Adolescent Vaccination

Last week, the Centers for Disease Control and Prevention approved the Pfizer COVID-19 vaccination for use by those those 12 and up. This has raised several legal and ethical questions related to adolescent vaccine policies. [To find a place to get the Covid-19 vaccine near you, you can go to vaccines.gov, text your ZIP code to 438829, or call 1-800-232-0233.]

Can/will schools mandate Covid-19 vaccinations?

Short answer: Almost certainly not in Indiana, and highly unlikely in most states. There are, however, many steps schools can take to make it easy for children and families to get vaccinated.

Students have not been the population at highest risk of severe adverse outcomes from catching the virus that causes COVID-19; however, the virus was a top 10 cause of death for children in 2020, can lead to hospitalization, and hospitalization is more likely in Hispanic and Black children and children with chronic health conditions. Furthermore, children who catch the virus can spread it to others — of particular concern would be a child spreading the virus to vulnerable classmates and family members (especially those too young or unable to receive the vaccine and those who are immunocompromised). A significant share of adolescents, along with most adults, will need to be vaccinated to slow and potentially stop the spread of the virus through our communities.

The Food and Drug Administration has not yet issued its full approval of the Pfizer vaccine; however, it is believed that they will do so this summer. This isn’t surprising: The safety and efficacy data needed to have the vaccine authorized under the Emergency Use Authorization process was very stringent, and included observing the period of time during which all major side effects from receiving vaccines are expected to arise. We also have the data from the more than 100 million vaccinated individuals in the U.S.

States — specifically, state legislatures — set the rules governing school vaccine policy. In Indiana, the legislature sets out a list of diseases that children enrolling in schools must show proof of vaccination for (or have an exemption for). The legislature has also set up the law (Indiana Code sec. 20-34-4-2(b)) to give the state health department the power to “expand or otherwise modify the list of communicable diseases that require documentation of immunity as medical information becomes available that would warrant the expansion or modification in the interest of public health.”

While an argument might be made in favor of adding COVID-19 vaccines to the list, Indiana does not require every effective vaccine as a condition of school entry. For example, Indiana recommends, but does not require, annual flu shots or the HPV vaccine. Given the actions taken this spring by the state legislature to constrain the use of state public health authority — in particular the legislature’s prohibition against the state requiring proof of Covid-19 vaccination, and taking steps to minimize situations delegating decision-making authority to public health agencies — it may be difficult, legally and politically, for the state health department to put such a requirement in place.

As I state in a piece in this past week’s Indianapolis Star: “I don’t think we need to [mandate the vaccine for children],” said Ross Silverman, professor of health policy and management at the Indiana University Fairbanks School of Public Health. “I think we need to answer people’s questions. It is a new vaccine. People have questions. So I think we can do a lot to let people know what the benefits of getting vaccinated are and make it as easy as possible for people to get vaccinated without having to take the step of mandating it.”

Can adolescents who want to be vaccinated get the shot if their parents disapprove?

Not in Indiana, but perhaps in a few other states, and the City of San Francisco passed an emergency order in April allowing minors 12 and older to consent to Covid-19 vaccinations.

Covid-19 vaccine hesitancy does seem to be higher in parents making decisions about their children than in the general population. According to the Miami Herald,

A survey of 971 members of the national nonprofit ParentsTogether found that parents are 17% less likely to allow their kids to get vaccinated against COVID-19 compared to their personal decisions to get vaccinated. The majority of parents’ concerns regarded short-term side effects, unknown long-term effects and the seemingly swift development of the shots….

The survey conducted by ParentsTogether revealed that Black and Hispanic parents are 70% more likely to be “unsure” about allowing their kids to get a COVID-19 shot than white parents; 27% of Black parents said they would “probably not” or “definitely not” vaccinate their kids, compared to 15% of white and 13% of Hispanic parents.

Because COVID-19 vaccines have been more accessible for white and higher income Americans, [Dr. Andrea] Polonijo believes access plays the largest role in low vaccination rates across marginalized populations — not to mention “a long legacy of racism and discrimination in medicine that continues today.”

“These are populations that continue to have negative interactions with the health care system today,” Polonijo said. “I think it’s very natural, having had those experiences, to be vaccine hesitant.”