Should Children Get COVID Shots Without Parental Consent? No.

California children 12 years and older may soon be allowed to get COVID-19 vaccines without their parents' consent if Senate Bill 866 (SB866) becomes law. Introduced on January 20th, the legislation stipulates that vaccine providers may give immunizations that “meet specified federal agency criteria.” SB866 is the first product from the state's “legislative vaccine work group,” a collection of legislators formed to advise their colleagues on which steps they “should take to improve vaccination rates and reduce misinformation,” the Los Angeles Times reported last week.

Advocates are trying to sell the proposal using anecdotes of teenagers who have tried unsuccessfully to convince their parents that the FDA-authorized COVID vaccines are safe. 17-year-old Ani Chaglasian “pleaded” with her parents, the LA Times wrote. “She laid out research showing [the vaccine] would safely protect her from being infected or passing the virus to others.” But her parents wouldn't budge and she remained unvaccinated.

I sympathize with the spirit of SB866 as a vocal advocate for immunization. Plus a reasonable argument could be made that the line between adolescence and adulthood is a blurry one; some people may be capable of giving informed consent despite their youth.

But ultimately this argument isn't convincing. Trying to cut parents out of important health care decisions will needlessly inflame the public's vaccine skepticism, which has long-term consequences. Educating parents is a far more effective way to boost COVID immunization.

How old is old enough?

This dispute centers around an age-old question: at what point do children become adults and thereby acquire all the rights and responsibilities that come with this legal status? In most US states, parents have to give consent for children under the age of 18 to receive medical treatment, though there are a handful of legal exceptions.

In Arizona, for example, a child or physician can ask a court to allow COVID-19 vaccination over the parents' objections. California is one of several states that go beyond this, allowing children 12 and up to consent to the Hepatitis B and HPV vaccines, treatment for substance abuse and mental health disorders, as well as diagnosis and treatment for sexually transmitted infections. Minors can also obtain an abortion without parental involvement.

It's not clear why voters and legislators set the age of consent where they have in these cases, but it prompts two questions. Why allow children to consent only to these few treatments? And why 12 as opposed to 10 or 11 years old? It all seems quite arbitrary because the teenage brain isn't fully equipped to make rational decisions. According to the University of Rochester Medical Center,

"It doesn’t matter how smart teens are … Good judgment isn’t something they can excel in, at least not yet. The rational part of a teen’s brain isn’t fully developed and won’t be until age 25 or so. In fact, recent research has found that adult and teen brains work differently. Adults think with the prefrontal cortex … This is the part of the brain that responds to situations with good judgment and an awareness of long-term consequences. Teens process information with the amygdala. This is the emotional part."

The more stringent among us might argue based on this information that the age of consent should be raised to 25, impractical though that may be. What seems inappropriate, at least to me as a parent, is that children less than half that age should be allowed to consent to medical treatment; even the LA Times' anecdote involved a 17-year-old, someone just a year younger than the existing age of consent.

Still, State Senator Scott Wiener (D-San Francisco), who introduced SB866, forged ahead, arguing his proposal is “about empowering teenagers to make decisions on their own health and their own safety.” But nobody in Sacramento really trusts children to consistently choose vaccination. Governor Gavin Newsom issued a vaccine mandate for all school children last October that takes effect as the FDA approves the shots for different age groups. Another recently proposed bill would simply mandate COVID shots for school-age children by January 1, 2023—whether they're approved or only authorized on an emergency basis. There's no personal belief exemption in the second proposal.

When either mandate takes effect, do you think Senator Wiener will applaud teenagers who “make decisions on their own health” and opt to skip their COVID shots? Probably not. Both bills and the governor's mandate are designed to boost vaccine uptake regardless of what children, their parents, or even the World Health Organization think. Vaccinating children is beneficial, WHO maintains, but in its updated vaccine guidance published on January 21, the organization recommended that

"Countries that have achieved high vaccination coverage in high-risk populations should prioritize global sharing of COVID-19 vaccines before vaccinating healthy children and adolescents who are at the lowest risk of severe outcomes [my emphasis].”

So far, developed countries like the US haven't taken this approach, encouraging vaccination for everyone five years and older. Vaccine expert Dr. Ben Locwin elaborated on the dispute in an email to ACSH:

Objectively, the calculus seems correct: Given the differential risk in younger age groups, the overall global suffering could be reduced by doing as WHO suggested. But that's a purely rational calculation; that's not how people work -- behavioral economics comes into play and nations make irrational decisions (from the perspective at a global level) which may make regional sense.

How will parents react?

Calls for mandatory COVID vaccination have met fierce opposition around the country. California isn't an exception in this regard. Parents who object to mandatory shots for their kids will not take kindly to a law that effectively cuts them out of the decision-making process; they will double down and the vaccine skepticism California is trying to combat will only intensify. Studies have repeatedly shown that people push back when you try to force vaccines on them.

The point here is clear, but it's one many public officials and scientists have failed to grasp throughout the pandemic. The fact that we're trying to exclude parents from the vaccine conversation indicates that we've failed to earn their trust. Something went wrong long before we got to this point.

My guess is that California parents remember their governor previously trashing the vaccine he now wants to mandate for their children. They also probably haven't forgotten that he tried to exempt the state's politically connected correctional officers from a vaccine mandate—while insisting that "Vaccines are how we end this pandemic." Is it really surprising that some people don't want to immunize their kids after enduring such blatant hypocrisy?

The way forward

The good news is that skeptical parents can be convinced to vaccinate their kids. Research has shown that physicians who communicate the benefits of immunizations often make a tremendous difference. In this 2018 study, for example, “A health care professional communication intervention significantly improved HPV vaccine series initiation and completion among adolescent patients.”

Instead of passing more laws that will fuel additional political opposition to safe, effective vaccines, let's try convincing parents for change—because forcing their hands clearly doesn't work.