Schools Usually Enforce Child Vaccinations. With COVID-19, That Job Is Falling to Private Businesses

Studio E School of Dance in the Forest Hills neighborhood of Queens in New York City is losing students. A city-wide policy that went into effect on Dec. 14 bars children ages 5 and up from attending certain extracurricular activities unless they’ve received at least one dose of a COVID-19 vaccine. Because the majority of Studio E’s students are preschool and elementary school kids, it is particularly vulnerable to parents’ decisions to forgo activities rather than get their children vaccinated.

“I’ve just been stressed out about how this will affect the business,” says studio director Nicole Siegel-Toruno, whose family has owned the business for 15 years. “We are pushing people to take virtual classes, but people are dropping out and it is affecting our businesses.”

New York City’s mandate is the broadest in the country, targeting its youngest eligible residents in an attempt to boost vaccination rates for that group as quickly as possible. In late October, the U.S. Food and Drug Administration (FDA) authorized the Pfizer-BioNTech vaccine for emergency use in 5- to 11-year-olds. Since then, about 20% of children in that age group have gotten at least one shot nationwide. In New York City, it’s 33%, which leaves a sizable majority currently ineligible to participate in dance and various sports, as well as other after-school activities like orchestra and band. Children are also required to show proof of vaccination to enter public indoor spaces such as museums, theaters, arcades, gyms and restaurants.

For the better part of two years, businesses across the country have been grappling with public health policies that limit their ability to operate but are critical to keeping their staff and patrons safe. That squeeze isn’t likely to go away as new child vaccination policies come to fruition—and could even make operations more difficult for some.

Public-health and legal experts anticipate that New York’s policy is the beginning of a more widespread effort to vaccinate children, despite resistance from parents. For example, a day before New York’s policy went into effect, Philadelphia announced that, starting Jan. 3, children who are at least three months beyond their fifth birthday will need to show proof of at least one dose in order to enter restaurants, sports venues, movie theaters and any other place that serves food indoors.

Local New York business groups say the rush to implement the policy before the holidays has put unnecessary stress on companies given that the mandate—announced a week before its rollout and without input from business groups—didn’t leave companies or parents enough time to prepare. As a result, they say, the vaccine requirement will negatively impact the local economy and hurt small businesses that have already experienced hardship since the start of the pandemic.

Studio E, for example, has had to shutter one of its two locations. And even after adding remote class options and implementing multiple health safety protocols, the dance school hasn’t recovered from New York’s shutdown nearly two years ago. “Vaccines are super important. No one is anti-vaccine,” says Lisa Sorin, president of the Bronx Chamber of Commerce. “But I think the timing of this is atrocious.”

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The city’s health department did not respond directly to questions about the timing, but pointed to Mayor Bill de Blasio’s comments on the day the policy was announced, in which he said parents had “plenty of time” to get to a vaccination site or attend a school-based vaccination event. Further, he noted the urgency to launch a “preemptive strike” against rising COVID-19 cases that threatened another shutdown if not kept in check. The vaccination rate for young kids in the city rose from 19% to about 30% in the week between the announcement and the rollout—an increase likely spurred both by families wanting to protect against the Omicron variant and not wanting to forfeit their Nutcracker tickets.

“A lot of public-health leadership believes that the preference is to push people to do the right thing without having to require them to do the right thing,” says Stacie Kershner, associate director at the Center for Law, Health and Society at Georgia State University. “But in an emergency situation we can’t wait for people to voluntarily do something.”

Enforcing vaccinations for children isn’t at all new and has withstood legal challenges for decades. But historically, the enforcement has centered around school participation, as TIME has previously reported—not private leisure activities. In New York City, schools are playing a role in enforcing the vaccine mandate, as students must be vaccinated to participate in school-sponsored activities including theater and music programs and certain high-risk sports. But the mandate doesn’t extend into the classroom.

To be sure, such school requirements are on their way. California, for instance, will make vaccination a requirement to attend school starting in the enrollment period following the vaccine’s full FDA approval. (Pfizer’s vaccine is approved for those 16 and over, but is currently available under emergency authorization for younger kids.) Similarly, Washington D.C.’s council proposed requiring students to be vaccinated by March 1 and making school enrollment for the next year contingent on it. The proposal is headed to a final vote after passing an initial vote one day before New York’s vaccine policies were announced.

New York’s current policies allowing unvaccinated children to attend school is a point of both contention and confusion in the private sector. “Why are you hurting businesses when the schools aren’t enforcing it?” asks Sorin, the Bronx Chamber president. “Get the kids vaccinated at school.”

“If this was required in schools then that would be easier on us,” echoes Siegel-Toruno, the dance studio director. “It’s on us to implement and it’s hurting our business because we’re the ones enforcing it.”

The problem with tying vaccinations to education right now is that two-thirds of New York’s elementary school students would not be allowed in the classroom. Moreover, unvaccinated students are disproportionately from the hardest-hit communities, where adult vaccination rates have also lagged. In the city, the disparity often falls along religious and racial lines; only 19% of Black children ages 5 to 12 are vaccinated, compared with 70% of their Asian peers, for instance.

Such disparities aren’t unique to New York. Other areas of the country would face similar challenges if they issued a school-based requirement at this point. In October, Washington D.C. proposed a strict mandate for students to be vaccinated by December in order to attend school. But that idea was scrapped after it was determined that such a policy would largely impact minority children.

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When it comes to public health, policymakers have to weigh the impact of vaccine mandates against the risks of infection to determine how restrictive a policy should be. “There’s certainly an economic impact and an administrative complexity [on businesses],” says Kershner, describing New York’s new policy. “City leadership probably weighed that decision and put a little bit of burden on the business in order to prevent disease spread.”

In restaurants, gyms and music classes, people can spread the disease more easily because they are more likely to be unmasked, in close proximity and breathing heavily. By targeting these establishments, public health officials are aiming to limit the risk of a superspreader event at places that, unlike school, aren’t an integral part of daily life.

“[Policymakers] are saying, if you want to take on the privilege of being involved in these enrichment activities during the pandemic, we’re going to make sure the risk is as minimized as possible,” says Ross D. Silverman, professor of health services administration and policy at Temple University. Parents may feel such risk decisions should be theirs to make. That puts business owners in a tough spot: between the parent and the state.

Another New York dance studio that caters primarily to young children is extending the deadline for its clients beyond the city’s mandate in an effort to accommodate parents whose children aren’t vaccinated. “We have been very on top of all protocols, restrictions and mandates since 2020, but I am very conflicted with this situation,” said the owner, who commented on the condition of anonymity so as to not incur fines from the city. “I could feel the unease amongst parents that are even vaccinated themselves and believe in the science.”

But ultimately, the state holds the legal authority over parents and businesses. “The state has a responsibility to protect the community from the spread of infectious disease first and foremost. And it has an additional responsibility to … make sure children are protected when they are not able to fully make decisions on their own about health issues,” says Silverman. “The Supreme Court has stated that the states can take additional steps to protect children from potential societal dangers above and beyond parental decision making.”

While some business owners feel overburdened by the new regulations, others are more accepting of them because they personally prefer that all their clients be vaccinated. Lacking the authority to impose their own vaccination policy, they see the public policies as a means to level the playing field.

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James Orfanos, director of operations at the NY Martial Arts Academy, anticipates the business may lose a small number of students. But overall, Orfanos has noticed that parents seem generally willing to comply with the new regulations, noting that several parents have asked to freeze their accounts until their kids get vaccinated.

“I believe in the vaccine. I’m fully vaccinated. But I’m not here to put my views on anybody else,” says Orfanos, who runs four locations with his family, three of which are in New York City. “From a basic standpoint, whether from a pandemic or anything else, I’m here to keep my clients safe.”

Patricia Kuszler, a health law professor at the University of Washington, says businesses need to step up so that children don’t get sick or spread the disease to more vulnerable people. “We all have a duty to take care of our fellow man, and that includes not exposing them to ourselves or our kids when we’re unvaccinated. It’s just that simple,” she says. “You’ve got to kind of take the bigger picture and say, hey, I’m here not only as someone who’s providing this opportunity for students to learn this skill, but I have to protect them.”

Having all the dancers vaccinated at Studio E in Queens would enhance COVID-19 safety, but Siegel-Toruno thinks the time pressure has been overly burdensome. The students had already been masked and practicing social distancing, and the studio has air purifiers and sanitation protocols in place. Thanks in part to those measures, there has been no COVID spread among students, she says. “I know the more we are vaxxed, the quicker it will be over, but I personally feel the policy came on very soon,” she says.

Typically, the dance school holds an end-of-year performance in December, but, prior to the mandate, it was moved to June. That turned out to be a fortuitous move. “We would have had to cancel it,” she says.