School entrance mandates are probably the single most effective thing we’ve done to achieve high vaccination rates in the U.S., one expert tells FiveThirtyEight. “Can you achieve it through voluntary means? No. Not really.'
. But ideological values, deeply personal fears and political polarization all mean that a vaccine mandate isn’t just a switch you flip on and walk away from. Instead, a mandate is a finicky machine that has to be maintained, lest it fall apart.
But the country has long waxed and waned on whether to require kids to get vaccinated. School vaccine requirements have— nearly as long as public schooling itself. Smallpox vaccination — the only vaccine that existed early in the history of public education — was required for entry into Boston public schools in 1827. But for much of American history, mandates were inconsistently applied across geography and tended to come and go over time.
Hanging over everything is the tradeoff between getting more people vaccinated and shutting out those who aren’t vaccinated. Douglas Diekema, the director of education for the Treuman Katz Center for Pediatric Bioethics at Seattle Children’s Hospital, noted that anytime a government institutes a school-based mandate, they’re balancing two public goods: preventing disease and getting kids educated.
Even once you decide on rules, you have to decide on how staunchly to enforce them. In schools, all states allow medical exemptions because some children have immune disorders or specific allergies to vaccine ingredients. Forty-four states allow parents to exempt their children from vaccines because of religious beliefs,efforts by Christian Scientists during the 1970s.
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