Measles outbreaks are spreading in two neighbouring US states, Washington and Oregon, with the former declaring a public health emergency. These states are among 17 that have laws allowing parents to opt out of vaccinating their children on the basis of personal beliefs. The latest outbreak has seen teenagers turning to social media to ask how they can get vaccinated against their parents’ wishes.
Legally, it is a difficult question, because children can’t necessarily make their own medical decisions. Regulations vary from state to state, but in general, some minors can access certain treatments without parental consent. Vaccines are not always specified on this list, but in some states the law is vague enough that a minor could potentially have a legal right to a vaccination.
In Oregon, anyone 15 or older can get hospital care, dental and vision services, and immunisations without parental permission. In Washington, minors can receive immunisations without their parents’ consent if their doctor determines they are a “mature minor”, which takes into account their age, ability to understand the treatment and self-sufficiency, although they need not be legally independent to qualify.
Trust in vaccines
Other states allow even younger children to access some vaccines. In California, 12-year-olds can consent to medical treatment for sexually transmitted infections (STIs). These include the vaccine for human papillomavirus (HPV), which has become a target for anti-vaccination campaigners.
“There were lots of claims about things that are bad about the HPV vaccine, which really aren’t founded in any scientific evidence. That created a lot of mistrust among parents,” says Claudia Borzutzky, a physician in the adolescent medicine clinic at Children’s Hospital Los Angeles.
Californian minors can also consent to the hepatitis B vaccine. “We don’t have the same resistance to hepatitis B as we do with other vaccines, which is mysterious to me because all our vaccines have the same efficacy. People forget it’s an STI,” says Borzutzky.
Almost every state allows minors to consent to medical care related to reproductive health – birth control, pregnancy testing, abortion – and drug and alcohol abuse services. Some states also let minors access mental-health services and sexual-assault treatment without a parent’s permission.
For other services, like standard vaccinations, only certain minors can consent. For example, in New York, teens who are pregnant, married, homeless, in prison or legally emancipated from their parents can make their own medical decisions.
Teenagers who want to get vaccinated should start by understanding what the law allows in their own state, says Borzutzky. Public health departments have information available on the rights of minors when accessing healthcare. Doctors and social workers at a clinic or school can also offer guidance.
Enlisting such people to help persuade a parent to support their child’s decision to get vaccinated may be the best strategy, especially because public funding for medical care isn’t available to teens in all states, says Borzutzky.
“We would always rather engage parents and have them on board for any healthcare we provide a young person, as long as the parent is going to be supportive,” she says. “There are parents who will come around on vaccines, but it’s not always in one visit. It may be over months or years.”
In some cases, teens may need to wait until they turn 18 to get vaccinated. But that may change, as law-makers wake up to the risks of an unprotected population. In the past few years, Washington and Oregon both passed laws requiring parents to be educated on the benefits of vaccines and the risks of foregoing them before opting out of vaccination. In light of the current outbreaks, both states are now considering bills to end non-medical exemptions all together.
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