California Senate Bill 866 proposes to grant children 15-17 years of age decision-making authority regarding vaccinations without parental or guardian consent. This is specifically aimed at increasing the administration of the COVID-19 vaccine. Co-lead author Senator Scott Weiner cited low vaccination rates among children as the impetus for this legislation on his website.1
The germane question that requires rigorous discussion is whether children have the capacity to make independent medical decisions. Capacity is the basis for informed consent. Informed consent details the risks, benefits, and alternative treatments for the patient in specific terms. The four components of capacity are understanding, appreciation, reasoning, and communication. In a 2018 American Family Physician article,2 the authors identified age < 18 years, chronic psychiatry conditions, and low education level as risk factors for impaired medical-decision making capacity. For research trials, the federal standards categorize children as vulnerable populations and have instituted additional safeguards to protect them from adverse outcomes.3 Cleary, the institutions of medicine and government acknowledge they have a greater degree of responsibility in protecting patients when they are children.
Numerous studies4-7 have concluded that children have experienced a decline in mental health during the pandemic; this includes increases in stress, anxiety, and depression. The aforementioned group consists of adolescents entering puberty, a tumultuous time of emotional lability. This is a critical time for brain development with regards to executive function. The adolescent brain is in a critical period of plasticity where rewiring occurs to help them transition from children into adults. However, this development is highly dependent on social interactions and presentation of social situations and experiences. Essentially, the pandemic and the corresponding shutdown measures have arrested this development. A UNICEF report8 estimated that schools worldwide closed for 95 instructional days from March 11, 2020 to February 2, 2021. This loss amounts to roughly half of the school year. A current chronological 15-year-old may be closer to a pre-pandemic 13-year-old with respect to executive function development.
SB 866 does not address who bears responsibility for an adverse reaction from vaccine administration. In all likelihood, it will be the parent or guardian who will be responsible for the costs associated with care from such reactions. This outcome will surprise, and perhaps shock, parents and guardians since there is no language in the bill that requires health care providers to notify parents or guardians of the immunization. In a JAMA Pediatrics article9 on policy recommendations for legislation that would grant minors consent for vaccinations, the authors concluded that “clinicians should notify minors’ parents of their immunization unless notification might pose a risk to the minor.” Essentially, SB 866 circumvents national policy guidelines by foregoing parental notification in most instances.
Do Senator Weiner and his co-authors sincerely believe that health care providers will allocate sufficient time to ensure a child has the cognitive skills to make an informed decision for consent when dealing with outcomes that may potentially impact organ function and quality of life from vaccines with only Emergency Use Authorization from the FDA? By eliminating parental or guardian consent, SB 866 increases the vulnerability in an already vulnerable population. The patients involved in SB 866 entered adolescence during a pandemic. The usual developmental upheavals have been further exacerbated by school shutdowns. Now is when children require more interaction and supervision so that they navigate their formative years with a sense of security and protection. That is the domain of parents and guardians. We often cite increased parental involvement in their children’s lives as a virtue, but the authors of SB 866 seem to think otherwise.