Should Minors Be Able to Receive the MMR Vaccine Without Parental Consent?: Public Health Watch

Kids frequently disobey their parents. It’s practically a rite of passage.

However, historically, children—particularly adolescents and teens—have rebelled over the styles of clothing they wear or the music they listen to, and not their medical care. Well, that’s starting to change, and now government is getting involved in these disputes.

Welcome to the “new normal.”

We’re of course referring to the issue of the measles-mumps-rubella (MMR) vaccine, and the idea that children try to circumnavigate their “anti-vax” parents to receive the critical “poke.” A scenario that would have at least seemed far-fetched a decade ago is now reality, thanks to the more than 1100 confirmed measles cases in the United States in 2019, the worst year for the disease since 1992. US Centers for Disease Control and Prevention (CDC) statistics suggest MMR vaccine uptake nationally stands at 91.1%.

Parents electing not to vaccinate their children because of unfounded concerns over a link to autism aren’t the only factor in the rise in measles cases, obviously—there are some communities in which religious beliefs play a role—but they are an important one. And, let’s face it, it makes for compelling headlines.

In March, Ohio teen Ethan Lindenberger testified before the US Senate Committee on Health, Education, Labor, and Pensions that he had decided to get the MMR vaccine in December 2018, after he turned 18, over the objections of his “anti-vax” mother. He consulted the online community Reddit beforehand, calling his parents “kind of stupid” when it comes to vaccines.

Although a few people responded to Lindenberger’s post on the online platform, federal and state legislators have also taken notice—hence, his appearance on Capitol Hill in the first place. According to a June 27^th report on the web site Governing, California, Delaware, Minnesota, New York, and Washington, DC, already had laws giving minors the right to choose to get vaccinated against sexually transmitted diseases, such as HPV and hepatitis B, long before the current measles epidemic. Meanwhile, states such as Alabama, Alaska, Idaho, Oregon, and South Carolina allow minors to make all their own health care decisions.

More recently, according to Governing, the New Jersey General Assembly has been debating a bill that would allow children as young as 14 years- old to get the MMR vaccine without their parents’ permission, while leaders in DC are mulling legislation that would enable adolescents to get vaccinated without permission—provided a physician determines they are mature enough to make the call (no subjectivity there). This spring, a similar bill failed to pass in New York state.

Such legislative influence may not be as much of a slippery slope as it seems, however, the authors of a commentary published on July 11^th in the New England Journal of Medicine (NEJM) suggest. They write that clinicians already “routinely explore [adolescents’ and teens’] understanding of health-related issues, solicit their agreement on care plans, navigate discordance between parental and [child] preferences, and protect [minors’] confidentiality interests,” they write. The authors note that vaccine services can be provided to minors in “alternative settings, such as pharmacies, which may be more accessible than health care offices in rural areas, or school health clinics.”

They continue, “Granting adolescents the authority to agree to vaccination without parental permission would allow them to catch up on any missed childhood vaccines. Although not a panacea for all vaccine uptake and access problems, such laws could improve rates of vaccination against highly infectious diseases such as measles.”

However, another commentary in the same issue of NEJM, specifically addressing New York City’s decision to mandate MMR vaccination in certain Brooklyn neighborhoods where members of an Orthodox Jewish community had objected, argues that government involvement in these decisions may have unintended consequences.

“Forced vaccination could inflict lifelong or even intergenerational trauma and could deter families from obtaining medical care entirely,” writes author of the commentary Julie D. Cantor, MD, JD, lecturer in law at UCLA. “It raises questions whose answers seem disproportionate to the potential harm: Will state troopers wrest children from parents? Will the children and parents be restrained? Can families relocate from Brooklyn, or do they risk extradition? Do we also force the second dose? And why wait for an outbreak when hot spots are predictable?”

Does this debate make MMR vaccination in the 2010s like rock ’n’ roll music in the 1950s? Not quite, but it may be giving parents and kids something new to argue about at the dinner table just the same. And how these disputes are resolved could have serious health consequences not just for the children involved but society as a whole as well.