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Conditioning school attendance on student vaccinations is an evidence-based way of maintaining and increasing vaccine coverage. State law establishes school vaccination requirements which apply not only to public schools but often to private schools and childcare facilities as well. All states allow an exemption for those where a vaccine poses a medical risk. Several states also allow non-medical exemptions, often based on an asserted religious, philosophical, or personal belief of the parents or child opposing vaccinations. However, a few states have recently abolished all non-medical exemptions.

One of the major disruptions to daily life caused by the COVID-19 pandemic was the rapid shift from in-person K-12 education to virtual learning. While necessary for social distancing and slowing the spread of disease, there is a concern that time away from traditional classroom environments has slowed student’s anticipated learning trajectory and milestones, resulting in what is referred to as learning loss. If left unmitigated, learning loss may result in lower educational achievement and poorer health outcomes in the future for current students, particularly students with disabilities.

Toxic stress contributes to a variety of negative outcomes for children. And unfortunately, COVID-19 has increased the likelihood of children experiencing childhood trauma, adverse childhood experiences (ACEs), and toxic stress. States and territories should have programmatic, and policy mechanisms to both prevent and mitigate the lifelong effects. A CDC Vital Signs Report found that preventing or mitigating ACEs could reduce depressive disorder by 44%, smoking by 33%, and unemployment by 15%.