Children Given Flu Shots in School Classrooms
Published December 5, 2018 | Ethics, Informed Consent
Story Highlights
- School districts have partnered with a for-profit corporation, CareDox/Healthy Schools, to provide students with free influenza vaccinations in classrooms during school hours.
- CareDox plans to collaborate with schools, families and health care providers to provide low cost health care in schools across the country.
- Important questions are being raised about informed consent, medical histories of children, and vaccine adverse reaction monitoring and reporting.
Denise Blatt, Director of Pupil Services for Elyria Public School in Ohio notes: “Our days are limited, you know, the time that we get to spend with our students here and get them ready for everything they need to know. One day is important, let alone when they’re out with the flu it can be multiple days sometimes a week.”1 2 3 4
Cintia Johnson, Assistant Superintendent for Administrative Services for Arlington Public Schools in Northern Virginia says that their goal is to improve student access to influenza vaccines. “We’re increasing awareness about the importance of flu shots, we’re providing education around that through the information that parents receive, and then we’re making it easy for parents to access by having it right there where their child attends.”3
According to news reports, Healthy Schools is paid to manage the entire school-based vaccination program, from seeking parental consent to setting up vaccination “clinics” on school property.1 4
Healthy Schools, LLC was founded by former Jacksonville Jaguars professional football player Tony Boselli.5 The organization’s website states:
Boselli established Healthy Schools when he realized how often students miss out on valuable classroom time when they cannot access quality care. On top of missing school, kids bring illnesses like the flu home to parents and siblings. Knowing a majority of families can’t afford to stay home, he created Healthy Schools to bring high-quality, no-cost health services directly to public school students during the school day. In-school health services provide a unique convenience for parents, reduce absenteeism in schools, and most importantly, create healthy kids and Healthy Schools.5In 2017, Boselli sold Healthy Schools to pediatric healthcare technology provider CareDox, Inc. of New York, where he is now a partner and the president.
CareDox, Inc. is a for–profit company with investors that include 7wire Ventures, AI Life Sciences, Access Technology Ventures, Band of Angels, Digitalis, First Round Capital, Kima Ventures, Prolog Ventures, Startup Health, Texo Ventures, Wanxiang Healthcare Investments and WTI Advanced Technology.6 7 8
CareDox, Inc.’s largest program, Healthy Schools, is focused on providing annual flu shots to as many school children as possible.6 The program expects to administer 600,000 flu shots to children in eight states at no cost to families.9 According to CareDox, it is able to “offer flu shots at no cost through reimbursement contracts with Medicaid and other insurance providers.”
According to an article in the Ponte Vedra Reporter:
Boselli said CareDox has agreements with the school districts to provide the platform in the schools so parents can sign up digitally (or via paper if they can’t digitally). Parents provide their child’s medical history and insurance information to make sure the child qualifies. If they don’t have insurance, Boselli said the company will administer the flu shot at no cost.”9The article further states:
CareDox then manages the workflow and scheduling, sends nurses to the individual states to provide the vaccine, which is recorded on the company’s platform, and bills services for those individuals who have insurance. The company then shares the immunization information with state registries to ensure records are updated.9Boselli has said that CareDox, Inc. requests parents to provide consent digitally through their website or via paper in order for their child to receive the flu shot; however, the question that remains is whether parents are given the right to full informed consent by being provided with all the information about the influenza vaccine before children are vaccinated. It is unclear whether the Healthy Schools program operated by CareDox, Inc. or school administrations are giving parents the CDC’s Vaccine Information Statement about influenza vaccination or any other information about potential vaccine complications, including vaccine reaction symptoms so parents can monitor their children and seek medical care or report reactions and have those reactions recorded in the child’s permanent medical record.10
In addition to informed consent, there are other unanswered questions regarding the in-school vaccination process. If no physical exams or personal medical histories are involved prior to vaccination, are children at higher risk of suffering vaccine reactions being screened? Who makes those medical care decisions and how are those decisions made? Are children monitored at the school by a health professional immediately following vaccine administration for signs of anaphylaxis, seizures or other serious potentially life threatening vaccine reactions? Are observed vaccine reactions reported into the Vaccine Adverse Event Reporting System (VAERS)?
According to Boselli, the goal for the company is to grow and not only make sure every child gets the flu shot, but also to move into other areas of health care.10
There are a lot of unanswered questions about the Healthy Schools program being marketed to schools by CareDox, Inc.
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