Vermonters—several have reached out with questions related to #covid19 vaccination in schools. Here are some thoughts on the policy, public health, and practical considerations on this topic. #vted #vtpoli

Let's start where there is agreement. Vermonters have consistently reflected a shared desire to protect vulnerable residents and to prioritize education. This analysis considers how to use scarce vaccine resources to advance these dual goals.

What are some policy considerations? Vermont set in-person education as a policy priority of its public health response. It reopened schools, targeted restrictions to keep schools open in November, and aims to increase in-person learning by spring.

Vermont's school leaders and teachers have undertaken heroic efforts to maintain educational continuity since March and reopen schools in September. This has not only helped to mitigate the educational impacts on children but has also helped to stabilize VT’s workforce.

Yet, schools have made difficult trade-offs between maintaining educational operations and protecting public health. Vaccinating teachers could enable teachers and schools to function more easily—and that this would have real benefits for kids and families.

While cases have remained low relative to other states, we should also acknowledge that even a single case is highly disruptive to school communities. One case may send a carefully constructed pod home, leave schools short on personnel, and incite fear in educators.

Vermont schools have also emerged as critical actors in the state’s public health response. Unlike peers in neighboring states, Vermont’s leadership has set keeping schools open as an explicit goal of its public health response and targeted restrictions accordingly.

Schools have helped to implement state guidance in their communities, served as public health messengers, and also supported other critical public health activities. Schools are bedrock institutions, and many families comply with guidance to protect them.

From a policy perspective, we might argue that vaccinating teachers both aligns with VT’s stated prioritization of in-person education and supports the public health response. If VT wants to expand in-person education, it should use public health resources to achieve this goal.

The question though is whether it makes sense to use scarce vaccine resource to achieve this goal, and this is a public health one. Here’s a short thread that I wrote on vaccine equity for a bit of background to ground this analysis: https://twitter.com/asosin/status/1350207581902483458

We know that social vulnerability falls along a spectrum. The most vulnerable workers are those who are unable to maintain physical distance, remain for long periods of time in closed, poorly ventilated spaces, and have a significant number of contacts. https://twitter.com/kbibbinsdomingo/status/1352751847715467264?s=21

Most teachers are in rigorously mitigated environments with a stable set of contacts. They are generally not among those essential workers with the highest risk (but also not necessarily the lowest risk). Risk also varies based on community transmission.

How safe are schools in Vermont? My assessment is that while there have been many introductions of cases into schools (largely reflecting community transmission), in-school transmission and outbreaks have been limited (more data here).

https://www.healthvermont.gov/sites/default/files/documents/pdf/COVID19-Weekly-Data-Summary-1-22-2021.pdf

State surveillance testing of teachers in December showed a very low prevalence of #covid19 in school staff (<0.3%). Some have voiced concern about the comparison of surveillance testing with state test positivity; however, the data independently point to low school prevalence.

I should note, however, that low prevalence from surveillance testing at state level doesn't reflect the epidemiology in one school or community and can vary over time. Also, we should recognize that reporting can & does miss cases (different from prevalence) for various reasons.

Low positivity and limited in-school transmission reflect a combination of factors, including community transmission, individual activities and exposures outside of work, and robust school efforts to limit introductions and mitigate transmission.

Yet, rising community transmission, expanded in-person learning, increases in other activities, and the near certain arrival of a new more transmissible variant are all factors that could increase risk in schools at state or local level. https://www.wired.com/story/everything-we-know-now-about-schools-kids-and-covid-19/

Compared to other essential workers, most teachers in Vermont are not the among the state’s most socially vulnerable essential workers, and some may be more at risk outside of the school environment (ie in a household with another essential worker).

So what does this mean? From a public health perspective, allocating extremely scarce vaccine product to teachers will likely not achieve the most benefit in terms of lives saved or hospitalizations avoided in the state of Vermont.

What might Vermont do given these considerations? First, it can align less limited public health resources with its goal of in-person education. This means maintaining community restrictions (and expanding as needed) and limiting other high-risk activities (ie indoor sports).

Are there alternative options to expanding vaccination to include teachers? Maybe. First, states may see increases in vaccine from the government, and Vermont might consider adding teachers (and possibly other essential workers) as additional allotments become available.

Another option would be to prioritize teachers that are medically vulnerable but that do not yet fall within a designated group. A third approach would be to target schools in communities with increased transmission or middle/high schools, where the risks to staff are greater.

I hope that this brief analysis can inform the ongoing discussion around #covid19 vaccination and schools. I would like to conclude by thanking everyone who has worked tirelessly to keep our communities healthy and our kids in school.