EletiofeThe Ethics of Vaccinating Teachers—and Keeping Schools Closed

The Ethics of Vaccinating Teachers—and Keeping Schools Closed


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On January 8, when New York governor Andrew Cuomo announced that at the present rate it would take 14 weeks to vaccinate the first two priority groups, I immediately opened my calendar. Teachers and education workers are in the second group, so by mid-April, I figured, my children’s schools would finally open full-time.

Parents throughout the country have been making similar calculations. Like in New York, teachers in a majority of states have been bumped to near the front of the Covid-19 vaccine line, ahead of most other people, including millions who are at a higher risk of illness and death than many teachers. From Tennessee to Illinois to New Jersey, teachers’ unions around the country vigorously advocated for this privileged position. “We cannot safely and fully return to face-to-face instruction without putting our public school workers at the top of the priority list,” said Claudia Briggs, spokeswoman for the California Teachers Association. A letter signed by 11 education associations, including the National Educational Association and American Federation of Teachers, the nation’s two largest teachers’ unions, sent to the Centers for Disease Control and Prevention, asked for school personnel to have “priority access” to vaccinations in order to “fully reopen our school buildings.”

These pleas always emphasize the “importance of fully reopening” schools. Yet the specifics of this implicit agreement have been, at best, left deliberately vague—and, at worst, in the view of bioethicists and others, an unfulfilled quid pro quo.

Raising concerns that the vaccine may not eliminate transmission, Briggs and the CTA explicitly said the vaccination of teachers will not be enough on its own for schools to reopen. If an area’s case rate is too high, that also would preclude opening, they said. The president of the largest teachers’ union in Washington state said teacher vaccination is not “a guarantee that schools can and should open.” Scott DiMauro, the president of Ohio’s largest teachers’ union, said even a widely distributed vaccine is “not a panacea,” noting that CDC distancing guidelines, which compel low-density classes and hybrid schedules, should continue through the end of the school year regardless of teacher vaccinations. The head of the teachers’ union in Fairfax, Virginia, said that the hybrid model in their schools must continue even after staff are vaccinated, and that it’s not until all students are vaccinated that full-time school can be considered.

Many district administrators have made similar statements, often basing their argument on state distancing guidelines that were contrived last summer, well before vaccines were even on the horizon. The superintendent of schools in Needham, Massachusetts, said that while he’s planning for a full return in the fall, at the same time he’s also planning for hybrid and remote learning, “because we just don’t know where this virus is going, and what the guidance will be for physical distancing.” Without a vaccine for children, he added, opening school full-time may not be safe, and he questioned whether they’ll even be permitted to do so “without physical distancing requirements in place.” Never mind that Massachusetts only requires 3 feet of distance in schools, spacing that would allow Needham to comply with guidelines and run full-time at full capacity. (He didn’t mention the prospect of opening in the spring, after staff have had the opportunity for vaccination, despite the fact that staff would be no less protected than they would be in the fall.)

Last week, the school board of Davis, California, where 8,500 students haven’t seen a classroom since last March, approved resolutions requiring—in addition to staff vaccinations—asymptomatic testing, hospital-grade air purifiers, and that the community must be in the state’s second-highest infection tier or lower just to consider beginning hybrid learning. Governor Gavin Newsom has said he will not compel teachers back to work even after they are vaccinated.

Asked if the schools in my kids’ district, north of New York City, would move to full-time after educators have had the opportunity for vaccination, the superintendent suggested that our schools would remain hybrid, regardless of vaccinations, until the governor changes the distancing guidelines. When reached for comment, a spokesperson for the New York Department of Health said that the school safety guidelines implemented at the beginning of the school year, which include distancing, are still in effect. She also noted that “more data is needed on long-term immunity and to determine whether those who are vaccinated can still be asymptomatic ‘carriers’ of the virus.”

How valid are these concerns? The degree to which vaccination will reduce transmission isn’t yet known. But taking into account concerns about data being preliminary, Paul Sax, an infectious disease specialist at Harvard Medical School, wrote in The New England Journal of Medicine that “the likelihood that these vaccines will reduce the capacity to transmit the virus to others remains excellent.”

Regarding community rates and children needing to be vaccinated as reasons for keeping schools from opening fully, it’s not clear why that would concern teachers, since they’d already be inoculated. Governors theoretically might care about this on the premise that children, who are at exceedingly low risk themselves, could still pass the virus among each other and into the community. But, according to reports from both CDC researchers and the World Health Organization, schools are not considered the prime source of community spread, and student-to-student spread is the rarest among school transmission scenarios. (And those reports analyzed data from before mass vaccination of educators.) Moreover, parents are given the option to keep their children home if they are concerned about vulnerable family members.

How to interpret data, especially real-world data compiled outside the confines of a double-blind study will always be up for debate. When I asked Vinay Prasad, a hematologist and associate professor in epidemiology and biostatistics at the University of California, San Francisco, when scientists will be able to say confidently whether and to what degree vaccinated people can transmit, he said, “Conclusive proof will take a long time, like only after we vaccinate most people.”

The question then is this: Is it appropriate to continue to keep children out of school until teachers or reticent politicians feel they have a degree of certainty about risk that may not arise for a long time, if ever? More broadly, was it ethical to prioritize education workers to be vaccinated without an explicit promise that schools would fully reopen immediately after?

“Whenever we think of the consequences of prioritizing one group, we need to think about the consequences of de-prioritizing other groups,” said Jennifer Blumenthal-Barby, a professor of medical ethics at Baylor College of Medicine. Stefan Baral, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, recently wrote, “Aligning coverage with risks is not just more equitable, it is critical to vaccine effectiveness.”

Baral’s colleague Jennifer Nuzzo, also a professor of epidemiology, emailed me, “Once we’ve protected teachers and school staff, I think it’s reasonable for children to return to school full-time if we can maintain other protective measures (masks, hygiene. cohorting). I don’t think it is in keeping with the social compact to accept a vaccine and not return to the job.”

“If a teacher gets a vaccine, they have a moral duty to show up to work,” said Prasad. “They have a near zero percent chance of severe Covid.” And the potential of transmitting to others, he argued, is likely to be greatly reduced.

As Daniel Sulmasy, a physician and director of Georgetown’s Kennedy Institute of Ethics, put it, “For a teacher to say ‘I won’t teach even after I’ve been vaccinated because I could bring the virus home,’ seems really fairly suspect, given the fact that health care workers have been doing this every day.”

During the pandemic, politicians like Andrew Cuomo have often touted that they are “following the science.” But science is not policy. A zero-Covid scenario is very unlikely for the foreseeable future, even after mass vaccination. As a society we have to ask at what point we can expect citizens, and certainly those deemed essential workers like teachers, to accept a minimal degree of risk. “We’ve been able to amass such control over natural forces that people now expect that everything can be controlled. That is a moral failing,” Sulmasy told me. There are tendencies in our society, he said, that are “extraordinarily risk-averse, beyond what’s reasonable and practical.”

While we cannot precisely quantify the risks to oneself or others after one is vaccinated, the likelihood that the risks are sufficiently minimized, Sulmasy said, obligates serving professionals to work. “This is what it means to have a role in society.” And governors have an equal obligation, especially once educators have had the opportunity to be vaccinated, to revise unscientific and outdated distancing guidelines that are preventing superintendents from opening schools for full-time in-person learning.

Bluntly, Prasad said, “Kids don’t need a vaccine for schools to open, and waiting for this is a bad idea.”

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