Parents generally hold the cards when it comes to medical decisions for minors. So teenagers who want to receive a COVID-19 vaccine against their parents’ wishes are finding that education and persuasion may be their strongest tools.
That doesn’t mean the kids aren’t fighting back.
A rise of teen-created organizations to advocate that young people be given more say in whether a vaccine is administered is gaining notice alongside news about the highly contagious delta variant of COVID-19 and the return to often-crowded classrooms.
Meanwhile, state lawmakers are busy making rules on how schools operate in the pandemic and how much clout parents or kids have in deciding everything COVID-19-related, from whether to wear masks to if children should be vaccinated.
The American Academy of Pediatrics used CDC data to show that 38% of 16- and 17-year-olds have had their COVID-19 shots, as have one-fourth of adolescents ages 12-15, who have access to the Pfizer vaccine right now under emergency use authorization. Full approval of a vaccine in that age group is expected sometime this fall. But the pediatrician group says data show vaccination for COVID-19 among teens has been slowing, not gaining momentum.
A Kaiser Family Foundation survey in April found nearly 1 in 5 parents said they won’t have their child vaccinated against COVID-19 unless schools require it. And 1 in 4 said no vaccine for COVID-19 no matter what. Meanwhile, the foundation said just 3 in 10 parents were anxious to get their teens vaccinated as soon as possible.
In a twist on the old “how to talk to your teen guides,” teen-run organizations like VaxTeen.org have posted guidance like “How to Talk to Your Parents About Vaccination,” information sheets on the vaccines and other resources to help teens decide how to approach the issue when there’s disagreement within a family and they want to get the shots.
The youth-targeted group was founded two years ago, pre-COVID-19, by Kelly Danielpour, now 18, with an aim to help students who want to get vaccines but have parents who are opposed. At the time, she was thinking about measles, pertussis and other vaccines. She told The New York Times that most adolescents don’t know the schedule of recommended vaccines or their rights.
COVID-19 has increased the intensity of the discussion.
Arin Parsa, now 14, founded Teens for Vaccines in 2019, which offers answers to questions about the COVID-19 vaccine and tips for those who fear needles, which might make them hesitant to get a shot. The group’s website features a section that offers help convincing parents to let kids who want a vaccine get one.
Parsa told BuzzFeed News that it’s “the most shocking” that teens have not been allowed into the discussion.
Mature minor rules
If education doesn’t work, teens may be able to show that they’re mature enough and informed enough to have some say in whether they can be vaccinated. Some states allow mature, informed teens to access certain medical services without parental consent.
Child and family law expert Robin Fretwell Wilson said many states have long recognized that youths and parents may not always agree when it comes to medical decisions — or may even have competing interests, such as when a parent might deny some kind of treatment to hide the fact a child has been abused or molested.
In the vast majority of cases, the reason isn’t that nefarious.
The concept that’s applied is called a “mature minor” doctrine that can be used in many settings, from custody hearing where judges ask older children which parent they’d like to live with to the health care arena where older teens may be able to get treatment for sexually transmitted diseases or obtain an abortion without parental consent, said Wilson, director of the Institute of Government and Public Affairs at the University of Illinois system.
The concept has most often been used around sexual conduct, she told the Deseret News, or in cases where parents “might go nuclear on the kid or where there’s violence in the family.”
Wilson said constitutional law cases typically “stand for the proposition that parents have the right to the control and the care of their children while minors, absent a showing of unfitness or abuse and neglect.” What that means, she added, is parents can decide what a kid does or doesn’t do “up to the point of harm.” The challenge is who has standing to stick up for the kid if there is harm. Often, the answer is no one unless a case goes before a judge.
With vaccines, mandates are more often used in the school context and the vast majority of states have those but also offer exemptions parents can use — whether religious or medical or philosophical or a combination. Wilson said those exemptions weren’t created with COVID-19 in mind, but rather diseases like measles, which are very different from COVID-19 in many aspects, including herd immunity.
Her reading of the recent Fulton vs. Philadelphia Supreme Court decision suggests that if an exemption is allowed for any reason, including a medical reason, exemptions have to be made for religious reasons, too — or the state has to show a compelling reason for not doing so.
Some states also apply a mature minor doctrine to life-saving medical care. The question is whether a COVID-19 vaccine for a teen would generally fall into that category since most young people who get COVID-19 do not become terribly ill.
States form a quilt
“Laws that were on the books prior to COVID-19 are getting a new look in light of the current situation (both for and against parental consent),” Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation, told BuzzFeed News.
State rules regarding vaccination without parental consent are a patchwork, but strongly lean toward requiring parental consent for minors to be vaccinated. Utah is among those states. Nebraska requires consent through age 18. Meanwhile, some states give teens more say under their versions of a mature minor doctrine, including Alabama at age 14 and South Carolina at age 16. Arizona and Idaho have mature minor doctrines. States may let a health care provider decide if a teen is mature enough to make the decision, according to Time.
But legislatures have been reacting to the challenges of COVID-19 and states have changed the rules regarding masks, vaccines and other pandemic-related issues. Some are mandating consent for vaccines, while others may loosen the rules. Information is easily outdated.
New Jersey and New York are considering allowing teens to get vaccines without consent. South Carolina is considering a bill that would specifically prevent teens from getting vaccinated against COVID-19 without parental consent. North Carolina passed a bill that would mandate parental consent to get any vaccine authorized only for emergency use, so that would apply to kids ages 12-15. With full approval of a vaccine, teens can choose to get vaccinated without that parental approval — again under a “mature minor” concept.
There are different rules in some states if teens are emancipated or homeless, the New York Times reported.
Washington, D.C., allows adolescents the most latitude in making that decision, with a mandate that says children 11 and older can be vaccinated without parental consent if they are mature enough to understand what they’re doing. But two federal lawsuits are now challenging that. And there are questions about how one decides just how mature a youth is.
Wilson said D.C. “did a smash-up of a mature minor treatment along with a vaccine exemption.
The National Conference of State Legislatures maintains a database that tracks states’ most recent bills regarding COVID-19.
Some health care providers face a quandary when caught between teens who want the vaccine and parents who object, as the New York Times reported.
The article describes part of the dilemma: “We may be in a legal gray zone with this vaccine,” Dr. Sterling Ransone Jr., a family physician in Deltaville, Virginia. “In his health system, a parent can send a signed consent form for a teenager to be vaccinated. But because the COVID-19 vaccine is authorized only for emergency use, the health system requires a parent to be present for a patient under 18 to get that shot.”
Wilson said the simplified answer to whether a teen can get vaccinated without parental consent in most communities is no. “In the District of Columbia, the youth has a very good bet. In the other 50 states, not so much. This is because of the constitutional right of parents to the control and custody and care of their children.”
Correction: A previous version stated Teens for Vaccines was founded recently. It was founded in 2019.