If you are going to school in Massachusetts this year — even remotely — you’re going to need to get a flu shot, state officials announced Wednesday in a first-of-its-kind mandate.

The timing for the new requirement, which impacts all pre-school and K-12 students as well as all college students who have access to campus, is designed to help in the ongoing battle with the COVID-19 epidemic, medical experts and state officials say. Restricting influenza cases tied to schools is essential, they say, in order to avoid complicating efforts to stem the spread of the coronavirus.

“It is more important now than ever to get a flu vaccine because flu symptoms are very similar to those of COVID-19 and preventing the flu will save lives and preserve healthcare resources,” said Dr. Larry Madoff, medical director of the Department of the Public Health’s Bureau of Infectious Disease and Laboratory Sciences, in a statement.

The mandate requires all Massachusetts students over the age of 6 months to receive a flu vaccine by Dec. 31, ahead of the 2020-2021 influenza season. Homeschooled children are exempt from the requirement, and parents may also seek an exemption for their children for medical or religious reasons.

Dr. Gregory Parkinson, a doctor at Falmouth Pediatric Associates, said he agrees with the state's decision.

“One of the major things we think about is: What would happen if there is a flu outbreak in the middle of COVID?,” he told WGBH News.

Parkinson painted a possible scenario during the fall and winter flu season, where students have spiking fevers and show other symptoms related to both the flu and COVID-19, and “it’s unclear until testing can be done what’s causing it.”

“You can see a situation where an already very difficult challenge with COVID alone become tremendously more challenging if we have to deal with a lot of flu,” he said.

Parkinson said that an increase in the number of flu vaccinations will help contribute to an environment that is “less stressful and safer.”

Marta Bausemer, a nurse at Boston Green Academy, a grade 6-12 public school in Brighton, said it’s unclear at this point what impact the new mandate will have on school nurses, or what role they will be expected to play in facilitating or enforcing it.

“Keeping kids safe, I think that’s the focus for sure,” Bausemer said. “I think everybody’s just waiting for more information from the state on how they plan to roll it out,” she said.

In general, Bausemer said parents are responsible for getting their children immunized, usually by a primary care physician or at a community health center. School nurses then track those immunizations and work with parents to gain compliance whenever possible.

“If they haven’t [been immunized], we send home information to their parents,” she said. “If they need any assistance then we try to make phone calls, make appointments for them, anything we can possibly do to help, always. That’s usually my role.”

James Hunt, Jr., head of the Massachusetts League of Community Health Centers, which serves the commonwealth’s 52 community health centers, said that immunizations are already a crucial aspect of what the centers do and that they will “embrace” the new flu vaccine mandate.

“Health centers will be on the frontline, as we always are,” Hunt said. “Clearly for the safety of schools, for the safety of patients and the safety of, if you will, communities, the science has dictated that flu mandates are necessary.”

Hunt said that health centers remain open for in-person vaccinations. Due to challenges posed by the COVID epidemic and the subsequent shutdown, they’re taking additional steps to ensure safe access to the flu vaccine for all, especially more vulnerable populations.

“From mobile vans to tents to going to schools, this will vary across the state, but health centers will adapt to those local needs in languages that the folks speak and in ways that will ensure patient safety and worker safety, as well,” he said.

As for whether the new mandate could impact the availability of flu vaccine here in Massachusetts, Gov. Charlie Baker did not appear concerned on Thursday.

“The federal government bought a ton of extra flu vaccine this year specifically because they would like to see states work to enhance and extend the number of people who actually get the flu shot,” Baker said during a press conference.

Flu vaccine is produced by private manufacturers, which appear to already be preparing for an increase in demand this year amidst the COVID-19 pandemic.

According to the CDC, manufacturers are projecting they will supply between 194 million and 198 million doses of influenza vaccine for the 2020-2021 season. That’s a 20 million dose increase compared to the 175 million doses distributed last flu season — itself a record number.

State officials confirmed on Thursday that the flu vaccine mandate is now a permanent requirement, not just a one-year effort. As with other vaccine requirements, such as those for polio, measles, mumps and rubella, students can seek an exemption to the new flu vaccine requirement for medical or religious purposes.

Massachusetts currently has the highest vaccination rate among students of any state, according to the Centers for Disease Control and Prevention, with the state reporting that some 81 percent of K-12 students meet requirements.

“Our view on it is, pushing that number higher would be a good thing,” Baker said. “Getting college students to play in this space would be a good thing.”

But the 2019-2020 school year also saw a record number of religious exceptions to vaccine requirements.
Of nearly 1,000 Massachusetts kindergarteners who received vaccine exceptions last school year, 80 percent did so for religious reasons.

To get a religious exemption, all a parent or guardian has to do is state "in writing that vaccination or immunization conflicts with his sincere religious beliefs," according to state law.

“I would expect that we would probably see more [exemptions], because we’re encouraging more people [to get vaccinated]," Baker said. “But I would hope people understand that this is an important part of how we continue to fight the virus here in Massachusetts.”