COMMENTARY

Should Kids Be Able to Get COVID-19 Vaccine Without Parental Consent?

Arthur L. Caplan, PhD

Disclosures

May 25, 2021

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the New York University Grossman School of Medicine in New York City.

Happily, vaccines are in greater and greater supply in the United States. We know they work. We've seen downturns in both death rates and hospitalization rates. The more people are vaccinated, the better things get. Many states now have no deaths reported over the past few days due to higher vaccination rates. A large number of Americans have had at least one vaccine dose. In terms of coverage within the population, we're not quite to herd immunity, but we're making progress and that's good.

One group, however, that hasn't been able to participate in vaccination includes young people, teenagers, and adolescents. The vaccines have been approved under an emergency use authorization from the FDA, which is a pretty solid basis for allowing vaccination to move forward. The data look good and the safety looks good, but the vaccines were not studied in younger people.

The Janssen vaccine is only approved for ages 18 and older; the Moderna vaccine, 18 and older; and the Pfizer vaccine is approved for ages 16 and older. Pfizer and the other companies are going to have approval to vaccinate 12- to 16-year-olds eventually. [Editor's note: After this video was recorded, the FDA did authorize the use of Pfizer's vaccine for 12- to 15-year-olds.]

That's not a small number of people in the United States; 10 million or more fit into that group. If we're trying to get to herd immunity, it will be very important to have those young people get vaccinated, not because they get sick at high rates — they don't — but some definitely need the protection. Some kids have gotten very sick or died from COVID.

They do transmit the disease, and cutting back on infectivity is a key step toward herd immunity. The more people vaccinated, the fewer targets that the virus has to jump from person to person and infect higher-risk people.

It's also the case that we want to get our kids back to school. School is a great place to spread diseases, which we know from measles and mumps. It's important that if we're going to open up the schools, public and private, that we get these younger people vaccinated both for their own protection and to cut back on turning schools into places where COVID is brought home and other people are put at risk who maybe can't vaccinate. Even for those who are vaccinated, remember that it's still only 94% percent effective, not 100%.

Most adolescents, I believe, are going to want to do this. I am optimistic. I think that they're going to want to participate. They know what it's like to not see their friends. They know what the toll is that COVID has taken on the nation. They know what it's like not to be at school, and as much as we joke about it, many kids want to be at school because they see their friends and they want to learn.

I'm very positive about young people wanting to go back to normality. I'm also very positive that we're going to see situations where young people are going to want to step up to the plate and protect the community.

Although adults don't always behave sensibly or rationally about vaccines, sometimes putting their own liberty and freedom ahead of what's good for their neighbors and for others, young people have a different attitude. They're community-minded and they care about family and friends. I'm very optimistic — I don't have the polls to prove it — that many of them are going to say, "I'm stepping up to the plate. I want to get vaccinated."

What do we do when a young person — say, 14 or 15 years old — says, "I want to get vaccinated" but their parents are anti-vaccination people and don't approve of it? Would we let a younger person get vaccinated against the will of their parents?

Many of you watching this know that parents absolutely have authority over the medical treatment of their children. There are very few areas where a child can go and get care without parental approval, but there are a few. Reproductive health is the primary one. You can seek out contraception or treatment for venereal disease without your parents' knowledge or permission. You don't have to get their permission to do that.

It may be that we should adopt a similar policy with respect to vaccination. Vaccination is very low risk. It is almost a micro risk in terms of harm. The benefits are strong in terms of protection to kids, protection of the schools, and protection to others, and finally in terms of helping to get us to herd immunity, which will allow us to finally relax some of our lifestyle and behavioral protections and really reopen society. I favor letting young people get vaccinated without parental consent.

If a young person came in to my office and said, "Please give me a vaccination and don't tell my parents," I would admit that I'd have to tell the parents. I might say, morally, that I'd give the vaccine and I understand that's a big, controversial step. We don't really want to get on the wrong side of parents, but in this case, I think a younger person is pretty competent to decide about vaccination. I think the risks involved are tiny and I think it will do them, their friends, and their community a lot of good.

Even if you're not ready to take that chance or you don't want to square off against parents who might say, "Well, that's the last time I'm sending my kid to see you," I do think it's important that medical organizations, nursing organizations, and other healthcare groups fight to start to say, "Let's drive another exemption." In addition to reproductive health, let's make it possible — and make it possible soon — for younger people, say 12 and older, to decide to get vaccinated even if their parents oppose it.

I think it's the right thing to do in terms of protecting the community and protecting autonomy on the part of younger people who I think can make this decision. And I think it's good for the kids.

I'm Art Caplan at the Division of Medical Ethics at New York University's Grossman School of Medicine. Thank you for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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