COVID-19: Vaccinating kids without parental consent?
By Maryanne Demasi, PhD
Australian experts say that administering Covid-19 jabs to children aged 12 and over should be allowed without parental consent. This echoes a US Senate Bill (No. 866) introduced in California last week.
“Children are not the property of their parents” wrote Professor John Massie and colleagues in the MJA recently, “It is ethically permissible to vaccinate a young person from the age of 12 years requesting a Covid‐19 vaccine, even if their parents do not provide consent.”
The authors went on to write: “Our clinical experience has been that some young people are motivated to receive a Covid‐19 vaccine, even when their parents do not wish for them to be vaccinated.”
In a follow up interview, Prof Massie, a respiratory paediatrician and child bioethicist, reiterated the ethical and scientific arguments for the recommendation, drawing on the principles of “Gillick competence.”
What is Gillick competence?
Traditionally, parental consent is required for the administration of a medical therapy to a minor, but some countries can apply “Gillick competence.”
It is a term established under the 1985 Gillick ruling, to describe when a 'mature minor' (below 16 years) is able to consent to his or her own medical treatment, without the need for parental permission or knowledge.
The case was based on Mrs Victoria Gillick, a catholic activist who objected to young people being provided with contraceptive advice without their parent’s knowledge.
The judicial ruling by the UK House of Lords meant that medical practitioners could provide advice about contraception to young people, assuming they had sufficient understanding of that treatment. The case is binding in England and Wales, and has been adopted to varying extents in Australia and New Zealand.
In Australia, there are guidelines at State and Federal levels to assist doctors in being able to determine whether a young person (12 or 13yrs) has the ability and maturity to weigh up the benefits and harms of vaccination.
“In Queensland and Victoria, it’s clear that the 12- to 15-year-old group should be able to get vaccinated under their own steam,” said Prof Massie.
“In South Australia, Western Australia and New South Wales, you need a parent’s consent, but in NSW it’s messy depending on who you ask.”
While there is “no minimum age for a mature minor,” Prof Massie said he did not think that the Gillick rule would be extended to the 5-to-11-year cohort.
Doubts over Gillick relevance
There is consternation among clinicians, legal experts and sociologists who argue against the ethical and scientific application of Gillick’s rule in this case.
New Zealand Barrister and advisor to the Law Society Warren Pyke, says the Gillick ruling should not be compared to the issue of Covid-19 vaccines.
“The contraception comparison does not hold, at all. The Covid-19 vaccine very rarely provides a health benefit to children and teenagers who are susceptible to pressure from authorities and peers,” said Mr Pyke concerned about the inadequate discussion over adverse events.
“They’re taking the vaccines to stay in sports, in university, go to concerts and bars. Then having swollen glands, seizures, nose bleeds,” says Mr Pyke.
There is concern the Gillick ruling is being used to open the door to an acceptance of more complex medical procedures, as in the case of puberty blockers for children with gender dysphoria.
Priscilla Alderson is professor emerita of childhood studies in the Social Research Institute, University College London. Her research career has spanned four decades, with over 300 publications in areas such as children’s rights, ethics and health.
The Gillick ruling, she says, is based on “informed consent” and the mature minor should have “sufficient understanding and intelligence to enable him or her to fully understand what is proposed.”
“However, the Gillick ruling doesn't really apply here, it’s irrelevant,” says Prof Alderson.
“Children cannot possibly give informed consent because they don't have the information to make that decision.”
“It's not about children's competence in this case. How can they make informed decisions about their future health when the information about mid- to long-term risks is not available?”
It’s true. Neither the drug regulators nor the vaccine manufacturers have released the trial data. Our knowledge is limited to drug company press releases and several pages in a peer-reviewed journal, which contain reporting biases and authors with financial conflicts of interest.
The Australian TGA will not allow independent researchers to authenticate the data, and transparency advocates have had to sue the US FDA for access to the data upon which it authorised Pfizer’s (Comirnaty) mRNA vaccine.
Prof Alderson says she is most concerned about inter-generation issues like fertility.
“There is incomplete information about the impact on children’s reproductive health which is a worry because incomplete information can be dangerous. And what are the impacts of repeated injections?” asks Prof Alderson.
The science doesn’t stack up
Professor Massie and colleagues argue that “parents refusing Covid‐19 vaccination for their children is not in the best interests of the child based on medical recommendations and, further, could be conceived as harmful by failing to reduce the risk of disease due to SARS‐CoV‐2 infection.”
“There's good evidence, they’ll make antibodies to the vaccine, that can minimise the severity of the illness….I think it's also likely that it will reduce viral load in those who've been vaccinated but become infected, it will reduce spread back to parents, and then obviously, grandparents,” said Prof Massie to the MJA.
However, Allyson Pollock, clinical professor of public health at Newcastle University says this is misguided.
“Antibodies are not a predictor of how protected you are,” says Prof Pollock.
“The vaccines are not actually stopping active disease and real-world data shows that most of the transmission and the disease is now happening in the vaccinated population in Europe and Britain.”
Indeed, countries with the highest percentage of fully vaccinated people are now considered to be ‘high’ transmission countries.
“Actually, there is no evidence that vaccinating children is going to provide wider benefits to society,” says Prof Pollock. “The argument really falls down, especially now that Omicron is showing immune evasion.”
While the risk of severe disease and death from Covid-19 in healthy, young people is very unlikely, there has been a lot of concern over ‘long covid’. But a recent Danish study adds to the mounting evidence that long covid in children is rare and mainly of short duration.
Further, the paediatric trials were underpowered to detect any rare harms and too short in duration to determine any long-term implications like cancer or genotoxicity. It took millions of people to be vaccinated before surveillance databases detected cases of myocarditis in young males.
Authorities have continually downplayed the risk, saying that myocarditis was more far likely to occur after viral infection than after mRNA vaccination. However, a recent Oxford study, which looked precisely at this issue, found males under 40y were significantly more likely to develop myocarditis after two doses of mRNA vaccine, than if they’d caught the virus.
Prof Massie trivialised the significant of myocarditis in young people. “In most of them, it’s a minor illness, some shortness of breath, maybe some chest pain, resolved with anti-inflammatories over a few days,” he said.
However, a large case series of suspected post-vaccine myocarditis in people under 21y showed that 77% had abnormalities, and of them, 99% had late gadolinium enhancement (signifies fibrosis or scar tissue) and 72% had myocardial oedema (swelling of heart muscle).
It is not known if there will be long-term consequences for young people, nor is it clear if new vaccine-related harms will emerge in the coming months or years, since they are a novel technology and still investigational.*
Whether these complex concepts are decipherable for young people is for the experts to determine, but for the moment, public health authorities and governments continue to maintain that “the benefits outweigh the risks.”
*In Australia covid vaccines are not fully-licensed; they only have TGA “provisional approval” and phase III trials for Pfizer (NCT04368728) and Moderna (NCT04470427) are ongoing, not due for completion until 15 May 2023 and 27 October 2022, respectively.