The U.S. Centers for Disease Control and Prevention’s vaccination advisors voted last week to recommend all children get the COVID-19 vaccine, a move that does not change California’s list of vaccines required for children to attend school.

The addition of the COVID-19 vaccine to the CDC’s recommended vaccines for kids is not a mandate for states’ school attendance requirements. Any additions to California’s list must be made by the state Legislature or the state Department of Public Health. In the last 12 months, the Newsom administration and the Legislature separately tried to mandate the COVID-19 vaccine for kids to attend school, and both failed.

People involved in those efforts said they do not expect the Legislature to consider a mandate for children again next year, barring a big spike in hospitalizations or deaths.

“Our goal should be getting the immunization rate up,” said Sen. Richard Pan, a pediatrician Sacramento Democrat, whose bill last session would have mandated the vaccine for children to attend school, with only a medical exemption. “We have work to do on outreach, making sure people have access and educating people about the vaccine.”

Since the federal government approved vaccines for children on an emergency use basis, children have received the COVID-19 vaccine at much lower rates than adults. So far, 67% of 12-to-17-year-olds have received the first series of the vaccine, 38% of children 5 to 11 have received the first series and of those under 5 years of age, 5% have received the shots, according to state data.

The state Department of Public Health refused to say whether it plans to add the vaccine to the required list. Instead the agency referred to its previous statement from April in an email: “…upon full approval by the FDA, CDPH will consider the recommendations of the Advisory Committee on Immunization Practices of the United States Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians prior to considering a school vaccine requirement.”

The role of the CDC

It suggests that children ages 6 months and older receive a vaccination for COVID-19 with shots approved by the U.S. Food and Drug Administration or approved for emergency use.

“It’s a step in the right direction for protecting the public’s health but I understand there is a lot of anxiety about vaccines in general and the COVID-19 vaccine,” said Dr. Alice Kuo, professor and chief of the Pediatrics/Preventative Medicine Division at UCLA. “It’s one step at a time.”

Dr. Naomi Bardach, a professor of pediatrics at the UCSF School of Medicine, said the CDC recommendation is a sign that COVID-19 is here to stay. She said the addition of the vaccine to the childhood schedule also normalizes the vaccine because pediatricians’ offices that already use the CDC’s list as guidance will fold the COVID-19 vaccine into patient care.

Under state law, children must receive a series of shots for 10 diseases to attend child care centers, family child care homes, preschool and kindergarten through 12th grade. If children are not vaccinated or are behind based on the state’s schedule, they can be barred from school until they receive their shots.

Infants are given their first vaccine before they are an hour old and the shots continue through adolescence. Most of the vaccines recommended by the Centers for Disease Control are required by California to attend school. They are: diphtheria, hepatitis B, haemophilus influenza type b, measles, mumps, pertussis (whooping cough), poliomyelitis, rubella, tetanus and varicella (chicken pox).

Prior to 2016 parents were able to opt out of vaccines for their children through a personal belief exemption. Sen. Pan authored the controversial law that eliminated the personal belief exemption for vaccines on the state’s list and left only medical exemptions that must be signed off by a physician. At that time, about 3% of new kindergartners entered school with a personal belief exemption for some or all vaccines.

The law applied only to the vaccines already on the list for children. Any new vaccines added to the list in the future by the state Department of Public Health would offer personal belief and medical exemption options. If the Legislature votes to add a vaccine to the list legislators would choose which exemptions to offer.

Vaccine rates for these childhood diseases have slipped during the pandemic. In August, the Department of Public Health said 1 in 8 children were not up to date on their vaccinations, due to skipping routine doctor visits during the last couple of years.

Failed efforts

In October 2021, Gov. Gavin Newsom said his administration would require the COVID-19 vaccine for school attendance for students 12 and older as soon as the U.S. Food and Drug Administration fully approved the vaccines for children. At the time, the mandate was to go into effect in July of 2022. Since the Department of Public Health would have implemented the plan, the requirement would have allowed parents to opt out of the vaccine for their children through personal belief or medical exemptions.

In January 2022, Pan authored a COVID-19 vaccine bill to go further, eliminating the option for a personal belief exemption.

In April, lacking the votes needed to pass the bill, Pan pulled it and said the vaccine needed to be more accessible to families and vaccination rates needed to be higher before a mandate could be successful. The same day, the Department of Public Health postponed to July 2023 its plan to require students get the COVID-19 vaccine.

On Monday, Pan said he does not expect the Legislature to respond any differently than it did last year to the idea of a mandate. Pan won’t be leading the effort if there is one, as he is termed out in November.

Pan said if the state considers adding the vaccine to the list it has to take into account all the recent developments about the vaccine and boosters, like how many times it’s going to be needed. If it is required multiple times like the flu vaccine, which is not required for school attendance, it could be a burden for schools to track. Pan said the Legislature has focused on vaccines that children receive as a series and then don’t have to take again, like measles and chickenpox.

“It will depend on how it develops and what the overall burden is,” Pan said.

Last year, Pan founded a legislative Vaccine Working Group that proposed numerous bills regarding COVID-19 and vaccines. Most of them failed, including proposed mandates for all employees and children to be vaccinated to work or attend school as well as a bill to allow teenagers to get the vaccine without parental consent.

“It was a rough year for vaccine legislation in the Legislature,” said Sen. Scott Wiener, a San Francisco Democrat, who authored the teen vaccination bill and is a member of the working group. “I don’t know if that dynamic will change before next year but it is something to consider because it should be part of the regular schedule for schoolchildren.”

Another member of the Vaccine Working Group, San Diego Democratic Assemblymember Akilah Weber, said she is not considering legislation that would mandate the vaccine.

“At this time, I’m not involved in any legislation that would mandate vaccinations, but I’m actively involved in education and outreach to encourage and provide community access for more parents to have their children vaccinated,” Weber said in an email.

In the past, proposed vaccine-related legislation has attracted protesters to the capitol en masse. They have disrupted hearings, yelled at legislators and even assaulted them. During one memorable protest, what looked like a menstrual cup full of blood was tossed over the gallery railing onto the Senate floor below.

If the administration, or the Legislature, pursues a vaccine requirement again critics are already planning to push back. They argue that this should be a family decision and that it raises questions about the number of breakthrough cases — when a vaccinated person tests positive for the coronavirus — efficacy and safety for children.

“The anti-vaxxers are very organized and very loud even though they do not represent the majority view,” Sen. Wiener said. “But that is a dynamic we have to contend with and that is true with a lot of political issues and policy issues.”