States Determine School Immunization Requirements, Not CDC
SciCheck Digest
Vaccines are added to the Centers for Disease Control and Prevention’s immunization schedule after consultation with an outside advisory group and when the benefits outweigh the risks. Contrary to claims from Tucker Carlson and others, the COVID-19 vaccines will not become mandatory in schools just by being added to the CDC schedule. States and local districts make those determinations.
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School-entry vaccination requirements are set by state or local officials, not the CDC or the federal government.
Numerous social media posts, however, claimed otherwise in advance of a two-day CDC vaccine advisory committee meeting starting on Oct. 19.
“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,” tweeted Fox News host Tucker Carlson on Oct. 18, sharing a clip of his show from that evening, which had also discussed the topic.
The false claim soon went viral. Former Fox News host Megyn Kelly said in an Oct. 19 tweet, for example, “HOW DARE THE CDC ADD THIS TO ITS LIST OF SCHOOL VACCINATIONS?”
The CDC doesn’t have a list of school-required vaccines. “States hold the reins on school vaccination requirements,” Lindsay Wiley, a law professor and faculty director of the health law and policy program at UCLA School of Law, told us in an email.
The process for adding a vaccine to school requirements varies by state, she said, but typically involves the state health or education departments, sometimes working together, who are given that authority from the state legislature. In some states, she added, local districts also have the ability to add a school-required vaccine.
The furor appears to have been sparked by Dr. Nicole Saphier, a Memorial Sloan Kettering Cancer Center radiologist and Fox News contributor, who wrote in an Oct. 18 tweet, “Tomorrow, the CDC’s Advisory Committee on Immunization Practices (ACIP) will vote on adding the COVID-19 vaccine to the schedule of childhood vaccines required of students in order to attend school.”
In reality, the CDC committee was voting the following day on whether to add COVID-19 vaccines to the Vaccines For Children program, which has nothing to do with school vaccination requirements. The program provides free vaccines to under-insured or uninsured kids, which would become relevant when the COVID-19 vaccines enter the commercial market and the government no longer provides them at no cost to the public. The day after that, the panel was voting on a variety of changes to the pediatric immunization schedules, including the addition of the COVID-19 vaccines.
While a listing on the CDC’s immunization schedule is necessary in some states for a vaccine to be required for school, and might encourage states to choose to require them, the listing itself does not automatically make a vaccine required. The schedule, which is reviewed each year by the CDC advisory committee, is primarily meant to inform pediatricians about which vaccines are recommended and when they should be given.
More than nine hours after her initial tweet, Saphier clarified on Twitter that the CDC would be voting on updating the immunization schedule, which “often gets incorporated into public school vaccine requirements but varies by state.” But she did not remove her earlier, erroneous tweet.
States Set School Requirements
On Oct. 19, the CDC attempted to correct Carlson on Twitter by sharing a link about state vaccination requirements and stating, “States establish vaccine requirements for school children, not ACIP or CDC.”
But that evening, Carlson doubled down on his false claim, accusing the CDC of “lying.” He said during a segment on his show, “More than a dozen states follow the CDC’s immunization schedule to set vaccination requirements — not suggestions, requirements — for children to be educated.”
He cited as examples Virginia, Massachusetts, Tennessee, New Jersey, Vermont and Ohio, and included select statements from some of the state department of health websites.
But none of those states automatically add vaccines listed on the CDC childhood immunization schedule to their school immunization requirements. In fact, none currently requires all of the vaccines that are listed on the schedule.
“Carlson is misreading the statutes and regulations he cites and quoting language out of context,” Wiley said, noting that his researchers might have confused references about following the CDC’s dosing schedule for state-required vaccines, which is different from requiring all of the CDC’s listed vaccines.
Ohio Department of Health Director Bruce Vanderhoff said in a statement to FactCheck.org: “The CDC’s Advisory Committee on Immunization Practices (ACIP) recommendation for the COVID-19 vaccine to be added to the formulary or schedule of vaccines for children does not mandate this vaccine for school children.”
Instead, “Ohio law determines required vaccines for school attendance,” Vanderhoff said, pointing to the Ohio Revised Code on proof of required immunizations. “The state’s list of required vaccines can only be changed through legislation.”
“Under Vermont law, the vaccine schedule for school attendance is adopted by regulation,” Katie Warchut, public health communication officer for the Vermont Department of Health, explained in an email, referring us to that state’s statute. “The Department of Health convenes an advisory committee that takes into account ACIP’s recommendations but is not bound by them.”
A Virginia Department of Health spokesperson, Maria Reppas, similarly told the Associated Press that there “is no direct, immediate impact” on school-required vaccines — and that it would take legislative or regulatory action to make such a change.
Tennessee, New Jersey and Massachusetts, as well, don’t always follow the CDC immunization schedule. Those states don’t require vaccination for rotavirus, influenza or HPV, for instance.
Tennessee actually has a law on the books prohibiting schools from requiring COVID-19 vaccination.
Wiley told us that ACIP’s recommendations on vaccines “have a lot of influence on state decisions about which vaccinations they choose to require for school attendance” — and that it’s possible some states could be swayed by the recommendation and require COVID-19 vaccines next school year. “But the decision is still up to the individual states,” she said. “I’m not aware of any state where statutes or regulations automatically trigger such a requirement.”
She noted that in some states, a vaccine must be on the CDC schedule to be considered for a school-entry requirement. But again, the decision would still be up to state and local officials.
Benefits Outweigh Risks for Vaccines on List
During the ACIP meeting, several committee members emphasized that a vaccine being listed on the immunization schedule does not constitute a mandate — and in fact simply reflects the current recommendations.
“This doesn’t represent new recommendations, this represents sort of a summary of existing recommendations,” committee member Dr. Matthew F. Daley said in response to many public comments about the issue. He added that he nevertheless recognized the symbolism of adding the COVID-19 vaccines to the schedule, and said that when shots are added, it’s because the benefits continue to greatly outweigh the risks.
A CDC presentation from Oct. 19 noted that myocarditis and pericarditis — the primary serious safety concerns identified with the mRNA COVID-19 shots — are already rare, but are even more rare in children.
The conditions, which involve inflammation of the heart or its surrounding tissue, are most common in adolescent males after the second dose. But even for that group, experts say the benefits of vaccination outweigh the risks.
As of Oct. 13, the CDC recorded 22 verified reports of myocarditis in 5- to 11-year-olds, after 21.6 million doses administered; 355 reports in 12- to 15-year-olds, after 24.4 million doses; and 308 reports in 16- and 17-year-olds, after 13.4 million doses.
Post-vaccination myocarditis is milder than typical viral myocarditis, and follow-up studies have shown that most people recover within three months.
The advisory group voted unanimously to add the COVID-19 vaccines to the Vaccines For Children program and to accept the proposed changes to the pediatric immunization schedule, which included adding the COVID-19 vaccines. Committee approval is required before the schedules will be published in the Morbidity and Mortality Weekly Report in February 2023.
“It’s important to note that there are no changes in COVID-19 vaccine policy, and today’s action simply helps streamline clinical guidance for healthcare providers by including all currently licensed, authorized and routinely recommended vaccines in one document,” the CDC said in a statement sent to FactCheck.org after the ACIP vote.
Along with conveying which vaccines are recommended for children — which is the basic function of the immunization schedule — there are other practical implications of adding vaccines, including triggering an Affordable Care Act requirement that health insurance plans cover the listed vaccines without charging a deductible or copay, Wiley said.
According to the National Academy for State Health Policy, no states are enforcing a COVID-19 vaccine mandate for school attendance, and only two jurisdictions have announced or implemented one.
California’s mandate, which would only apply to vaccines that have full FDA approval — and therefore only to primary vaccination for kids 12 and older — would not take effect until at least July 2023. Washington, D.C., has implemented a mandate, also only for vaccines that have full approval, but is not enforcing it until January. The city council is scheduled to vote on Nov. 1 on whether to further delay the mandate to the 2023-2024 school year.
Numerous states have banned requiring COVID-19 vaccines in schools. The National Academy for State Health Policy shows in a map last updated on Oct. 3 that 21 states have such bans, although the details of these vary, with some only applying to vaccines that don’t have full FDA approval.
Lori Robertson and Robert Farley contributed to this article.
Editor’s note: SciCheck’s COVID-19/Vaccination Project is made possible by a grant from the Robert Wood Johnson Foundation. The foundation has no control over FactCheck.org’s editorial decisions, and the views expressed in our articles do not necessarily reflect the views of the foundation. The goal of the project is to increase exposure to accurate information about COVID-19 and vaccines, while decreasing the impact of misinformation.
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