“We keep cohorts together during lunch, so if you’re in a mask-required classroom, you’re eating as a group — socially distanced,” said Superintendent Mark Hansen. “We’re keeping those bubbles pretty tight.”

Until now, elementary schoolers couldn’t get a COVID-19 vaccine. No longer. Centers for Disease Control and Prevention Director Dr. Rochelle Walensky on Tuesday endorsed the unanimous vote of a CDC vaccine advisory panel recommending Pfizer-BioNTech’s pediatric coronavirus vaccine for use in children ages 5 to 11. That means as many as 28 million children can begin receiving shots this week. 

But just as parents split on masks, they’re also divided on vaccines: Nearly half say they may pass on vaccinating their children for now, mostly because they aren’t especially worried their children will get seriously sick from coronavirus — even as doctors warn the virus will become endemic and virtually unavoidable in coming years, much like the annual flu.

That could set up a tense confrontation in coming months between schools and parents as public health officials push to make the shots part of mandatory school vaccine regimens. And as with the divide over masking, social distancing, and other practices, it could also change how schools operate, as pro-vaccine parents insist on keeping their kids apart from unvaccinated classmates.

Even requiring the vaccine for enrollment might not settle the dispute: An Oct. 23 poll found that 46 percent of parents simply wouldn’t send their child to school if COVID vaccinations are required.

In southern California’s ABC Unified School District near Los Angeles, Superintendent Mary Sieu said many cautious families are already hesitant to send their children back to school — about 700 have remained in remote instruction programs this fall. Overall, she said, the district has lost more than 1,400 students over the past two years, forcing her to consider closing one of her schools next year.

“I just feel that a lot of people are afraid of coming back to school,” she said.

While suggests that children remain at a lower risk than most adults of contracting serious illness due to the virus, outbreaks happen. In , conducted in early October, nearly one in three parents said their child’s schooling had been disrupted by COVID-19.

“Look at your ZIP code and see what your vaccination rates are, and your infection rates are,” said Daniel Domenech, executive director of the American Association of School Administrators. “That’s going to tell you the quality of education that those kids are getting in those schools. If a child isn’t in school consistently, they’re not going to be getting the quality education that they need. That’s the bottom line.”

Domenech, a former superintendent in Fairfax County, Va., said he fears that the vaccination gap taking shape between districts could replicate the existing achievement gap. Recent research in has found, for instance, that communities with high poverty rates had COVID-19 infection rates in 2020 that were two to three times as high as those in wealthier areas.

“What we’ve seen is that the areas that are suffering the most in terms of lack of a vaccine and high infection rates are exactly [high-poverty] areas, where families of color are afraid to get their kids vaccinated and are afraid to send their kids to school,” Domenech said. 

‘Ripe for a contentious situation’

Though they typically get a raft of vaccinations just to attend school, children’s COVID-19 vaccination rates have already shown evidence of parental hesitation. In September, the CDC said just of children ages 12 to 17 had gotten at least one shot and 32 percent had completed the two-shot dose by July 31. That’s more than two months after the FDA granted it emergency use authorization — and more than seven months after it first approved the vaccine for adolescents aged 16 to 17. 

In Marshalltown Community School District, northeast of Des Moines, Iowa, as many as 90 percent of school employees are vaccinated, said Superintendent Theron Schutte. But just 40 to 50 percent of eligible students have been vaccinated so far. For the youngest eligible students, ages 12 to 13, the vaccination rate is closer to 40 percent. “My guess is that a lesser percentage of the younger kids’ parents will probably get them vaccinated,” he said. “I’m hoping that more of them do.”

Dr. William Raszka, a professor of pediatrics at the University of Vermont’s Larner College of Medicine, said the risk-benefit analysis for vaccination “is just so overwhelming. I have trouble understanding why someone wouldn’t get vaccinated at this point in time.”

So far, he said, life-threatening illnesses associated with the vaccines “are awfully rare.” One of the most common reactions to Pfizer’s vaccine — the only one approved for emergency use in children — is “a sore arm,” he said.

From the beginning of the pandemic, said Schutte, “We operated on the premise that we know COVID’s going to come into the school. There’s no way we can know whether it is or isn’t coming in – but what we can control is its opportunity to spread.”

He couldn’t immediately predict how his school board would respond to the recent FDA approval of childhood COVID vaccines. “They’re a reflection of our community. So if our community is split on whether we should or shouldn’t require vaccinations, I think it’s always going to be ripe for a contentious situation.”

Mandates are years off

Once COVID vaccines earn full FDA approval, states could move quickly to mandate them for school attendance — California Gov. Gavin Newsom has he plans to add it to the list of vaccinations required to attend school in-person for middle and high school grades, as with vaccines for measles, mumps, rubella, and the like. “We want our kids back in school without episodic closures,” on Oct. 27.

Speaking after he received a COVID booster shot in Oakland, Newsom said children already receive 10 other vaccinations in order to attend school. “The politics around this are disturbing to me. Lives are quite literally at risk.”

Leaders in four of the state’s — Los Angeles, Sacramento, San Diego and Oakland — have already said students must get a first shot of the vaccine or attend school virtually from home in January.

But former FDA commissioner Dr. Scott Gottlieb in October predicted that any COVID vaccination mandate for school attendance would be “a couple of years away, perhaps a little longer,” for children ages 12 to 17, and even further for children ages 5 to 11. Appearing on CBS’s , Gottlieb said CDC has typically taken several years to add most childhood vaccines to their immunization schedule. 

That will leave the decision for now to parents like Debra Garrett, a mother of four children, all of them under 12, in Troy, N.Y. 

Garrett said she’s vaccinated, but added, “I’m not really sure about my kids getting it done right now.” Parents need more information about how the vaccines affect children, she said. “It’s all brand new. We don’t know how anybody’s going to respond to it.”

That sensitivity is heightened, Garrett said, because she grew up Black in a country with a history of mistreating Black research subjects in the name of medicine. “I just don’t want my child to be looked at as ‘the tester,’” she said.

Garrett’s four children all attend , part of the Uncommon Schools network of charter schools in six Northeastern cities. She said the school has given parents of students 12 and up the choice to vaccinate. 

But if Uncommon makes vaccination mandatory, “that’s when it’s going to be tricky — and it’s going to get tough for the school, and for parents. I just feel like there is going to be some kind of push and pull on both ends. I can’t say whether one is right or wrong, but what I do know for certain is that we have to educate people in order for them to be able to fully get it and fully feel like, ‘They’re not just pricking my kid.’”

Many parents will likely find themselves agreeing with Garrett. In a June survey , as the more-contagious Delta variant began to take hold in the U.S., the parents of just 51 percent of students under age 18 said they’d “probably” or “definitely” have their child vaccinated, with vaccine hesitancy much higher for parents of younger children. They’re far less likely to say they’ll vaccinate their kids compared to parents of high schoolers — 46 percent vs. 59 percent. 

Political party affiliation also plays a role: Republican-identifying parents of 35 percent of children say they’ll vaccinate their kids, while that figure is much higher for Democrats at 66 percent.

A September Gallup poll suggests that of parents of children under 12 would get them an available vaccine. Parents’ own vaccination status strongly predicted their attitude toward their kids: 82 percent of parents who were fully vaccinated against COVID-19 said they’d vaccinate their child, while just 1 percent who don’t plan to get vaccinated themselves planned to vaccinate their kids. 

Dr. Benjamin Lee, a pediatric infectious disease specialist and associate professor at the University of Vermont Children’s Hospital, said the findings are cause for concern.

“It’s discouraging to me to see how many parents have already sort of expressed that they don’t want to get their children vaccinated as soon as vaccines are available,” he said.

While it’s natural for parents to hold out a high threshold for vaccine safety, he said, no vaccine carries zero risk. “And that includes all of the vaccines that we use routinely” for both children and adults. “In all scenarios, the data are so overwhelming that risks from vaccination are far lower than the risks of natural infection.”

Schutte, the Iowa superintendent, said it’s true that children are less likely than adults to get seriously ill due to COVID, but he urged parents to see the bigger picture: Even if kids don’t get sick, they could take the virus home. “We have a lot of multi-generation (families) living under the same roof in our community,” he said. “So it’s not only the parents, but the grandparents, and maybe in some cases, the great-grandparents.” 

The longer it takes to get most people vaccinated, he said, “the longer the situation is going to stretch out.”

In reality, said Lee, the Vermont pediatrician, SARS-CoV-2 “is going to be with us from now on. Any chance to completely eradicate this virus is long gone. And this will become an endemic virus,” like the annual flu, sticking around for years. Because it’s so contagious, he said, “what we should recognize is that all of us are going to get this virus. And the question is: Under what conditions or terms do we want to catch it?”

So far, the only statistically significant side effect of the vaccine is a mild case of myocarditis, or inflammation of the heart muscle, in adolescent males. But it’s enough to prompt physicians in a few countries to give young people of the Pfizer-BioNTech vaccine, offering at least partial protection from the virus without this side effect. 

“We should acknowledge that that is a known risk of vaccination,” Lee said. “However, when you look at the risk of myocarditis from vaccine versus the risk of myocarditis from COVID-19, the risks are far higher of catching myocarditis if you catch COVID-19 than from the vaccine itself.” 

Also, he noted, “almost without exception” the myocarditis associated with the vaccine is “a very, very mild illness that completely resolves.” COVID-19, by contrast, carries a higher risk of severe outcomes. 

Lee also warned against taking to heart the many unsupported claims about the vaccines’ quick development and emergency approval, claims that might turn parents, like Garrett, off to vaccination. “When all is said and done, these will end up being the most heavily scrutinized vaccines in terms of safety perhaps ever, compared to any vaccine that we’ve ever used.”

Leading Republicans on the Senate education committee are calling on the head of the Centers for Disease Control and Prevention to provide details about how much the agency interacted with teachers unions and whether she has been completely forthcoming about their involvement in .

North Carolina Sen. Richard Burr, ranking member of the committee, and Sen. Susan Collins of Maine, sent to CDC Director Dr. Rochelle Walensky Thursday with a list of questions about why the guidance was delayed from late January to mid-February. The letter asks Walensky to identify all administration personnel, including political appointees who prepared and reviewed her April 22 letter to the committee, and requests a complete list of “stakeholders” the CDC contacted, including parents. The senators want to see all documents and communications between the CDC and union employees or members.

“That your agency would give teachers’ unions privileged access to the agency’s internal decision-making process on an issue as critical as school re-openings is a betrayal of that trust,” they wrote. “That you then would appear to try to avoid Congressional scrutiny by providing incomplete testimony is deeply troubling.”

The letter is the latest example of concerns about political influence over the agency in charge of the nation’s response to the pandemic. During the Trump administration, Democrats whether senior officials were pressuring the CDC, then led by Dr. Robert Redfield, to downplay the threat of the virus. Now, Republicans are questioning whether President Joe Biden’s supporters have interfered with efforts to reopen schools.

The CDC did not respond to requests for comment.

On Feb. 27, ����Ӱ�� filed a request with the CDC seeking information similar to what the senators want — all documents and communication, such as emails and transcripts of meetings, involving the CDC and any interest groups or individuals consulted in preparing the guidance. The CDC has so far provided internal CDC emails, but not the full list of groups and individuals.

Walensky testified before the committee May 11, saying that the agency sought input from over 50 “consumers.” During that hearing, she said the CDC’s communication with the unions focused on what schools should do if they have immunocompromised teachers.

But obtained through the Freedom of Information Act by Americans for Public Trust and Open Fairfax County Schools, a parents’ group in Virginia, show there was extensive email communication between CDC officials and the unions, especially the American Federation of Teachers.

“Your testimony seems – at a minimum incomplete – if not inaccurate,” the letter said. “The email correspondence makes clear that the involvement of the teachers’ unions went well beyond accommodations for high-risk teachers.”

AFT, for example, pushed for language saying the agency could change its guidance if a new variant of COVID-19 was detected.

In a Feb. 11 email to Walensky, as well as White House officials, Kelly Trautner, AFT’s senior director of health issues, suggested: “In the event high community transmission results from a new variant of SARS-CoV-2, a new update of these guidelines may be necessary.” She wrote that the union was concerned that even with safety protocols in place, some schools in “high-density, crumbling infrastructure areas” would not be able to safely reopen.

The final guidance reads: “As more information becomes available, prevention strategies and school guidance may need to be adjusted to new evidence on risk of transmission and effectiveness of prevention in variants that are circulating in the community.”

The Fairfax group said the senators raise important questions and that the public needs to understand why the guidance didn’t always coincide with the studies and recommendations it received from experts, such as the agency recommending 6 feet of social distancing even when research showed 3 feet was still effective in minimizing transmission. The CDC later reduced its recommendation 3 feet, which the AFT initially opposed.

“The draconian guidelines, many of which the CDC has subsequently pulled back from, resulted in slower reopenings in parts of the country that treat such guidance as mandatory, a result that was in alignment with the positions being advanced by the AFT and NEA but which caused real harm to the nation’s school children,” the Fairfax group said.

Following the initial release of the emails May 1, AFT spokesman Oriana Korin issued a statement saying the union was in touch with the CDC on behalf of its members, just as it was during the Trump administration.

“And while we have at times been concerned about their conclusions — as we were initially with the change in classroom physical distancing rules — we respect deeply that the CDC career staff has always taken its responsibility seriously,” she said. “And we appreciate that under Dr. Walensky’s leadership, the CDC welcomes stakeholder feedback, as opposed to ignoring it.”