Tesha Akins, who works directly with COVID patients at Vanderbilt University Medical Center in Nashville, receives the hospital’s first coronavirus vaccination from nurse Robin Steaban on Thursday, Dec. 17, 2020. (Image: Donn Jones/VUMC)

As the first coronavirus vaccines were given this week in Tennessee, a legislative push is under way to weaken a state law requiring them for school, even though convincing skeptics to get the shots might be the quickest way to return education to some degree of normalcy.

Several immunization bills up for consideration in 2021 would relax vaccination requirements as sponsors seek to protect Tennesseans’ rights to choose what goes into their bodies. Legislative leaders say there’s a good chance at least one of them will pass.

On Thursday, Gov. Bill Lee declared Pfizer’s vaccine “safe” as Tennessee gave its first doses to healthcare workers while recording some of the nation’s highest rates of virus spread. The Republican governor reiterated that the shots will be optional for people in public schools. He also said the state is considering bumping up teachers on the vaccination priority list “because of the importance of kids being back in school.”

But public health officials say the mixed messages on schools could end up discouraging Tennesseans from participating in the nation’s most ambitious vaccination program ever. Medical experts say more than three-quarters of the population need shots in their arms to achieve a level of protection that will crush the virus.

Revising vaccination requirements also could hurt the state’s pre-pandemic immunization rate of 95% among kindergarteners for other communicable diseases like measles, mumps, and rubella.

The worsening pandemic has forced more Tennessee schools to pivot to remote learning in recent weeks because administrators can’t keep their classrooms staffed. The trend is elevating worries that students are falling behind and frustrating weary parents who say virtual learning isn’t working for their kids.

Dr. Stephen Patrick, director of the Vanderbilt Center for Child Health Policy, is urging leaders to offer hope by talking about the vaccine in a way that is clear, consistent, transparent, and grounded in evidence.

“Parents don’t really know who to trust right now as they consider next steps in the pandemic,” he said.

Tennessee law allows parents to refuse to vaccinate their children based on their religious beliefs and practices, as long as the state is “in the absence of an epidemic or immediate threat of an epidemic.”

bill from Republican Rep. Jay Reedy and Sen. Mark Pody would eliminate the so-called “pandemic clause” so that parents can opt out of the coronavirus vaccine for their kids, even after it’s been vetted and recommended for younger age groups. Separate legislation proposed by Rep. Bud Hulsey, also a Republican, would prevent state or local authorities from “forcing, requiring, or coercing” a person to get a COVID-19 vaccine against their will.

House Education Committee Chairman Mark White said legitimate concerns raised about the new vaccines and philosophical beliefs about the importance of personal choice are putting the legislature in “new territory” during a pandemic. He acknowledged that he is conflicted about the issues.

“I don’t see us mandating vaccines for COVID-19,” White said, referring to the governor’s stance on the matter. “Tennessee does already require vaccines for measles, mumps, and rubella to go to school, but this is a new one. At the same time, I want to see our children back in classrooms as soon as possible.”

He plans to hear from medical experts when the legislature convenes in January.

“We can’t just pass legislation because it’s politically expedient,” said the Memphis Republican. “We need to have some hard discussions and be thoughtful about this. I think we’re going to have to do a lot of listening.”

According to the National Conference of State Legislatures, all 50 states and the District of Columbia have policies requiring vaccines for students and exemptions for those with documented medical reasons for not being vaccinated. All but four states — California, Mississippi, New York, and West Virginia — allow exemptions for religious beliefs, while another 15 allow exemptions based on philosophical reasons.

Such policies have prevented 21 million hospitalizations and 732,000 deaths among children born over two decades, according to the Centers for Disease Control and Prevention.

New national data from Blue Cross Blue Shield shows routine vaccinations for other diseases already dropped by 26% in 2020 as a result of the pandemic.

“The messaging is so critically important right now,” said Vanderbilt’s Patrick. “There’s good evidence about the importance of routine vaccinations of children. We have to be mindful that whatever policies we pass and processes we use around the coronavirus vaccine have implications for overall vaccinations of children.”

Although COVID-19 vaccines have gone through an accelerated but rigorous federal review process, Americans have a lot of questions about their safety and many don’t want to be first in line to take them.

Safiyyah Salaam is among the skeptics. Even though the Tennessee teacher is diligent about keeping immunizations up to date for her three school-age children, she doesn’t plan for anyone in her family to get immunized against the coronavirus, including herself, as vaccines become more available.

“This vaccine has come to market way too soon,” said Salaam, who teaches in Cordova, a bedroom community of Memphis. “I don’t trust its safety.”

This fall, the Vanderbilt Center for Child Health Policy polled more than a thousand Tennessee parents to gauge their views about masks, vaccines, and COVID-19. Only half said they were likely to vaccinate their children. And among Black parents, only two out of five were.

“We’re entering this new phase of the pandemic with a significant trust deficit, Patrick said. “We’ve got to earn that trust back.”

The results were equally jarring from a separate survey of mostly educators conducted recently by the Professional Educators of Tennessee. Almost half of 1,400 respondents said they did not plan to be vaccinated against the coronavirus, while a fifth were undecided.

“Basically, no one thinks they should be forced to take it,” said JC Bowman, the group’s executive director.

Patrick identified two issues at the root of the skepticism.

“For some, they’ve heard a barrage of misinformation on platforms such as social media and using some of the same messaging of the anti-vaccine movement,” he said. “For others, it’s rooted in a legacy of systemic racism and mistrust of a system that has failed and exploited communities of color.”

Salaam understands the second issue.

“I don’t have a single friend who is an African American who is planning to take the vaccine,” said the Shelby County teacher and mom, who is also Black.

The decisions of her friends are based in part on generations of experimentation on Black Americans such as the infamous Tuskegee study. Conducted in Alabama with the approval of the U.S. government, doctors tracked hundreds of Black men living with syphilis from the 1930s to 1972, without offering guidance or treatment as the men struggled with health complications, infected others, and died.

At the same time, communities of color have been hit particularly hard by COVID-19. Salaam has eight relatives that have contracted and recovered from the virus.

Barton Thorne is white and doesn’t plan to get vaccinated either. He is the principal of Cordova High School, also near Memphis. “The vaccine may be more damaging than the virus,” he said, citing a lack of data on possible long-term effects.

Other educators can’t wait to get their shots, though, to protect themselves, their households, and their school communities.

In Knox County, substitute teacher Lois Chmely said she’ll get inoculated but worries that others in schools won’t. That could keep the virus active and prolong disruptions to schools and learning. “I’m very concerned,” she said.

Mike Stein, a high school teacher in Coffee County, south of Nashville, says he’ll get the shots, in part to be a role model for his students and families in his rural community, where many are wary of the vaccine.

“My biggest concern is the rampant spread of misinformation, combined with a healthy general skepticism about a new vaccine,” Stein said. “It will take true leadership on a local and a statewide level to convince people to get vaccinated.”

Words and actions based on facts instead of mandates would help leaders build trust, Vanderbilt’s Patrick said.

For instance, on children and the vaccine, he said the message should be: We’re awaiting further study before making recommendations.

Seeing leaders in government, schools, churches, synagogues, and neighborhoods roll up their own sleeves will build trust too.

That’s the case for Salaam. She still doesn’t plan to get vaccinated, but says watching broadcasts of healthcare workers getting vaccinated this week made an impression.

“It caused me to reflect,” she said. “It’s possible I could change my mind.”