The time has come for all schools to require the flu shot

The requirement that children receive vaccinations before starting school has come to be accepted by most parents in this country as normal. It is after all, common sense: children are notoriously good at spreading germs.

Vaccinations have become an expected part of the routine checkups that take place in late summer, when parents bring kids to the office for pediatricians to check them, and to check off the boxes on school forms.

But one shot has long evaded the list of required vaccinations on these school forms. On Wednesday, Massachusetts became the first state to require the flu shot for students K-12 as well as for college students. Outside of Massachusetts, only a handful of states require the flu shot for day care and preschool children under 5 years old; the requirement goes away altogether after that.

This year, as the Covid-19 pandemic drags on, the flu season rapidly approaches and schools scramble to ensure safe learning environments, we badly need children of all ages in all states across the country to get the flu shot.

While it is true that children under 5 are most vulnerable to severe illness and death from the flu, the influenza virus does not stop infecting children simply because they have turned a certain age.

During the 2018-2019 flu season for example, more than seven million kids and teens ages 5 to 17 were symptomatic from the flu, 21,000 required hospitalization and 211 died. This compared to more than three million kids under 5 who were symptomatic, of whom 25,000 required hospitalization and 266 died, according to the CDC.

It is precisely because the influenza virus can cause serious, life-threatening illness in children and adults of all ages that both the American Academy of Pediatrics and the US Centers for Disease Control and Prevention recommend everyone over the age of six months receive the flu shot every year.

This winter, our country simply cannot afford to have thousands of children infected with and hospitalized for influenza. Not only is every child who has to be hospitalized one child too many; our already strained health care system, school system and communities will not be able to accommodate both the flu and Covid-19. The time has come for schools across the country to require the flu vaccine for children of all ages.

Now to be clear, the flu shot is not perfect. In seasons in which the flu shot is well-matched to circulating strains of the flu, the vaccine can be 40-60% effective at preventing infection. But what is often less discussed is that even when the person exposed to the virus contracts influenza, having received the vaccine can significantly reduce the risk of complications from the illness, namely hospitalization, ICU stay and death.

Despite this data, schools have historically fallen short in requiring the flu shot, leaving parents to think that although recommended, the flu shot is not necessary. I have heard it over and over again in my office: If the flu shot was really necessary, schools would surely require it. Close to 40% of all children went without a flu vaccine in the 2018-2019 season, the latest season for which CDC data is available.

School vaccine mandates work. I see it in my practice every day — nothing gets a busy parent to squeeze in a doctor’s visit like a school requirement. Mandates have also been associated with higher rates of vaccinations for illnesses other than flu — in DC for example, one of the few places requiring the HPV vaccine for school, 78% of kids ages 13 to 17 have been vaccinated against HPV, compared to 49% of kids nationwide.

With a mandate for all ages, schools have the opportunity to send a clear message to parents that the flu vaccine is not only recommended, it is more important than ever.