Third meeting of the Technical Advisory Group on Safe Schooling During the COVID-19 Pandemic

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Third meeting of the

Technical Advisory Group on Safe Schooling During the COVID-19

Pandemic

Copenhagen, Denmark

26 January 2021

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ABSTRACT

Evidence on the impact of school closures on children and the effectiveness of infection prevention and control measures being implemented in schools is now emerging. The WHO Regional Office for Europe and the Government of Italy jointly convened a high-level meeting on 31 August 2020 to discuss the situation and share experiences. Member States agreed to establish a network of experts to collate and review the emerging evidence on best practices and the potential negative effects of school reopening. A technical advisory group (TAG) was convened to review the evidence and make recommendations for a second high-level meeting, held in early December 2020. Member States reconvened at this meeting to review lessons learned and further emerging evidence, adjust interventions accordingly and recommend the way forward. This report is of the third TAG meeting, held in Copenhagen, Denmark, on 26 January 2021.

Keywords CHILD SCHOOL COVID-19 SARS-COV-2 SCHOOL TEACHER INFECTION CONTROL

WHO/EURO:2021-2083-41838-57383

© World Health Organization 2021

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CONTENTS

Page

Summary ... iv

Background ... 1

Outline of the third TAG meeting ... 3

Overview of school measures and school closures ... 3

COVID-19 variants of concern and children ... 4

COVID-19 vaccines and vaccination in the WHO European Region ... 7

Youth perspective ... 10

Conclusion and way forward ... 10

Annex 1 ... 11

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Summary

Since March 2020, around 180 countries worldwide have closed their schools to control the transmission of SARS-CoV-2, leaving about 1.5 billion students missing out on learning. After the summer, most countries opened their schools again. with many schools putting infection prevention and control (IPC) measures in place to reduce the risk of transmission of the virus in the school setting.

To review the evidence and build an understanding of the effectiveness and adverse effects of IPC and other measures implemented in school settings, the WHO Regional Office for Europe established a European regional technical advisory group (TAG) for schooling during the COVID-19 pandemic. The purpose of the TAG is to ensure that children’s lives and education are as unaffected and uninterrupted as possible, while ensuring the safety of children, educators and other school staff and keeping COVID-19 transmission under control.

The previous TAG meetings were held in October and November 2020 and led to

recommendations to a high-level meeting of Member States’ ministries of health and education in December 2020. This third TAG meeting took place on 26 January 2021 to review updates of the COVID-19 situation, review previous recommendations, particularly with a focus on the new variants of SARS-CoV-2, and discuss the possible impact of recently licensed vaccines in the context of schools and children’s health and education.

SARS-CoV-2 variants of concern

Several variants of concern have arisen since autumn 2020, with the SARS-CoV-2 VOC 202012/01 or 20I/501Y.V1 variant being seen most commonly in the European Region. Of concern is the clear increase in transmissibility of SARS-CoV-2 VOC 202021/01 across all ages, including among children, although children and adolescents have a very low risk of severe disease.

The TAG considered its previous recommendations in the light of this new information. While the emergence of new variants across the European Region is of concern, the TAG continues to view school-opening as an important objective. The increased transmissibility of the new variant will make this objective challenging, particularly when community transmission increases. To meet this challenge, it is important that schools are supported to ensure that current IPC and public health measures are implemented and adhered to in school settings.

The emergence of the new variants continues to reinforce the need for implementation of public health measures recommended by WHO whilst upholding the recommendation that school closures should be a last resort.

The TAG on schooling during COVID-19 was set up to provide strategic and technical advice to WHO/EURO on matters relating to schooling in times of COVID-19 including the epidemiology of school transmission, infection prevention control and public health

measures and their effects on the development and well-being of school-aged children.

The TAG aims to identify findings from the emerging evidence to inform policy decisions in terms of education, social, development and health outcomes for children and adolescents.

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Vaccination against SARS-CoV-2 in the school context

In January 2021, 35 Member States began vaccinating the adult population, but currently there are no vaccines licensed for children under 16 years. Four COVID-19 vaccine clinical trials are ongoing for children and adolescents aged between 3 and 18 years. As yet, there are no trial results. As the demand for vaccines currently exceeds the amount of vaccine available, priority population groups are being identified for vaccination. The European Technical Advisory Group of Experts for vaccination (ETAGE) recommends the prioritization of target groups for

vaccination against COVID-19 in three stages, with teachers included in stages II and III (when vaccine are available for 20–50% of the population). Health-care workers generally are given higher priority. In considering vaccination strategies, equal weight should be put on other unintended outcomes, such as effects on the mental health and well-being of children, teachers and parents, if schools are closed.

The United Nations Educational, Scientific and Cultural Organization (UNESCO) and Education International recently released a joint statement that recognized the importance of identifying schoolteachers as a priority group for vaccination so education can be maintained as an important societal outcome.

The TAG agreed that schoolteachers should be given priority for COVID-19 vaccinations, as this may lead to schools being open longer, improve education and prevent other unwanted

outcomes. Children and adolescents across the region have already missed out on an average 17 weeks of school due to partial and complete school closures caused by COVID-19.

The TAG recommended that upcoming information on trial results in children, which are expected from the respective manufacturers, needs to be used speedily to refine vaccination strategies. Further expansion of vaccine research on children is needed and it is critical to understand what vaccines will do in terms of transmission of the infection for children.

Young voices.

The TAG youth representatives:

• related the difficulties of teachers not being able to adhere to public health and IPC measures as their work requires closer contact with children than is the case for many other groups of workers.

• added that governments need to ensure appropriate facilities and education for children.

School closure should not be a reaction to not being able to ensure IPC measures within schools.

Main messages from the third TAG meeting.

• children and adolescents in the region have missed out (on average) 17 weeks of school due to partial and complete closures caused by COVID-19;

• the new COVID-19 variants do not seem to affect children and adolescents severely;

• closing schools should be the last resort and opening schools should be the first priority;

• youth representatives advocate that closing schools cannot be a response to not being able to ensure mitigation measures within schools; and

• a statement for governments and the international community to consider teachers and school personnel as a priority group in vaccination efforts has been endorsed by UNESCO and Education International, and is supported by the TAG.

In line with its mandate, the TAG will continue to review the key issues and observed trends of school closure and reflect on the lessons learned since the beginning of the pandemic in

upcoming meetings.

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Third meeting of the Technical Advisory Group on Safe Schooling During the COVID-19 Pandemic page 1

Background

Since March 2020, around 180 countries worldwide have closed their schools to control the transmission of SARS-CoV-2, leaving about 1.5 billion students missing out on learning. After the summer, most countries opened their schools again, with multiple IPC measures in place to reduce the risk of transmission of the virus in the school setting.

To review the evidence and build an understanding of the effectiveness and adverse effects of IPC and other measures implemented in school settings, the WHO Regional Office for Europe established a European regional technical advisory group (TAG) for schooling during the COVID-19 pandemic. The overall objective of the TAG is:

• to ensure that children’s lives and education are as unaffected and uninterrupted as possible, while ensuring the safety of children, educators and other school staff and keeping COVID-19 transmission under control.

TAG meetings were held in October and November 2020 and led to recommendations to a high- level meeting of ministries of health and education from Member States in December 2020.

The key areas identified by the second TAG meeting and leading to the recommendations were:

• Key issue 1. Keeping schools open is a key objective

• Key issue 2. Testing strategy in the school setting

• Key issue 3. Effectiveness of applied control measures on infection control

• Key issue 4. Educational outcomes, mental and social well-being

• Key issue 5. Children in vulnerable situations

• Key issue 6. Changes in the school environment that are likely to be of overall benefit to infection control AND child health

• Key issue 7. Children’s and adolescents’ involvement in decision-making.

Following discussion on the key issues, the high-level meeting in December 2020 promoted eight key messages that advise on the best balance of benefits and harms. The main messages were:

• while children are not the drivers of this pandemic, they risk being among its biggest victims: largely spared from the direct health effects of COVID-19, the measures put in place to control the pandemic are having a profound effect on children’s health and well- being;

• effective policy considerations for the school year should focus on the goal of having children and adolescents physically present in school: schools should be among the last places to be closed, as school closures have been shown to be detrimental to child health and well-being and educational outcomes;

• keeping distance, limiting contact between children, wearing masks, practising good hygiene and enhancing ventilation are the mainstays of transmission control in schools;

• public health approaches need to balance ALL effects of the measures: actions need to be monitored carefully and adapted as more evidence becomes available so that we can do better than cause harm;

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• the overall schooling and learning environment needs to improve: investments should aim to make every school a health promoting school and ensure better learning facilities, overcoming the digital divide;

• children living in vulnerable situations need special attention: they continue to be disproportionately affected by the pandemic and by consequent school closures;

• the measures affect several aspects of children’s rights: countries need to undertake a child-rights assessment when implementing them; and

• children and adolescents need to participate in decision-making: they have different experiences arising from school closures, online learning and control measures, and their opinions and values are important for making decisions affecting them.

This third meeting of the TAG on Schooling During the COVID-19 Pandemic was held on 26 January 2021. It enabled further expert input from various stakeholders on issues and messages and updating of evidence and experience regarding the new SARS-CoV-2 variant. As vaccines against SARS-CoV-2 are becoming available for countries, discussions on considering school- related vaccination strategies were initiated.

The meeting contributed to the overall objective of the TAG by:

• receiving updates from WHO, UNESCO and ETAGE on issues relating to:

o the implementation of school measures in the European Region o COVID-19 variants in relation to children

o COVID-19 vaccines and vaccination; and

• discussing the implication for TAG work specifically in relation to the current recommendations.

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Outline of the third TAG meeting

Natasha Azzopardi-Muscat (Director of the Division of Country Health Policies and Systems, WHO Regional Office for Europe) opened the third TAG meeting and welcomed participants. She noted that this meeting aimed to review the current situation in Europe with respect to two main issues; variants and vaccination. With new variants emerging; issues about schooling and school closures are arising in relation to these variants that have increased transmissibility. As vaccines are being introduced the opportunities and implications for schooling continuation need to be discussed.

Antony Morgan (Chair of the Technical Advisory Group and Professor in Public Health at Glasgow Caledonian University, United Kingdom) explained the purpose of the meeting, which was to assess updates from WHO, UNESCO and ETAGE on implementation of school measures in the European Region, updated data on new variants of COVID-19 in relation to children, and COVID-19 vaccinations. He encouraged general discussion on the areas of

recommendations that were given to WHO to see if there were any implications or new issues to add. Explanation of the role of the TAG followed and he emphasized that expert opinions (combined with evidence) are very important in enabling the TAG to give up-to-date advice to WHO. He added that TAG recommendations will be updated regularly depending on incoming new information to provide schools with as much information and support is vital. He also discussed the possible timeline of future TAG meetings.

Martin Weber (Regional Advisor for Child and Adolescent Health, WHO Regional Office for Europe) presented the overall objective of the meeting, which was to ensure that children’s lives and education are as unaffected and uninterrupted as possible while ensuring the safety of children, educators and other school staff and keeping COVID-19 transmission under control. He asked TAG members to be outspoken in their advice so WHO could receive better

recommendations. He added that requests for further research on evidence were also welcome and ended by explaining practical information on the meeting

Overview of school measures and school closures

Kayla King (Consultant for Country Health Emergency Preparedness and the International Health Regulations, WHO Regional Office for Europe) provided a comprehensive overview of school measures across the WHO European Region. She emphasized that there was a widespread pattern of reactive closures in spring 2020, but that countries employing proactive closures or quicker migration to distance learning had also appeared as a common trend in the early months of 2021. While many countries opted to lift or lighten school measures during the summer, measures have since increased in severity through the autumn and winter semesters. Overall, children between kindergarten and third or fourth grade remain in schools to engage in face-to-face teaching, while all other grades have moved to distance learning.

Other common trends in the new year focus on the delay of in-person teaching start dates and the continuation of kindergartens or day-care settings when all other education establishments have closed. More countries are requiring teachers, parents and some age groups of students to be tested prior to returning to school. Additionally, discussion on the prioritization of teachers within vaccination schedules has begun to move forward in the European Region. Full school

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closures are often the last non-pharmaceutical public health measure adopted when all others have been implemented.

Maya Prince (Project Officer, UNESCO) highlighted the number of students who are still impacted by full school closure (with no in-person schooling) and those who are in distance learning. Children and adolescents have missed out on an average 17 weeks of partial and complete closures due to COVID-19. She explained that UNESCO places importance on in- person schooling, regardless of whatever measures are put in school settings, as social space is important for children and adolescents. Schools are also important in providing nutrition, protecting vulnerable communities and promoting personal development. When children are removed physically out of school settings, their academic and extracurricular activities are bound to be affected.

Currently, there is little evidence on the effectiveness of distance learning, but it is well recognized that it is not working everywhere, especially where interaction with teachers is not possible due to poor Internet connections and where children have to turn on the radio or TV and learn by themselves.

Ms Prince introduced the contents of the upcoming round of UNESCO, UNICEF and World Bank surveys on school closures. Until now, much data on health and equity aspects have been collected. She explained how the plan now is to include the issue of vaccination prioritization of teachers in the next survey.

COVID-19 variants of concern and children

Richard Pebody (Team Leader of Infectious Hazard Management, WHO Regional Office for Europe) gave a presentation on the new COVID-19 variants and the implications for children. Four types of variants have been seen in Denmark (Cluster 5, which seems to have disappeared), initially in the United Kingdom (SARS-CoV-2 VOC 202012/01 or 20I/501Y.V1), South Africa (SARS-CoV-2 20H/501Y.V2) and Brazil (SARS-CoV-2 20J/501Y.V3). The SARS-CoV-2 VOC 202012/01 or 20I/501Y.V1 (United Kingdom) variant is seen most in the European Region, although many countries are detecting cases in travellers returning to their respective countries, and several countries are now finding evidence of local transmission.

Countries are encouraged to investigate for local transmission, particularly if there is an unusual or unexpected increase in activity despite the introduction of other measures.

He explained that in general, any new variants can be more or less transmissible compared to the current circulating viruses. The evidence suggests that SARS-CoV-2 VOC 202012/01 is

significantly more transmissible compared to other circulating lineages. This increase in transmissibility is found across all ages, including children and adolescents. There is also a probable increase in infection severity across all ages, although children and adolescents have a very low risk of severe disease.

He summarized that the new variant seems to have an increase in transmissibility across all ages, including children. The emergence of the new variants does not change the public health

measures recommended by WHO, which should be based upon an assessment of local transmission, but the increased transmissibility of the new variant will make the objective of keeping schools open more challenging, particularly when community transmission increases.

He ended by reinforcing the aim that school closures should be last resort.

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Discussion Transmission

Walter Haas (Head of Respiratory Infections, Robert Koch Institute, Germany) asked if there was additional data on age stratification between 10 and 20 years of the new variants.

Richard Pebody replied that currently there are no more data on detailed age stratification and added that other research data suggest that transmission is higher among adolescents or teenagers than primary-school-age children. Mark Jit (London School of Hygiene and Tropical

Medicine, Department of Infectious Disease Epidemiology, United Kingdom) added that data mainly suggest there were introductions into households from children who are of school age, but whether the transmission happened in schools is unknown; this occurred predominantly in secondary schools.

School closure and reopening

Jonathan Suk (Senior Expert for Public Health Emergency Preparedness, European Centre for Disease Prevention and Control (ECDC)) mentioned the effort and demand to keep schools open, but acknowledged the increased likelihood that there may be a need to close schools in cases where transmission is high. Unless there is a change in the relative transmission rates among children, school closure should still be the last resort. He explained that last resort does not mean never close, but efforts should be made to make sure everything else is in place before deciding to close. He emphasized that all other community measures should also be in place and that it is vital to discuss what measures should be placed in school settings as

proactively as possible. Schools should not have to make a binary choice between opening and closing and can tighten up IPC measures in school settings instead. He also suggested an open question for discussion on whether the new variants and the case for keeping schools open as a last resort changes the way the vaccine should be prioritized for teachers.

Mark Jit (London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, United Kingdom) stated that most agree that closing schools should be last resort, but when schools get to the last-resort stage, they should consider tightening school measures. He emphasized that it is important to be careful not to react to case numbers, death rates or hospitals being full, as these are lagging indicators to actual infections. He added that schools should react to the data on infection, should they close reactively.

Jonathan Suk agreed that transmission data should guide decision-making on school closures.

In ECDC’s most recent rapid risk assessment, it was noted that the last resort of closing schools may come sooner, but there would probably be stronger effectiveness from closing secondary schools over primary schools.

Richard Pebody added that more specificity is needed in terms of guidance on school closure and what has to be done if it is decided that schools are to be kept open to protect children. It is important to retain the value of ensuring that the long-term impacts of COVID-19 are mitigated while maintaining the safety of children and teachers in school. If we react to the lagging indicators, measures will have to be imposed for much longer, as it would take longer for the case numbers to come down.

Antony Morgan asked if there was any explanation for the basis on which people were deciding to close schools in other parts of the Region. Kayla King replied that various measures are being

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implemented on international travel and schools. When looking into data in the United Kingdom, while children are still unlikely to be severely affected by COVID-19, the Government

recognizes that schools must be included in the restrictions to have the best chance of getting the virus under control. Overall, there are mixed approaches across the European Region. Maya Prince added that there is much diversity in terms of school closures in Europe compared to other continents. Latin America uniformly has closed and most schools in Africa seem to be open.

Measures implemented in schools

Walter Haas was interested to see what measures have been taken in schools and how strictly they were being implemented to prevent transmission within schools.

Leena Paakkari (Research Centre for Health Promotion, University of Jyväskylä, Finland) asked if there were any data on how countries successfully have implemented other protective measures before deciding to close schools. She questioned if school closures are reactive measures in a situation where other measures have not worked (the measures are not sufficient, though they have been well implemented) or where other measures have not been well

implemented (no change in protective behaviours such as using masks even though masks should be used, for instance).

Eva Rehfuess (Chair for Public Health and Health Services Research Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians University, Germany) replied that based on observations in Germany, many recommended and/or required public health measures (non-pharmaceutical interventions) are either not fully implemented or not properly enforced. This applies to school measures (such as recommendations from the Robert Koch Institute) and other measures (like travel restrictions). She added that this suggests implementation failure more than intervention failure in many cases. There is a lack of studies and reports on implementation aspects.

Freia de Bock (Head of Department of Effectiveness and Efficiency of Health Education, German Federal Agency for Health Education (BZgA) Germany) added that in Germany, other measures such as home-office regulations were not fully implemented when schools were closed. She suggested that all other possible measures should be fully implemented, especially when closing schools and day care for younger children under 11 years, as the potential side- effects on children’s development and education need to be balanced.

Ensuring workforce to reopen schools

Eileen Scott (Health Intelligence Principal of Public Health Scotland, United Kingdom) explained the challenges of reopening schools, the biggest of which have been around the workforce. She stated that Scotland is experiencing a surge in the United Kingdom variant and the data on mortality are bringing significant concerns. Data also suggest that teachers are at equivalent or less risk compared to other occupations in terms of risk or severity of infection.

This might also cause significant challenges for other countries in opening schools and keeping them open. She asked an open question to the TAG on how reassurance can be offered to a workforce who have concerns, and how reopening can occur without their support.

Colette Kelly (School of Health Sciences, College of Medicine Health Promotion Research Centre, National University of Ireland Galway, Ireland) explained that Ireland has tried to reopen education for children with additional or special education needs, but the workforce has

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been reluctant pushed back due to concerns about their own health. While the Government reiterates that schools are safe, the message is not getting through. She emphasized that communication and discussion on how to reopen schools is essential.

David Edwards (General Secretary of Education International) seconded Eileen Scott’s point and added that when schools, early learning and childcare settings are closed, it is often the grandparents who provide child care, which is likely to increase poor health outcomes for those at most risk.

Bruce Adamson (Children and Young People’s Commissioner Scotland, Chair of European Network of Ombudspersons for Children) agreed to the need to reassure the workforce and added that there is a requirement to look more broadly at other risks from school closure. There is good understanding of issues such as loss of education, socialization, development, mental health impact, child protection and poverty issues, but he also expressed concerns about impacts on parental mental health, which also affect children. People seem to be finding the current restrictions much harder than last year, but mental health support for parents and caregivers is limited.

COVID-19 vaccines and vaccination in the WHO European Region Siddhartha Datta (Regional Adviser for Vaccine-preventable Diseases and Immunization, WHO Regional Office for Europe) presented an overview of COVID-19 vaccines and

vaccination steps in the European Region. As of now, WHO has approved the emergency use listing (EUL) only of the Pfizer/BioNTech vaccine. There are plans to include the Moderna and AstraZeneca vaccine by the end of February 2021. These three vaccines currently are being used only in the adult population, and 35 Member States have enrolled one or two other vaccines in the European Region. Currently, only four vaccines for children and adolescents are in clinical- trial phases, but it is too early to see trial results.

He explained that it is paramount that countries prioritize populations groups, as the demand for vaccines is not commensurate to vaccines available. The European Technical Advisory Group of Experts on Immunization (ETAGE) has devised a public health strategy for countries to consider when developing their national vaccination strategies. Important principles include the need to reduce morbidity and mortality through vaccination, ensure the maintenance of the most critical essential health services and respect the principle of reciprocity. Prioritizing the vaccination of schoolteachers depends on the three stages of vaccine availability. The WHO global Strategic Advisory Group of Experts on Immunization (SAGE) recommends that critical schoolteachers should be part of Stage II, which is when around 20% of the vaccine needed in a country is available. Moving forward, when the country receives around 50% of the vaccine, all teachers should be part of Stage III. He also added that the preparedness of vaccinations is most crucial.

COVID-19 vaccination and teachers

Tigran Yepoyan (Regional Advisor for Health and Education, Eastern Europe and Central UNESCO) shared the statement made by UNESCO and Education International that

governments and international communities should consider teachers and school personnel as a priority group in vaccination efforts. Teachers have stressed that school closure has a negative impact on students’ learning, safety and well-being and has adverse social and economic consequences on societies. Reopening schools and education institutions safely and keeping them open as long as possible therefore is imperative. In this context, teachers and education

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support personnel, especially those in countries where online distance education is rarely available, should be considered a priority group for vaccination.

UNESCO and Education International emphasize that the call for considering school personnel a priority group does not question existing decisions on other priority groups. In October 2020, heads of states and ministers of education committed to support all teachers and education personnel, acknowledged them as frontline workers and prioritized the health and safety of students and educators.

Discussion

Prioritization of vaccines for school staff

Didier Jourdan (UNESCO Chair, Global Health & Education, and Head of the WHO Collaborating Centre for Research in Education and Health) stated that the joint statement on schoolteachers’ vaccine prioritization is a strong asset for advocacy. The vaccination of school staff is a priority not only to show how important their protection is perceived, but also because of their educational role.

Bruce Adamson mentioned that the four United Kingdom children’s commissioners have written to the United Kingdom Joint Committee on Vaccination and Immunizations and governments in the United Kingdom to ask for prioritization of school staff.

Eileen Scott explained that there is a strong argument for prioritizing teachers and education staff based on the wider harms for children and young people of not doing so. Conditions for mental health problems for parents, children and young people are increasing. Evidence on wider harms suggests an increase in child maltreatment and domestic violence. Alongside disruption to education, this will have generational impacts and exacerbate inequality.

Tigran Yepoyan brought up the issue of perceived contradiction when it comes to prioritizing vaccinations for school staff. Schools are not considered primary settings for transmission, yet teachers are being prioritized while children are not. Also, teachers are asking to be prioritized for vaccination due to their proximity to children, but there are other settings, such as

supermarkets, where workers are also in close proximity to other people, yet they are not prioritized.

Leena Paakkari added that if new variants are more virulent among children, prioritizing school staff over other groups could be given stronger justification.

Adam Finn (Chair of the International Technical Advisory group of Experts, Head of Academic Unit of Child Health, University of Bristol, United Kingdom) followed by stating that because keeping schools open is the number one priority and closing is the last resort, school staff should be prioritized. The particular issue around schools is the density of the schools and the difficulty of achieving non-pharmaceutical interventions, particularly in young children.

There is enhanced risk of transmission because people are not aware of the virus being present, as children are more likely to be asymptomatic. This may be mitigated to an extent if efficient testing systems can be implemented, but it is also an argument for deployment of vaccines to teachers because they are not aware of the risk, meaning it is difficult for them to protect themselves, particularly with young children. He added that the education sector and children need a voice to ensure policy-makers remain aware of the need for prioritization. More information on the impact of vaccines on transmission of infection is needed to inform these

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decisions. He followed by saying that when the time comes for the discussion on using vaccines in children, who are very unlikely to get ill with COVID-19, it will be critical to understand what the vaccines will do in terms of transmission of infection.

Vaccine hesitancy among school staff

Kayla King mentioned that Israel is the first country to discuss vaccination of schoolteachers and would begin vaccinations of students aged 16–18 who are returning to schools. The teachers’

union, however, has released a media statement saying that teachers would not return to schools until they at least had the first vaccination, and this view sems to be shared by most, but not all, teachers.

Efrat Aflalo (Head of Education, Ministry of Health, Israel) elaborated more and explained that Israel has asked teachers to be vaccinated two weeks prior to the reopening of schools and is trying to encourage teachers to do so. There is an element of vaccine hesitancy among teaching staff, however, and it appears that some teachers do not want to take the vaccine.

David Edwards responded by saying that he was surprised to see that in Europe, only Israel has prioritized vaccination of teachers. Prioritization, he explained, acts as a signal that science is being deployed as protection and is a good steppingstone towards building trust. Guidelines should be established on this. He added that teachers and front-line workers have a very important role to play in terms of making sure that the broader community is open to vaccination, and timely conversations and information campaigns will be important in communities that already are showing resistance.

Maya Prince added that the new survey conducting by UNESCO, UNICEF and the World Bank will track the issue of vaccinations and shed light on prioritization of teachers.

Tigran Yepoyan presented information on a global survey which indicates that some teachers and educators are hesitant about getting vaccinated. He added that there should be more awareness-raising among educators about the importance of vaccination, so that it does not become an obligation for them or a condition to continue working. He emphasized the need to work with educators and teachers to provide them with updated and complete information about vaccines so they feel confident when making choices.

Vaccine recommendations

Antony Morgan asked the TAG if there is enough information to give recommendations on vaccines.

Siddartha Datta responded by suggesting that countries be requested to consider the Values Framework developed by WHO and SAGE, which outlines some important political values, when developing their vaccination strategies. He added that the Behavioural Insights Team in the Regional Office is looking into perceptions of COVID-19 vaccines among the wider population.

Initially, people were reluctant to receive the vaccine due to concerns about its safety and

efficacy, but recent surveys show this is decreasing. Health-care workers and professionals, who are both receivers and providers of the vaccine, and schoolteachers, who are seen as role models, play a big role in promoting the vaccine.

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Youth perspective

Frida B. Rasmussen (Birkerød Gymnasium, Denmark) stated that due to the specific characteristics of school environments, where teachers have to interact directly with children, school staff should receive priority of vaccination over other groups. She gave the example that grocery workers are able to wear protection and keep physical distance within their work environment, whereas teachers are not able to do this because their work requires close contact with children.

Emilia Carai (Copenhagen International School, Denmark) added that governments need to ensure appropriate facilities and education for children, and school closures should not be a reaction to being unable to ensure IPC measures within schools. She also emphasized that countries need to know that other measures can be taken into account to reduce the spread of infections in schools, and schools should not be closed because it is “easier” than implementing other measures.

Conclusion and way forward

Natasha Azzopardi-Muscat thanked the TAG members and the Chair for having shared their views and summarized the key points from the meeting.

It is worth making a clear case for, and clear statement about, prioritization of vaccinations of teachers, to avoid any backlash. School closures should be the last resort, but waiting too late to close them is not beneficial. Questions, like at what point school closures are being carried out, what the criteria for closures are, have any lessons been learned from last spring and how have countries altered their perspectives to keep schools open during lockdowns, need to be asked.

She concluded that it is vital to update issues and recommendations from the previous TAG meetings to signal that the TAG has met and has appraised the evidence that is currently available.

Antony Morgan followed by adding that if schools are to close, more attention needs to be paid to some of the unintended outcomes, such as negative effects on the mental health and well- being of children, adolescents, teachers and parents. It is also important to make more explicit the support schools receive to improve the provision of online schooling and distance learning.

Martin Weber concluded the meeting by ensuring that all inputs from the TAG will be reflected in the meeting report based on the discussions. He asked the TAG for feedback on items that will be discussed at the next meeting in early March. He also announced that there will be a new TAG on mental health and emphasized the importance of all chairpersons of the different TAGs working together. He thanked all TAG members, who represent a wide variety of stakeholders.

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Annex 1

Provisional programme

26 January 2021, 10-12 a.m.

10:00-10:10 Opening the meeting and setting the scene (from August 2020 to start of year 2 of the pandemic)

Natasha Azzopardi Muscat Martin Weber

Antony Morgan

Presentations

10:10-10:20 Moving forward the TAG Antony Morgan

Chair TAG 10:20-10:30 Overview of school measures implemented in the

European Region in response to COVID-19

Kayla King WHO EURO Maya Prince UNESCO 10:30-10:40 COVID-19 variants – latest updates in relation to

children.

Richard Peabody, WHO EURO

10:40-11:10 Discussion

11:10-11:20 COVID-19 vaccines and vaccination:

Update on development of COVID_19 vaccines and licensing of vaccine use for children including

prioritization of target population groups for COVID-19 vaccination in the WHO European Region with specific reference to teachers and school staff.

Adam Finn.

CHAIR ETAGE

(European Technical Advisory Group on Immunization)

11:20-11:25 UNESCO statement on vaccination of teachers Tigran Yepoyan UNESCO 11:25-11:50 Discussion

11:50-12:00 Closure of the meeting – the way forward

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