Updated: On Nov. 2, 2021, children between the ages of 5 and 11 became eligible to get a COVID-19 vaccine.
Earlier this week, drugmaker Pfizer announced its internal studies showed that its COVID-19 vaccine, at a lower dosage, was safe and effective for children ages 5 and up.
The news brought a wave of relief for school administrators. Although the research still needs to be reviewed and approved by the U.S. Food and Drug Administration, the idea that young children could be inoculated as soon as Halloween heralds the prospect of a return to more-normal operations after a bruising 19 months.
But for that to happen, more students will need to be vaccinated. And that takes some careful planning and partnership with health agencies to pull off.
Some school systems have taken the lead in setting up vaccination clinics for teachers, adults, and eligible adolescents in their school communities. And due to their geographic advantages—schools are located in every community in America—there’s a strong argument to be made that they should double down on that role once the vaccine is approved for younger children.
“We are trying to remove any barrier to vaccination, and if it’s inconvenient to travel and obtain vaccinations from an access standpoint, there’s a barrier right there,” said Dr. Matt Willis, the public health officer for Marin County, Calif., who with his counterpart in the Marin County Office of Education, Superintendent Mary Jane Burke, has helped oversee school-based clinics there. “It’s removed by taking advantage of what happens in a school setting. Children are there together, and there’s an obvious benefit built into the fact that you have them gathered on site every single day, and all the transportation is worked out. It’s a setting that is already organized and formatted for ensuring they’re all present and can be vaccinated in a systematic and efficient way.”
Education Week spoke to Marin County and several other districts that have had success hosting vaccination clinics about what they’ve learned in the process—and their insights about extending the service to younger children.
We’ve distilled their insights for you, and we’re also linking throughout this story to our earlier coverage on schools serving as vaccination centers.
Lean on your medical professionals and your community.
If there’s one major takeaway for school and district leaders, it’s that it takes some elbow work to create the infrastructure to host school-based clinics. Both schools and public health leaders need to create it together.
“Maybe it goes without saying, but you need a dedicated campaign; the numbers are too high to expect this to be absorbed into existing infrastructure. I think it’s a common mistake to say, ‘Well, we have health-care providers, we have pediatricians, and they do vaccines.’” said Willis. “If you really want to get through thousands of children in a matter of days or even weeks, you’re going to have to build dedicated infrastructure that is on top of and outside of what already exists.”
This spring, Marin County hosted a series of weekend clinics devoted to vaccinating 12- to 17-year-olds. Because of the longstanding partnership between the county office and its public health department, which began before COVID shut down schools in March 2020, the partners had developed the cohesive set of protocols, strategies, and volunteer structure needed to run the clinics. All of that’s underpinned by a robust data portal that spells out which schools are open and rates of staff and student vaccinations, said Burke.
“Every single step we’ve taken has involved the leadership of public health, so I cannot stress enough: This is not schools going it alone. This is public health working in collaboration with schools,” she said.
Other community partners can also serve as help or to help find volunteers.
The Northshore district in Bothell, Wash.—the first in the nation to shut its doors in March 2020 due to the coronavirus—also took the lead on vaccinations. In May, when vaccine appointments were harder to come by, the district worked with a local grocery store chain and health clinics to secure doses for a weekend clinic at a high school. It also worked with the Shoreline Fire Department to put together vaccination clinics at middle and high schools during the school day last spring and this fall.
“We couldn’t have done it without our fire department partners. We couldn’t have done it without our volunteers,” Lisa Youngblood Hall, Northshore’s chief communications and experience officer, said of the clinics.
Start planning now by setting aspirational—and inspirational—goals.
Marin County is already well on its way, crafting plans on how to move quickly once approval comes through.
“The way we have been working, which has been great for us, is anticipate: If [the FDA approval] happens on this date, what do we have to do to vaccinate a percentage of students by this other date? That sort of sets our parameter of what we’re working towards,” said Burke. “Then it’s backward planning on a variety of issues. ... If you wait until you know [the vaccine] is approved, it will take a while to get things going.”
The county expects that if FDA approval is granted on Oct. 15, it will begin its first dose clinics on Oct. 23; if the vaccine is not approved until Oct. 25, then clinics will begin Oct. 30.
Marin County has about 21,000 students who fall in the age 5 to 11 category. Its plans will be built around ensuring that 25 percent of those students are fully vaccinated by the winter recess.
Not only does the goal-setting build accountability and transparency among the partners, Burke said, it can help to generate community excitement and get families out and about doing their part to reach a common goal.
“You signal that and generate some excitement around what that means for us and the protection it’s going to offer for us and build some hoopla into the process, where kids are excited about getting vaccinated, and you create a friendly setting. There are balloons, people who are welcoming you, music’s playing,” added Willis. “You create an atmosphere where people are excited to be there.”
Starting the planning process early also shows the community that you’re not waiting around, and can also help to build community trust. Marin plans to host two sessions in October, one the week of the 13th and another the week of the 20th, for local pediatricians to answer families’ questions and concerns about vaccination. (One of them will be in English with Spanish interpretation, and the other the inverse.)
Be mindful that younger students will have some different needs.
The Winnebago County Health Department, in Rockford, Ill., which partnered with the Rockford school district to offer vaccine clinics, is now in planning stages for vaccinating younger students. Dr. Sandra Martell, the public health administrator for the health department, said that planning vaccine clinics for younger students requires some new considerations. A mass vaccination site could be overstimulating for an elementary schooler who is used to getting their shots in a quiet doctor’s office.
Finding ways to provide for students’ comfort—like inviting them to bring a favorite stuffed animal—should be a priority, Martell said. "[We’re] recognizing that this is a big event for them, and how we’re going to attend to their developmental needs during this time,” she added.
Marin County will be targeting teachers in its elementary school areas to serve as volunteers if possible, so children can see their own teacher or someone else in their school that they know. And it will provide opportunities for parents and kids to have a consultation with a public health official before the inoculation.
“Most children have had shots before so this won’t be new, but we’ll be working on sort of the social-emotional side. Our doctors and pediatricians will be talking about those strategies as part of the overall training: What are the things to say to kids?” Willis said.
The Centers for Disease Control and Prevention currently offers some resources for working with adolescents, and it may release additional resources once the vaccines are approved for younger children.
Don’t underestimate the logistics.
Don’t make the error of thinking running a clinic is as easy as hanging up the shingle and starting vaccinations, the experts cautioned; that’s the end point after carefully working out the logistics.
“You really need to plan out the flow, what the day is going to look like, making sure you have enough time for each person to be vaccinated, especially for little kids—they need more hand-holding to get through the process. Having a realistic schedule is important, so you don’t have people waiting long periods of time, especially if that leads to crowding,” Willis said.
Prior Education Week coverage offers a case study of the Anchorage, Alaska district’s planning process as well as a downloadable to help with some of this planning.
It’s best, Willis said, if districts can work out parental permissions and other paperwork beforehand so that on vaccination days medical professionals and volunteers can simply focus on getting through their rosters. “It’s really challenging to get all the written permission and identification cleared at the same time you’re actually doing the vaccines themselves: you want to take care of that up front, beforehand.”
In the Northshore district, for the clinics to run smoothly, students had to be pulled from class at the appropriate time, have their paperwork reviewed, and be allowed to call parents if they needed to double-check anything on their forms. The fire department staff did much of that work, Youngblood Hall said.
Administrators should also be sure they have the space for the observation period after inoculation and that there are enough chairs for everyone to have a place to sit.
And finally, expect that more people will come on clinic days than those who’ve registered. “Beware of walk-ins,” Willis said.
Meet students and families where they are.
For middle and high school students, an at-school clinic can offer convenience: Families didn’t have to make a special trip to take their kids to another location. But the Northshore district is working with a slightly different calculation as they plan for when the vaccine is authorized for younger children.
“As we’re thinking through how we can provide vaccines for our elementary age students whose families want them to be vaccinated, we also want to be cognizant of the fact that they are littles,” said Youngblood Hall. “Some of them may want mom or dad or guardian to be with them, or mom or dad or guardian may want to be with them. So we’re going to try to figure out what that means.” She added that the district might start with large weekend gatherings, or possibly offer shots before or after school.
For Shanetta Harrington, the interim nurse coordinator for St. Louis Public Schools, meeting families where they were meant never turning anyone away. While the district’s student vaccine clinics last summer and this fall were geared toward kids, they vaccinated any eligible family member who came along and wanted the shot, too. “The only parents who didn’t get vaccinated were those who were already vaccinated,” Harrington said.
Districts and health partners may also determine that students’ home schools aren’t the best place to locate clinics and find another option. That’s what happened in the St. Louis district.
Thinking it would be most convenient for students and families, the St. Louis district first planned to hold clinics at each school site. Soon, though, it realized that wouldn’t be the most efficient use of resources.
“You can’t predict how many students are going to be interested in one school,” Harrington said, and it didn’t make sense to set up an entire clinic for just a handful of students. Instead, the district decided to hold clinics at one school site, and worked with the transportation team to bus students there from their schools, like a “field trip,” Harrington said.
And attending to families’ needs also means taking a careful look at the calendar. Last May, the Northshore district realized that some students’ second doses were scheduled to fall the day before prom: not the ideal time to be feeling some of the vaccine side effects—like headaches, fatigue, or muscle pain—that some recipients feel after getting the shot.
Northshore’s fire department partners were flexible, telling students that they could delay their second shot by a week if they wanted to, Youngblood Hall said. But she offered a word of caution: “Look at the timing of major school events for those doses. They mean something.”
Know that it may take some time for parents to come around.
Vaccine hesitancy continues to be a general problem in the United States, and even parents who gamely got vaccinated themselves could be warier about how they might affect children. All that’s coupled with misinformation about vaccines and alternative treatments on social media.
Generally it’s not a good idea to badger families or to downplay the risks of side effects. Better approaches include providing information from trusted sources, like the CDC; being willing to tailor outreach to different communities; and, most of all, acknowledging that parents will have questions and fears, answering their questions, and giving them time to navigate their choices.
(Education Week has also published a rundown of common questions and answers about the vaccines and schools, as well as tips for encouraging families to get their children vaccinated.)
One potentially effective message for families is to remind them that vaccination is a tool that will help to keep schools open and normalize the school experience for children. Plus, vaccination isn’t just for the protection of students; it also serves a larger civic function in keeping the community as a whole safe.
“I also think there’s going to be a longer tail—individuals who are going to want to have it administered in the context of a conversation with a pediatrician in their office, and those who weren’t ready when we offered the large clinics,” Willis said. “There’s no real shortcut to that process. We’re going to be removing barriers and offering large scale vaccination at sites, recognizing there’s going to be some who are going to take longer. Every shot helps.”
