When COVID-19 vaccines became available in the U.S., adults rushed to mass vaccination sites and stood in lines for hours with hopes of quashing fears of infection and returning to some sense of normalcy.
Now, it’s children’s turn. But swap the long lines for consent forms and tense, sometimes unsuccessful, conversations with doubtful or concerned parents. It’s a situation that varies by state, and one that experts fear could hinder the nation’s progress toward herd immunity — when enough people have protection against COVID-19 that the virus can no longer spread easily between people.
Fourteen-year-old Francesca Richards, an eighth grader in Boca Raton, Florida, is one of the millions of kids aged 12-15 in the U.S. who are now eligible to receive the Pfizer coronavirus vaccine following federal authorization this week.
Francesca, like many others, said she wants to get vaccinated as soon as she can, but her mother, who’s fully vaccinated, prefers she wait a couple of months.
“I’m trying to go back to my normal life and I want to feel safer at school,” Francesca told McClatchy News. “I think I’m going to talk to [my mom] to see if I can get it earlier, but I can wait, too. I’m super cautious.”
Francesca’s mother, Florence Richards, said she “believes and trusts the science of the vaccine,” but added she isn’t rushing to get her daughter vaccinated because “unfortunately, sometimes there is new or updated news or events that may happen right after it comes out.”
“I wanted to give it a few months’ time and talk to the pediatrician and others for professional opinions,” Richards, 51, told McClatchy News.
She isn’t alone.
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.
Fortunately for Francesca, her mom said she will support her if she really wants to get vaccinated right away.
“I would rather her to be more protected than not, and there’s always a chance she could spread the virus or bring it home,” Richards said. “There is always worry and apprehension even with adults getting the vaccine, but overall I am 100% for it.”
Not all children are as lucky. Francesca said she knows of classmates who want to get their shots, but their parents won’t allow it.
Vaccine consent laws are up to states
Florida is one of several states — including Texas, Mississippi, Kentucky, Georgia, Pennsylvania and Colorado — that require parental or legal guardian consent for vaccination in minors of all ages. Some states allow all minors to get any vaccine as they please without parental consent, such as Idaho, Washington and North Carolina.
Other states have more specific rules. For example, minors in South Carolina don’t need their parent’s permission to receive any vaccine as long as they are 16 or older. In Illinois and California, kids aged 12 and older don’t need consent to get the HPV or Hepatitis B vaccines, but do need it for all other shots.
Andrea Polonijo, a medical sociologist and postdoctoral fellow at the University of California, Riverside School of Medicine focusing on social inequalities in vaccination, said there’s a “small percentage of [parents] that will not come around.”
“I think you don’t need to necessarily consult with your parent or guardian to get a vaccine if you’re in a state where you can consent for yourself. [Teens] can go speak to a health provider,” Polonijo told McClatchy News. “Exercise your own agency to consent if that’s what you feel is right. If your parent is really not coming around, go for it. You don’t need to have that conversation if it’s only going to create more tension.”
At the same time, “we can’t only leave this up to the teens that often have very little power,” Polonijo said, adding that such parental hesitancy could “absolutely” slow the country’s progress toward herd immunity.
Brian Marks, an economics and business analytics professor at the University of New Haven in Connecticut, told McClatchy News that “states will need to re-examine existing consent and mandate laws and the applicability to COVID-19” in light of a national public health emergency.
In other words, “states may need to catch up,” he said, especially given the federal government has little power in state public health decisions, apart from issuing guidance and recommendations.
When it comes to reaching herd immunity, which some experts say is becoming less attainable in the U.S., “consent, in and of itself, will not necessarily thwart the country’s progress toward addressing the pandemic,” Marks said.
But, he continued, “the devil is in the details.”
Another consideration for vaccine providers: rebellious teens hopping state borders to get their shots.
Marks said states will need to carefully consider their own consent laws and those of other states when in a position to vaccinate a minor from out of town.
“At its core, is this a matter of emergency, extremely time limited with no alternative options for the same medical outcome, or a matter of urgency, with options and not necessarily time limited?” Marks said.
Why are some parents hesitant to get their child vaccinated?
Polonijo of UC Riverside said the majority of parents who are hesitant to vaccinate their child aren’t necessarily “anti-vaccinators” and instead more accurately described as “vaccine hesitant.”
“Perhaps they have misinformation about vaccinations, or they don’t have enough information. And really, they’re looking out for the best interests of their child,” she said. “They think that by not allowing their teens to get vaccinated, they’re protecting them.”
While hesitancy is widespread, there are racial disparities among parents who are most concerned about vaccinating their children.
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, 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.”