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States, not CDC, set school vaccination requirements

A boy wearing a mask winces as he gets a shot in his left arm
Paolo Canizales, 10, winces as he gets a shot of the Pfizer vaccine at Hellen Keller Elementary School in Lynwood.
(Luis Sinco / Los Angeles Times)
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A Centers for Disease Control and Prevention advisory committee on Thursday voted that the agency should update its recommended immunization schedules to add the COVID-19 vaccination, including to the schedule for children.

But in the lead-up to the vote by the Advisory Committee on Immunization Practices, false claims spread widely that it would mean children would be required to have the vaccination to attend school.

In reality, the CDC doesn’t have the authority to set school immunization requirements, and the vote doesn’t mandate the vaccination for schoolchildren. That’s a decision left to the states.

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Here are the facts.

Claim

If the CDC adds the COVID-19 vaccination to the immunization schedule for children, the shots will be mandatory to attend school.

The facts

The false claim gained momentum after it was shared by Fox News host Tucker Carlson this week.

“The CDC is about to add the Covid vaccine to the childhood immunization schedule, which would make the vax mandatory for kids to attend school,” Carlson tweeted on Tuesday night. The tweet included a segment from his show in which he began by making the same claim.

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Another popular tweet similarly claimed the CDC committee’s vote would make the vaccination “mandatory for school registration.”

But the public health agency doesn’t determine school vaccination requirements. “States have the authority to enact state laws requiring vaccination, not the CDC,” said Wendy Mariner, a professor emerita of health law, ethics and human rights at Boston University. “ACIP has no authority to make law.”

In Los Angeles County, officials plan to offer the updated boosters for children as young as 5 at an estimated 625 sites starting as soon as Wednesday.

CDC spokesperson Kate Grusich said in an email that the agency “only makes recommendations for use of vaccines, while school-entry vaccination requirements are determined by state or local jurisdictions.”

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Grusich explained that the action was meant to streamline clinical guidance for healthcare providers by adding COVID-19 vaccinations to a single list of all currently licensed, authorized and routinely recommended vaccinations.

“It’s important to note that there are no changes in COVID-19 vaccine policy,” she said.

The immunization practices advisory committee is a body of experts that makes recommendations to the CDC about vaccinations.

Its recommendation to update the schedules, which included other revisions, still needs to be formally adopted by the agency, and the amended schedules wouldn’t take effect until 2023, Grusich said.

A panel of U.S. vaccine experts says COVID-19 shots should be added to the lists of recommended vaccinations for kids and adults.

In a follow-up segment on Fox News by Carlson on Wednesday night, he revisited the topic and claimed the CDC was “lying.” Carlson claimed that “more than a dozen states follow the CDC’s immunization schedule to set vaccination requirements — not suggestions, requirements — for children to be educated.”

“For example, the Virginia Department of Health states that ‘vaccines must be administered in accordance with the CDC’s schedule,’ ” he stated. He cited Massachusetts as another example.

But those states do not list every vaccination from the schedule in their school requirements.

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Virginia, for example, does not require the annual flu vaccination in order for children to attend school — even though the vaccination appears on the CDC’s schedule. Nor does Massachusetts.

A Virginia Department of Health spokesperson, Maria Reppas, said in an email that there “is no direct, immediate impact on COVID-19 vaccine being added to the Immunization Schedule on school required vaccines in Virginia.” Reppas said changes to the school requirements would need legislative or regulatory action.

Physicians and advocates concerned about homebound patients fear that L.A. County has not reached many who could be at high risk from COVID.

Dr. William Schaffner, a vaccine policy expert and professor of infectious diseases at Vanderbilt University Medical Center, said he was not aware of any states that automatically require all vaccinations on the schedule for school.

“Those are recommendations that go to pediatricians and family doctors as they care for children,” Schaffner said. “They’re just recommendations; there are no automatic mandates that follow.”

There has also been reluctance by many states to require the human papillomavirus, or HPV, vaccination, even though it appears on the childhood schedule, Schaffner said.

States can use legislation to require specific vaccinations or can authorize a state agency or local health entity to require specific vaccinations for certain age groups, Mariner said. She added that some states include private schools when establishing requirements, though in other cases private schools may also voluntarily require vaccinations.

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