At a time when health authorities say their best advice for insulating young children from COVID-19 is to vaccinate the adults around them, Palm Beach County education leaders don’t really know how many teachers or school-based staff have done that.
Administrators know only that at least 47.5% of the 19,436 employees on the district’s health care plan had their shots by late August. The district employs more than 22,400 and roughly 13,000 of those are teachers.
Superintendent Mike Burke and his team suspect the actual vaccination rate is higher.
“It would be a fair estimate that roughly half of our employees have been vaccinated and that figure could be higher due to lag in data — possibly 60%,” Burke said. “It’s also possible teachers may be more highly vaccinated than some of our other employee groups.”
A vaccination rate under 50% falls below the county (61%), state (56.4%) and national (60.8%) vaccination rates, as reported by the U.S. Centers for Disease Control and Prevention. It is also quite distant from estimates made by national teachers unions that roughly 80% to 90% of their membership has gotten inoculated, an estimate supported by the CDC.
Regardless, amid a surge driven by the highly contagious delta variant, it isn’t enough, doctors warn.
“Universal masking and vaccines for all students over age 12 and teachers/staff are what will help us win this battle and save our children, their parents and our teachers,” Dr. Shannon Fox-Levine wrote on behalf of the Palm Beach Pediatric Society in a letter to the school board last week.
“This is a public health crisis, a pandemic, which should not take into account just the individual, but the health, safety and wellness of the whole,” wrote Fox in the statement signed by more than 75 doctors, 55 of them from Palm Beach County.
While Fox did not explicitly call for a mandate, Dr. Anthony Fauci advocated for one last month in an MSNBC interview.
“I’m going to upset some people on this, but I think we should (require teacher vaccinations),” said Fauci, director of the National Institute of Allergy and Infectious Diseases.
“I mean, we’re in a critical situation now. We’ve had 615,000-plus deaths, and we’re in a major surge now as we’re going into the fall, into the school season. This is very serious business,” said Fauci, who is also President Joe Biden’s chief medical adviser on COVID-19.
But don’t expect a mandate to come from the federal level, Fauci said. Instead look to state and local governments.
On Aug. 23, New Jersey’s governor became the fourth in the country to announce a vaccine mandate for teachers. The state will require all school employees be vaccinated against the virus or submit to weekly testing beginning Oct. 18.
California and Hawaii are also requiring school staff to prove they’ve had their shot or undergo regular COVID testing in order to work. Washington has taken its demands of school workers a step further, requiring the vaccine and offering no testing alternative.
At the national level, any pushback against mandates from unions has faded with the rise of the more aggressive version of the coronavirus.
In mid-August, the National Education Association, the nation’s largest teachers union, boasting 3 million members, issued a statement supporting requirements that all educators receive a COVID-19 vaccination or submit to regular testing.
Also in August, American Federation of Teachers President Randi Weingarten said the rise of the delta variant has eased prior hesitance in that union’s stance.
“As a matter of personal conscience, we need to be working with our employers — not opposing them — on vaccine mandates,” Weingarten said.
Mandates are not on the table in Palm Beach County schools currently, says Justin Katz, president of the Palm Beach County Classroom Teachers Association. Instead, the conversations the union has had with district administrators have been about ways to encourage vaccination.
“If we go with an incentive approach at first, you’d find out real quick what number already have it,” said Katz, who found the rate offered by the district’s health insurer to be “shockingly” low. “If you find 75% or 80% have already vaccinated, it makes it less urgent.”
And, Katz said, it could make a more compelling argument to those who haven’t gotten the shot to say most of your colleagues have.
Driving more people to roll up their sleeves will require the right incentive, and Burke says the district is trying to determine what that would be.
There’s been a discussion about a discount on health premiums, much like the ones given when employees attest they do not use tobacco products. But many options come with their own hurdles, said Burke, who added that he found it hard to imagine a better motivator than the devastation COVID-19 already has wrought.
“If seeing your neighbors in the community die doesn’t do it, what is an incentive going to do?” Burke said.
Incentives move one group more than others
Incentives have proved most successful with fence sitters, people who have procrastinated or felt no urgency but held no deep-seated opposition.
“The idea of using incentives to get that middle group over that hump and nudge them along is a very reasonable idea that has definitely worked in the past for these sorts of short-term, concrete activities that we want to incentivize people to do,” researcher Karen Sepucha told Scientific American this summer.
Sepucha is director of the Health Decision Sciences Center at Massachusetts General Hospital’s general medicine division and an associate professor of medicine at Harvard Medical School.
Cash or the freedom from social restrictions such as mask wearing or social distancing appear to motivate the unvaccinated middle-grounders, according to as yet unpublished research Sepucha is collaborating on. The latter motivator was reflected also in a CNN survey that found vaccine interest increased when the CDC said vaccinated people wouldn’t need to wear masks, advice that has since been tweaked with the surge of the delta variant.
Could freedom from regular testing have the same effect? As for cash, how much is enough?
Last month, Broward County’s school board decided to try a one-time $250 bonus to those who show proof they’re vaccinated by Oct. 20.
But both the teachers union and the association representing school administrators there say that doesn’t go far enough. The Broward Teachers Union president told the school board that the union favors a vaccinate-or-test weekly rule. The Broward Principals and Assistants Association is seeking a mandate both for employees and all students eligible to be vaccinated.
Other government agencies in Palm Beach County have wrestled with how to boost vaccination rates.
Delray Beach is demanding its non-union workers be vaccinated or tested weekly. Since the announcement, city officials report vaccination rates have increased and the firefighters union has agreed to follow the policy.
Palm Beach County Tax Collector Anne Gannon has imposed a mandate on her employees. The head of the county Clerk and Comptroller’s office, Joe Abruzzo, announced this week that it will offer $500 bonuses to those who get vaccinated and those who don’t will be subject to weekly testing.
Abruzzo has 650 workers; the school district has more than 22,400.
What it takes to protect roughly 165,000 children
The school district is also tasked with the care of roughly 165,000 children in its non-charter schools, at least 76,000 of whom are too young to be vaccinated.
The CDC underscored the importance of vaccinating and rigorous mask protocols to protect children when it published its investigation Aug. 27 of an outbreak in a California elementary school that occurred in May.
The CDC traced the outbreak that infected at least 12 of 24 students to an unvaccinated, and, during reading time, occasionally unmasked teacher who felt sick on a Wednesday but attributed symptoms to allergies and continued to work until Friday, when she tested positive for COVID-19.
By Sunday, cases began to be reported among fellow staffers, students, parents and siblings connected to the school, the CDC reported. In the end, 27 cases including the teacher were tied to the outbreak.
Eight of 10 kids seated in the front two rows tested positive, infection rates in the three back rows was lower with four of 14 students positive. Two students were not tested. Cases jumped to another class and spread to siblings and parents as well, the CDC said.
Families and school staff reported students were fairly diligent in wearing their masks. The room in question had a portable air filtration system and windows on two opposite sides of the room were open — it was the Bay area in May, so weather permitted.
The investigation analyzed the genetic sequencing of the virus from 18 patients, not including the teacher, to map their relationships.
The CDC’s takeaways from this one classroom: “This outbreak of COVID-19 that originated with an unvaccinated teacher highlights the importance of vaccinating school staff members who are in close indoor contact with children ineligible for vaccination as schools reopen.
“Further transmission might have been prevented by high levels of community vaccination; at the time of this outbreak, approximately 72% of eligible persons in the city where the school is located were fully vaccinated.”
The first step Palm Beach County schools is making to improve vaccination rates is to improve availability. The district has partnered with the Health Care District of Palm Beach County to administer vaccines from the HCD’s mobile clinic vans. They will be stopping at two high schools a day and vaccinating teachers and other school staff as well as students ages 12 to 17 who are accompanied by their parents — 18-year-olds need only to have a completed consent form.
School board member Erica Whitfield, who previously worked as the district’s wellness director, says she hopes the carrot works.
“I don’t want people to think they don’t have a choice when it comes to health care,” said Whitfield, who both recovered from COVID-19 and has been vaccinated. “A mandate just feels like a little too far… it doesn’t sit well with me.”
School board member Debra Robinson, a retired physician, said a mandate would be more palatable if the district supplied the opportunity to be tested twice a week as an alternative. “I could support that.”
Robinson says she is concerned for students, teachers and also bus drivers. “They’re in this contained space with students for an hour sometimes.”
From Fox’s perspective as president of a large pediatric practice in Palm Beach County, the need to build vaccination rates is urgent.
“It’s been horrible,” Fox said, describing a 20% positivity rate among the sick children tested in the Palm Beach Pediatric offices from West Palm Beach to Boynton Beach. The doctors are seeing more students hospitalized, and if they aren’t seriously ill, their parents sometimes are.
“In the last three weeks, we’ve had four parents who died — and those are just the ones we know about,” Fox said.
“I understand this is what people consider a new vaccine, but after you’ve given, what, 650 million doses? That’s probably the best clinical trial we’ve ever had from a vaccine. That’s how we defeated polio, measles, mumps, rubella.
“If your house is on fire, the firefighters come and put out the fire. You don’t question how they put it out,” Fox said. “We have a forest fire.”