What precautionary strategies have countries taken in school settings in light of the recent rollout of vaccination programs?

Cross-Country Analysis

What precautionary strategies have countries taken in school settings in light of the recent rollout of vaccination programs?

Across the European Region, the spring semester of the 2020-21 school year (that began in January 2021) has presented multiple challenges to educators, learners and communities amidst increasing cases of SARS-CoV-2 and variants of concern.

Unique methods for mitigation of cases in schools have been utilized  including rapid diagnostic testing and vaccination of teachers. Member States continue to implement infection prevention and control measures such as mask wearing, hand hygiene, physical distancing and staggered start times alongside hybrid or distance learning models. Furthermore, a majority of Member States have transitioned to sub-national measures targeting regions with higher infection rates rather than sweeping nationwide measures. This reflects a risk-based approach taken throughout the Region, most often considering increasing hospitalization rates, higher incidence rates and variants of concern in particular areas.

This analysis examines the strategies implemented by countries across the European Region both in approaches to support the reopening of schools and responses to variants of concern in school settings. Information was collected from open sources including media and government websites by the COVID-19 Incident Management Support Team of the WHO Regional Office for Europe and the COVID-19 Health Systems Response Monitor (HSRM) (up to 25 March 2021). Selected country examples are provided for Austria, Estonia, Germany, Hungary, Israel, Slovakia, Slovenia and Turkey. This analysis can help to inform the development of school policies for the remainder of the 2020-21 school year as variants of concern continue to emerge.

School closures across the European Region have varied and fluctuated over time

Based on a composite index score for schools, Figure 1 below provides a visual representation of school closures across the WHO European Region. Based on the severity of the measure, the darker colour indicates how strictly the measure has been implemented (i.e., full closure). Alternatively, the lighter the colour, the less severe the measure (i.e., open but with modifications for infection prevention and control). For example, in Figure 1 below, all schools were closed in the Czech Republic, Hungary and Iceland, while schools were partially open in Finland, Ukraine and the Russian Federation. In France, Germany and Sweden, schools were open with required infection prevention and control measures.

As of 25 March 2021, 30 countries and 1 territory out of 53 WHO European Member States closed schools at some or all levels, oftentimes requiring secondary students to engage in distance learning while continuing in-person education for primary students in grades K-3 (children aged ~4 to 9).  

Figure 1. Status of school closures across the WHO European Region, as of 25 March 2021. Composite scale of school closures included.

Figure 2. Member State school measures response overall, from February 2020-25 March 2021

Across the Region, schools are often the last place to fully close and restrictions on schools are amongst the first measures to be eased. The decisions to close or open are often risk-based approaches, adapted to sub-regional epidemiological situations, unless a comprehensive national lockdown is in place. Compared with school closure decisions during the spring and autumn of 2020, countries’ decisions to close schools in early 2021 have been more targeted and delivered faster at sub-national and national levels. Higher incidence levels, increased hospitalization rates or response to emerging variants of concern are the most common indicators for the implementation of measures in schools. Throughout 2021, Member States have continued the trend of migrating students in grades 4-12 to distance learning (ages ~10 to 18) while continuing in-person education for younger learners, grades K-3 (ages ~4 to 9).

Rapid diagnostic testing has been used to support a return to school at different intervals and for different groups

Member States have begun to utilize rapid diagnostic testing of students, teachers, educational staff and parents as an additional precaution to prevent transmission when returning to classrooms alongside infection prevention control. As outlined below, approaches vary significantly across the Region as countries use different strategies: specified days for testing, wholistic testing once per week, testing of all students twice per week, testing kits sent home with students and even required community testing.

At the time of writing, additional countries engaging in rapid diagnostic testing for schools include Andorra, Austria, Bulgaria, Croatia, Cyprus, Denmark, Finland, Georgia, Germany, Greece, Israel, Lithuania, Luxembourg, Monaco, the Netherlands, Poland, Romania, Slovakia, Slovenia, Spain and the United Kingdom.

Testing of educational staff and teachers once per week

In Slovenia, all school employees were required to undergo weekly testing for COVID-19 using rapid antigen tests before children K-3 (ages ~4 to 9 years old) could return to in-person classroom environments on 26 January 2021. In addition to compulsory testing, all educational staff and students in 6th grade (~aged 10) and above are still required to wear masks on the school premises, students must remain in bubbles with regular disinfection; ventilation and infection prevention control must also be carried out.

Figure 3. Composite index score for Slovenia, as of 25 March 2021

Note: The individual and composite PHSM severity scores are used to present detailed timelines of the level of stringency of the individual measures that are being implemented by a government as part of a comprehensive national PHSM response. When combined with epidemiological data the chart can provide valuable insights into possible correlation between the epicurve and the national PHSM response.

Testing twice per week for students or educational staff and teachers
From 15 February 2021, Austrian students of all levels were allowed to return to classrooms with a negative PCR or rapid antigen test result. While primary school children (ages ~6 to 10) engage in face-to-face lessons five days per week, older students (ages ~11-17) have been divided into two groups, attending schools either on Monday/Tuesday or Wednesday/Thursday with both groups participating in distance learning on Fridays. Participation in face-to-face lessons for older pupils is only possible with a negative rapid antigen self-test conducted at their school. Teachers supervise these tests on Mondays and Wednesdays for each respective group.

Testing at the community level (parents and caregivers)

In Slovakia, students must carry proof of a negative PCR test result with them on their journey to school. This is applicable for years 5-9 of primary school (ages ~10-14 years old) and all secondary students if their schools are open. Additionally, adults taking a child to kindergarten or school must also present a negative PCR test result. To allow teachers and students to return to schools, testing took place from 22-24 January as schools were able to reopen from 25 January 2021.

Prioritization of teachers for COVID-19 vaccination gains momentum across the Region

As vaccines continue to gain emergency use authorization in the European Union and phased rollout is implemented in Member States, the debate concerning whether or not teachers and other educational staff should be a priority group for jabs continues. With school closures often the last non-pharmaceutical measure to be enforced, the conversation has focused on whether teachers should be considered as frontline community workers since they are consistently in close proximity with children, other educational staff, parents and community members where schools are open with in-person education.

As discussed below, some Member States have announced that teachers will be eligible for vaccination in one of two ways: 1) teachers will specifically be targeted for vaccinations prior to students returning to in-person learning, or 2) teachers will be moved up alongside other priority groups in national vaccination plans. In other Member States, teachers are not considered a priority group and will be vaccinated according to other criteria (i.e., age or chronic condition).

Teachers specifically targeted for vaccination

From late December 2020, Israel added teachers and other education staff to its priority list for vaccination. As of February 2021, localities adhere to a traffic light system and schools within green and yellow localities may open depending not only on an index score, but also on the vaccination rate in which at least 70% of people aged 50+ are vaccinated.

Figure 4. Composite index score of Israel, as of 25 March 2021

Estonia initiated priority vaccination of teachers in early February 2021, beginning with general education, kindergarten and vocational school teachers. This effort has been undertaken to ensure a more stable learning environment for pupils as the school year continues and seeks to avoid the sudden disruption caused by transition to distance learning. However, all students have since been moved to distance learning models from 1-28 March 2021 due to rapidly increasing cases nationwide.

Amendments to vaccination plans for prioritization of teachers

Germany amended their vaccination ordinance to allow all persons who work in childcare facilities, day care, elementary or special schools to be vaccinated in the federal states. Thus, teachers have been moved into a priority group of professionals who are at high risk of exposure to COVID-19 and who play a key role in the general community services (i.e., along with police officers, etc.)

Figure 5. Composite index score of Germany, as of 25 March 2021

While Turkey reopened village schools and preschools from 15 February 2021, the Ministry of Education  reopened schools for elementary, 8th and 12th grade students (children ages 13 or 17) from 1 March 2021 on a voluntary attendance basis. Since the initial announcement, teachers returning to schools were prioritized for vaccines starting 24 February 2021.

Since early March 2021, the opening of schools and the vaccination of teachers have been top priorities for Slovenia. Priority vaccination began for staff in educational establishments starting with those over 50. Since 8 March 2021, lessons in all grades of primary school returned to in-person learning, while the remainder of secondary students returned to classrooms via a hybrid model from 15 March 2021 where pupils alternated in-person attendance on a weekly basis.

Hungary has released a plan to reopen kindergartens, primary and secondary schools from 12 and 19 April 2021, contingent on the number of vaccinated people in the country reaching 2.5 million. Teachers, nursery workers and educational staff will be prioritized alongside health, social workers, registered seniors, police officers and soldiers. Vaccination remains voluntary, therefore kindergarten teachers, nursery staff and teachers were asked to register in advance and by 24 March 2021 in order to receive vaccine appointments by 1-3 April 2021.

As of 25 March 2021, additional countries engaging in the vaccination of teachers include Italy, Kazakhstan, Latvia, Malta and the Russian Federation.

Potential trends for vaccination rates and schools

The vaccination of teachers also paves the way for additional alternative plans for returning students to in-person teaching schedules. Israel, for example, has stipulated that in red-designated localities where schools are fully closed, some schools may open their doors when approximately 75% or more of all 11-12th grade pupils (ages ~16-17) are either vaccinated or recovered from COVID-19.

Conclusion and next steps

In response to increasing community and school-based outbreaks due to variants of concern, rapid responses with mitigation measures by Member States have been used as effective tools when attempting to prevent further transmission. However, negative aspects due to total school closures continue to accumulate, including gaps in schooling, lack of stable learning environments and disruptions to students’ opportunities to socialize. These have manifested as negative impacts to students related to their mental health, motivation or severe disruption to learning trajectories, to name a few. Additionally, students, teachers and parents must continuously and quickly adapt to constantly changing schooling environments as measures related to distance learning, infection prevention and control, and rapid diagnostic testing are often implemented within days or weeks of the announcement by Member States.

Different school approaches have been defined at the national and sub-national levels since the beginning of the pandemic. In 2021, these approaches have expanded to include new strategies such as vaccinations for educational staff and rapid antigen testing. While vaccination plans continue to be rolled out, comprehensive public health and social measures have remained effective in directly reducing transmission via stay-at-home orders, mask mandates, school/business closures, reductions in mass gathering sizes and more.

As vaccination plans move forward, some countries have prioritized teachers or moved them into priority groups due to their proximity to large and age-diverse populations within communities. The vaccination of teachers will provide crucial flexibility when countries consider the feasibility of keeping learning environments open, especially as variants of concern continue to emerge.

WHO/Europe has established the European Technical Advisory Group (TAG) on schooling during COVID-19 to provide strategic and technical advice to WHO/EURO regarding matters relating to schooling during times of COVID-19. When facing variants of concern, the TAG places emphasis on support for schools to ensure current infection prevention and control alongside public health and social measures, highlighting that schools staying open remains a key objective. The fourth meeting of the TAG occurred on 24 March 2021 where the vaccination of teachers and rapid diagnostic testing were discussed at length.

As the WHO European Region faces a third wave, the need for continued implementation of risk- based approaches to public health and social measures, infection prevention and control, and vaccination of teachers will be of the utmost importance in order to continue schooling.

Kayla King, Tanja Schmidt, Ihor Perehinets

Reference for Figures
Underlying Methodology and Application of the PHSM Database and PHSM Severity Index. https://apps.who.int/iris/handle/10665/337686