A doctor vaccinates a young girl. Photo courtesy Centers for Disease Control and Prevention

In summers past, those with young children about to start school would be updating immunizations about now, in keeping with state guidelines. But this fall, schools will be shuttered. Our mishandling of SARS-C0V-2, which causes the disease COVID-19, has effectively cancelled this occasion for vaccination—and opened a backdoor to the possibility for resurgence of once-deadly childhood diseases. One way to guard against this is paying more attention to the important life transition school entry vaccinations signal.

As a medical anthropologist studying immunization choice-making, I learned that most parents do not give vaccination a second thought: they told me and my data collection crew things like “it’s part of the program.” When pressed to explain why they were having their children fully vaccinated, many had little to say. Vaccination was simply routine—like brushing teeth.

That’s OK: the public’s health depends upon myriad habitual hygienic undertakings. Lunchtime, for instance, can trigger a hand-washing ritual, as should the knowledge that one is about to cook. The cues triggering completion of pediatric vaccination included, until this year, the immunization record form required to ensure a seat in the schoolroom.

When we all do our part, everyone prospers; and, to date, public participation in efforts to vanquish vaccine-preventable disease through mass immunization, which fosters community immunity, has been notably good overall. Access has barred some from participating, and some have fallen prey to propaganda circulated by those standing to profit from such anti-social behavior. Anti-vaccination influencers—who prefer to market themselves as “health freedom” entrepreneurs—have amassed great financial wealth on the backs of naive and vulnerable followers who also buy the snake oils and other swag their websites sell. But until COVID-19, the nation’s overall pediatric vaccination rates were reasonably high.

Now, we are seeing decreases. Letting immunization rates fall too low puts us all at an increased risk for the epidemic and potentially pandemic spread of numerous diseases beyond COVID-19, including measles, which caused 2.6 million deaths annually prior to the vaccine. Given how COVID-19 has dislodged the immediate utility of school vaccinations (as well as having decreased opportunities for boosters and for other forms of vaccination among adults) we may soon see such rates again.

But there’s another reason to vaccinate now: it provides a special way to celebrate with our children the important step they are taking in becoming school-goers. For many, there will be no new clothes to mark the shift. There will be no bittersweet goodbyes at classroom doors, no triumphal returns home at the end of the first school day by children already taller than they were that morning. But savvy parents can use school vaccinations instead to ritually mark the transition.

As anthropology teaches, a rite of passage is a set of ritual acts intended to move a person or a group of people from one social status to the next. Take for example the first haircut: in some cultures this in fact makes a baby into a human. Or take baptism, which many Christians practice. The quinceañera serves as a rite of passage for young women in many Latinx cultures. Judaism has the bar and bat mitzvah. High school and college graduations also work as rites of passage.

Historically, rites of passage have generally involved discomfort or feats of endurance, and those undergoing them often were transported away from home. Military boot camp provides a modern example.

When a rite ends, individuals are altered. They emerge ready for the responsibilities entailed in a new stage of life. Because of this, experts today recommend developing rites for use in community interventions to help youth become successful young adults.

The transition from early to middle childhood is important also. Across cultures, it generally occurs when the milk teeth are falling out, and it comes with new responsibilities. In Papua New Guinea Kwoma children tend their own gardens at this stage; in Northern Africa, Berber girls prepare entire family meals unassisted; in Central Africa, Mbuti boys begin hunting for real. Marking such accomplishments ritually reduces any ambiguity related to the transition between stages, both for newly responsible children and for family members.

Without the standard “first day of school” excursion this fall, it will be harder than normal for American children to own their new status as school-goers—and to internalize attendant responsibilities. Here is where vaccinations, so important to the public’s health, can make a double difference.

Rather than highlighting the inconvenience of vaccinations or priming children to fear the needle, parents can present school shots in the context of the growing child’s increased responsibility to others. The clinic visit becomes a special event commemorating the transition from mere child to student or big kid. Celebrating this transition not only helps give our young ones a solid socio-emotional start to middle childhood. It helps us all with the larger challenge of maintaining community health.

Elisa J. Sobo is a sociocultural anthropologist specializing in health, illness, and medicine. She chairs the anthropology department at San Diego State University and is past president of the Society for Medical Anthropology. Her latest book is Dynamics of Human Biocultural Diversity: A Unified Approach.

Show comments