State Vaccine Mandates for COVID-19 – An Emerging Disparity between Childcare Providers and School Teachers

Abstract

INTRODUCTION: On December 22, 2020, the Advisory Committee on Immunization Practices (ACIP) issued guidelines for the allocation of the coronavirus disease-2019 (COVID-19) vaccine. Childcare providers and K-12 school teachers, as designated ‘frontline essential workers,’ were recommended for early vaccination. Despite ACIP recommendations, some states chose only to prioritize school teachers, sending the message that childcare providers’ occupational risk was less than that of school teachers and other frontline essential workers. More recently, on August 11, 2021, California became the first state to require COVID-19 vaccination of school teachers, but excluded childcare providers. To better understand this emerging disparity, we characterize state vaccine mandates for childcare providers versus school teachers.METHODS: To determine which states had issued legislative and/or regulatory directives requiring vaccination of childcare and/or school personnel (as of November 1, 2021), we reviewed official archives of executive orders for all 50 states and the District of Columbia (DC) and COVID-19 state databases maintained by the National Conference of State Legislatures and the National Academy for State Health Policy. For each state with legislative or regulatory directives, we collected information on issue date and compliance deadline, type (e.g., executive order, public health order), issuer (e.g., governor, public health officer), availability of vaccine exemptions and testing alternatives, and acceptable proofs of vaccination.RESULTS: Ten states (including DC) had issued executive-branch directives requiring either COVID-19 vaccination or routine testing for school teachers, of which only five included childcare providers (no states had issued directives for childcare providers alone). No states had passed legislation requiring COVID-19 vaccination. Three states required COVID-19 vaccination without a routine testing alternative; six states allowed for both vaccination and routine testing to fulfill the directive’s requirement; and one state (New York) required routine testing with opt out vaccination for those who objected. Five states did not specify any exemptions to vaccination, with the rest allowing medical and/or religious belief exemptions and none allowing personal belief exemptions. All states required formal proof of vaccination either in the form of an attestation from a healthcare provider, a signed CDC vaccination card, and/or a record from a state immunization registry; no states allowed for personal attestation to support receipt of vaccination. The results can be found summarized in the table. CONCLUSION: While ten states (including DC) have issued directives requiring either COVID-19 vaccination or routine testing among school teachers, only half include childcare providers. This emerging trend suggests an unwarranted disparity between childcare and school settings in states’ efforts to promote vaccination, as the argument in favor of vaccinating the former is at least as strong as that of the latter for several reasons. First, both staff and children in childcare programs may be at higher risk for contracting COVID-19 than those in schools, given the congregation of infants and young children who are both ineligible for vaccination and possibly less effectively adherent to nonpharmaceutical interventions (e.g., masking, social distancing, handwashing). Second, childcare providers have a lower COVID-19 vaccine uptake compared to school teachers (78% versus 90% as of late Spring 2021). Finally, childcare providers skew more heavily minority, and therefore may be at greater risk for COVID-19-related morbidity and mortality (17.3 and 19.3 percent of childcare personnel are Black and Hispanic versus 12.1 and 13.0 percent of school personnel, respectively). To ensure equitable consideration for the health and safety of childcare providers and school teachers alike, states should consider expanding directives to include childcare providers—as has been done by both New Jersey and Illinois—to bridge the COVID-19 vaccination gap between childcare providers and school teachers.