced through the door, exclaiming again, ‘It doesn’t hurt, it doesn’t hurt,’ to reassure their classmates still waiting to be ushered in for shots.” That year, public and private schools across the country served as sites of vaccination campaigns against a disease that, for decades, had instilled fear and disability in countless children and families.
Today, we’re once again faced with the monumental challenge of disseminating a vaccine. While children under 16 have not been approved to receive any of the currently available COVID-19 vaccines, pediatric clinical trials are underway and expect results by the summer. To develop a plan to vaccinate kids as quickly as possible, it is prudent to consider the strategies public health officials used during times when infectious diseases were prevalent. As the Biden administration encourages schools to open up, perhaps they should reprise their role of serving as vaccination sites as well.
Vaccinating children in schools was common practice throughout the first half of the 20th century, helping to protect children from diseases like smallpox, diphtheria, and polio. Public health officials used schools for a number of reasons. Perhaps most obviously, they provided physicians and nurses easy access to those who were among the most at risk of these diseases. Schools helped disseminate the polio vaccine among children quickly and efficiently, which contributed to a dramatic decline in total cases—from 38,000 in 1954 to 5,500 in 1957. The disease’s epidemiology changed as well, from primarily affecting first and second graders to affecting preschool children and adults (prompting health officials to propose a “Babies and Breadwinners” vaccination campaign in 1961).
While a child’s participation in a school vaccination campaign remained contingent on parental permission, schools could help encourage parents to participate. Parents in the 1950s were generally enthusiastic about the polio vaccine, but 30 years earlier, parents whose children were encouraged to receive the novel diphtheria toxin-antitoxin were more hesitant. William Hallock Park, then laboratory director of New York City’s Board of Health, wrote that when principals and teachers expressed their support for his 1921 school-based efficacy study of the diphtheria toxin-antitoxin (which, as physician-historian Jeffrey Baker noted, “blurred the line between clinical study and immunization campaign”), he obtained consent from three-fourths of the parents. Without their support, he was lucky if one-fourth agreed to participate.
Notably, Park had another, related reason for using schools: He thought that the participation of school-age children would in turn encourage parents to vaccinate their preschool children, the age group that faced the highest rate of mortality from diphtheria. It was, in fact, common at the time for school and governmental authorities to use schoolchildren as “messengers” to encourage parents to adopt various health-promoting behaviors.
Vaccinating children in schools likely also encouraged participation simply because it made it much easier for parents to participate—they didn’t have to go through the trouble of bringing their children to a clinic or doctor’s office. This is also in part why many schools provided, and continue to provide, preventive health screenings to children, like vision and hearing tests.
Using schools as vaccination sites helped promote equity as well. The National Foundation for Infantile Paralysis (now the March of Dimes) provided the first two (of three) shots of the polio vaccine to first and second graders in schools across the country for free. Once their supply was exhausted and vaccinations largely migrated to doctor’s offices, some states continued to provide vaccines in schools to children whose parents couldn’t afford to pay; the states didn’t want protection against the disease to be a function of a family’s wealth. Public health officials weren’t entirely successful at ensuring equity in all respects, though. Even among school-age children, a significant racial disparity in vaccination rates appeared. One study found that by the fall of 1961, 81 percent of white individuals under 20 had received all three shots, whereas 64 percent of nonwhite individuals had. This disparity would likely have been more severe if schools had not been involved, however.
Now that children receive vaccines as part of routine well-child visits, school-based vaccination campaigns in the U.S. have become less widespread. But there have been several instances in recent years of public health officials redeploying this strategy. When the hepatitis B vaccine became recommended for all newborns in 1991, several cities administered “catch-up” vaccination programs in middle schools for adolescents throughout the 1990s. In 2009, New York City offered the H1N1 vaccine to students in more than 1,200 schools, as did other cities. Communities have also organized school-based chickenpox (varicella), HPV, and seasonal influenza vaccination programs.
Schools have the ability to help disseminate vaccines quickly, and they can encourage participation by reducing logistical barriers and serving as trusted sources of information—a particularly valuable benefit today given the acute return of vaccine hesitancy. Schools ought to be part of our national strategy in disseminating COVID-19 vaccines to children in the coming months.