In what is believed to be a first in the nation, Massachusetts on Wednesday mandated that nearly all students under the age of 30 get a flu vaccine by the end of this year amid fears that concurrent outbreaks of influenza and COVID-19 in the fall could overwhelm the state’s health care system.
The mandate, hailed by public health experts nationwide, requires the vaccination for anyone 6 months or older in child care centers, preschool, kindergarten, K-12 schools, and colleges and universities, unless they have a religious or medical exemption, are home-schooled, or are a higher education student living off campus and taking remote-only classes.
Elementary and secondary students whose schools are pursuing remote-only models this fall are not exempt.
State officials said that requiring the vaccine is “an important step to reduce flu-related illness and the overall impact of respiratory illness” during the COVID-19 pandemic. In New England, flu season usually begins in the fall and lasts through March.
“Every year, thousands of people of all ages are affected by influenza, leading to many hospitalizations and deaths,” said Dr. Larry Madoff, medical director for the state health department’s Bureau of Infectious Disease and Laboratory Sciences. “It is more important now than ever to get a flu vaccine because flu symptoms are very similar to those of COVID-19 and preventing the flu will save lives and preserve healthcare resources.”
Massachusetts has about 1 million children enrolled in K-12 schools, according to state records. About 81 percent of those age 17 and younger received a flu shot in the 2018-19 year — the highest rate in the nation — according to the Centers for Disease Control and Prevention.
There are another half-million attending colleges in Massachusetts, and the new mandate could prove challenging for health officials to enforce, especially among the sizable number of students who travel here from other states and countries.
The rule is also likely to encounter resistance from elements of the population who oppose vaccines for themselves or their children.
Keri Rodrigues, founding president of Massachusetts Parents United, an urban parent advocacy organization, said that while she favors more vaccination for students, the state’s mandate must be followed by a clear plan and resources to see it through.
“Parents are already under enormous pressure and anxiety and are dealing with a lot,” she said. “I’m just hoping our elected officials have a robust plan and a big check to make sure this happens.”
Health care leaders applauded the new rule, saying it will help relieve already burdened hospitals. As students return to schools and colleges, hospitals are also thinking about the arrival of seasonal respiratory viruses. Whenever there is a bad flu season, hospitals fill up. Now they will have to make room for COVID-19 patients, as well.
“The upcoming flu season is of major concern to our healthcare providers, which are already working around the clock to prepare for a second wave of COVID-19,” Steve Walsh, president of the Massachusetts Health & Hospital Association said in a statement.
“We appreciate the Baker administration’s proactive focus on areas like classrooms, where a flu outbreak could further harm the health of our communities and overwhelm our hospitals,” he said. “Just like wearing a mask and social distancing, getting a flu shot is a simple but powerful way to help our healthcare community through what will be a very challenging fall.”
Dr. William Schaffner, professor of preventive medicine at Vanderbilt University School of Medicine, said science shows children transmit more flu virus than adults and for longer periods of time, making this flu mandate critical, especially amid the coronavirus pandemic.
“We know that children have the distribution franchise for the influenza virus in the community. They spread it among themselves and bring it home,” Schaffner said.
The Massachusetts flu vaccine mandate is “distinctly unusual and wonderful,” he said.
The Immunization Action Coalition, a Minnesota nonprofit that tracks vaccination regulations nationwide, said that while a handful of states require flu vaccines for childcare and preschool-aged children, none have mandated it for nearly all students.
Now, some public health experts hope other states will be inspired to follow Massachusetts’ lead.
“Every state looks to see what their peer states are doing and each state tries to learn from another,” said Dr. Howard Koh, a former Massachusetts public health commissioner who was an assistant health secretary in the Obama administration.
“This [mandate],” Koh said, “is how change occurs.”
Tom Scott, executive director of the Massachusetts Association of School Superintendents, said the flu-shot requirement made sense, noting that reducing the chances of students becoming sick could also decrease false alarms about possible COVID infections.
“I think there is merit to having kids protected as much as we can,” he said.
Doreen Crowe, president of the Massachusetts School Nurse Organization, said in a statement that the organization “supports preventative measures to keep children healthy, safe, and ready to learn.”
“It will be important for school districts to collaborate with health care providers and local boards of health to insure students are in compliance with the new flu vaccine requirement,” she said.
Massachusetts already has a program that pays for local health departments and school districts to buy and administer flu shots for children 18 and younger who rely on state-funded health insurance. And Rodrigues, the parent advocate, said it is imperative now to ensure those resources are going to communities of color and lower-income areas, which have been hit hardest by the COVID-19 pandemic.
Officials need to ensure that “health centers have the vaccine, the supplies they need and that they can handle the surge of parents that will need to meet this requirement,” Rodrigues said, adding that it could serve as a trial run to make sure the COVID-19 vaccine is available and providers are prepared when it is released.
The state must also make its information clear and accessible to those communities, she added, because Black Americans are among the most skeptical of the safety of vaccines, recent surveys have shown.
James Vaznis of the Globe staff contributed to this report.
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