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Should pediatric patients be able to make their own decisions on vaccination?
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An Ohio teenager who chose to get vaccinated despite his mother’s objections recently testified before the Senate about the harms of vaccine hesitancy (for more on this story, click here). Three New York state chapters of the AAP have backed legislation that would allow minors aged 14 years and older to consent to all appropriate vaccinations for their age. Additionally, the chapters have made the abolishment of nonmedical exemptions a legislative priority for 2019. Infectious Disease News asked Elie Ward, MSW, director of policy, advocacy and external relations at New York State AAP Chapters 1, 2 and 3, how these laws would affect practice.
New York State, like many other states, is being challenged by outbreaks of vaccine-preventable diseases like measles, mumps and whooping cough.
To help address these disease breakthroughs, the state is exploring two options that can help address the current crisis. One option is legislation reflecting the “mature minor” concept in health care, which allows young people aged 14 years and older to consent to their own immunizations. New York has long recognized that for decision-making in terms of reproductive health care, mental health, substance abuse and emergency services, adolescents and young adults often have a clearer grasp of what kinds of health care decisions make the most sense for them.
In this instance, which is specific to immunization, young people are often more conscious about misinformation on the internet and can, in many cases, disagree with parents who have bought into unfounded and dangerous anti-immunization diatribes and pseudo-science. These young people have a right to protect themselves from diseases that can be easily prevented by immunizations.
We believe that children have rights, and the many parents who refuse to immunize their children are not protecting their children but rather making decisions based on inaccurate and misleading information, which places their children in danger. This legislation will allow those aged 14 years and older to make an informed decision about immunization for themselves.
The second option on the table in New York is to eliminate religious exemptions and have only medical exemptions. Immunization is a medical intervention that protects infants, young children, adolescents and adults from preventable diseases. As a medical intervention, decisions regarding immunization should be made based on solely medical criteria.
Universal immunization is a public good. Families who participate in other public goods, such as public school, day care, summer camp and play groups, need to take the responsibility to immunize their children so that all children are protected. Immunization works to protect all children through the concept of herd immunity. No vaccination is 100% effective for every child. Protection is afforded through universal immunization because most children are immunized; therefore, disease cannot spread.
If we allow parents who are afraid of vaccination and those who are persuaded by anti-scientific misinformation on the internet to decide to reject immunization based on their “religion,” then children who are medically fragile and cannot be immunized for medical reasons and children who are too young to be immunized will be vulnerable to infection.
Parents who choose not to immunize their children for nonmedical reasons have every right to make that decision, but they do not have a right to include that child in public school or group day care, where their lack of immunization has the potential to cause harm to other children.
Disclosure: Ward reports no relevant financial disclosures.
Editor’s note: To read our April cover story, click here.