Rhode Island will expand its vaccination requirements for students and child care workers beginning next August, though the changes will likely not affect Brown students, since Health Services’ current standards already meet the state’s new criteria.
Rhode Island children will be affected by the changes, which include a mandatory influenza vaccine for children aged six to 59 months who are attending a licensed daycare facility and a mandatory requirement that students receive the first dose of a three-part series to protect against human papillomavirus in seventh grade, according to a document from the R.I. Department of Health. The subsequent two doses of the HPV vaccine will be required for entry into grades eight and nine, respectively.
“The new requirements are just reflecting the changes in the advance of medicine,” said James McDonald, chief administrative officer of the RIDOH, adding that the vaccines being mandated “are not new vaccines. … These are very safe vaccines.” One primary reason for mandating the influenza vaccine for young children — albeit only those aged six to 59 months and enrolled in a licensed daycare center — is because “children are very efficient at spreading the flu,” McDonald said, adding that it is “a public health principle.”
Vaccinating children could very well reduce the transmissibility of influenza, said Richard Bungiro, senior lecturer in molecular microbiology and immunology, adding that “the flu vaccine is actually more effective in children than in older people.” Targeting the vaccine to younger children is a good move, Bungiro said, noting that there is a false perception that vaccines might overwhelm a young child’s immune system. In fact, he said, young children have immune systems that are “much more robust” than those of older people.
“I would trade my immune system for the immune system of a six-year-old in a heartbeat,” Bungiro said. Both of his children have received all their scheduled vaccines, he added.
Parents can still exempt their children from the required vaccinations on the basis of religious beliefs or conscientious objections. Pre-existing medical conditions that might preclude children from receiving vaccines are rare, but permissible, exemptions.
But not everyone supports the new requirements. Hillary Davis, policy associate for the Rhode Island chapter of the American Civil Liberties Union, said “it’s really sort of an exploding trend we have seen, where people didn’t want to get the (influenza) vaccine, so now they’re forcing it.”
Davis cited a 2012 mandate that required health care workers to receive the flu vaccine, noting that opposition is partly rooted in the belief that the vaccine “is not regularly highly effective.” Davis added that she was concerned about the consequences for unvaccinated children, who would be prohibited from attending school during flu outbreaks.
Getting a flu vaccine reduced the risk of needing to see a doctor for the flu by 60 percent for both children and adults last year, according to the Centers for Disease Control and Prevention’s February 2014 mid-season vaccine effectiveness estimates. The report added, “Even with moderate effectiveness of about 60 percent, flu vaccination can reduce flu-related illness, antibiotic use, time lost from work, hospitalizations and deaths.”
Bungiro acknowledged that the flu vaccine does not offer perfect protection against infection. He noted that the vaccine’s efficacy depends on a variety of factors, but added that “it sure is better than nothing.”
Both Bungiro and McDonald emphasized that vaccinating children can help many others who could contract the illness from children to stay healthy.
Davis also raised concern over the HPV vaccine requirement. “HPV is not being transmitted in school … so we don’t feel that it is an appropriate school requirement.”
“I think once people understand that it’s about preventing cancer, they’re going to want to get it,” McDonald said of the HPV vaccine. “It’s tragic when a young woman dies because of a preventable disease.”
Bungiro said he thought that even if the transmission of HPV is not happening in schools — an assumption to which there might be exceptions — it nonetheless makes sense to add the vaccine as a requirement for school, which has become the standard method for improving a population’s vaccine coverage. Commenting on the students’ relatively young age, Bungiro said “it is better to establish the protection very early,” before the ages when most people usually become sexually active.
Though the University does not require students to be vaccinated against HPV, Bungiro said he thinks that it should be a requirement. Statistically, most people will have sex in college, he said, adding that because it is such an effective method of risk reduction, “we shouldn’t have to tell people to get the vaccine.”
“I think that mandating any vaccine is a two-way road,” said Julia Dodenhoff ’17, adding that though “vaccines are important and the common good sometimes needs to override personal preferences, … you can’t just approach it from a scientific basis.”
Health care providers and policymakers should always be mindful of cultural context, Dodenhoff said.
Monica Kunkel, nursing coordinator of Health Services, said the HPV vaccine is available to students from Health Services. “I support vaccination — I think it was probably one of the greatest public health advancements in the last 100 years,” Kunkel said.
“I know college students are busy,” McDonald said, but “this is one vaccine you can get that can protect you for your entire life.”
“I would hope that Brown students would intellectually consider the risks and benefits” of vaccination, McDonald said.
An earlier version of this article misstated Richard Bungiro's title. He is a senior lecturer in molecular microbiology and immunology, not a lecturer in biology, molecular microbiology and immunology. The Herald regrets the error.
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