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The prospect of vaccinating children and young people against COVID-19 raises questions that apply more widely to vaccination in children. When can children or adolescents consent, on their own, for vaccination? What should happen if children and their parents disagree about the desirability of a vaccine? When, if ever, should vaccination proceed despite a child’s dissent or apparent refusal? A range of ethical dilemmas may arise (box 1). In this article, we will address general ethical issues relating to consent for vaccination, highlighting their relevance to COVID-19. We will not address the wider ethical questions of whether or when children should be vaccinated against COVID-19.
Ethical dilemmas relating to vaccine consent for children and young people
A. Two parents disagree about vaccination for a young child (one supports, the other is opposed).
B. Both parents support vaccination, but a 3-year-old child cries vigorously and tries to escape when vaccination is attempted.
C. A 12-year-old requests a vaccine in the absence of parental permission (eg, in a school vaccination programme).
D. Parents decline vaccination, but an adolescent requests vaccination.
E. Parents support vaccination, but an adolescent refuses.
Parental consent
In general, parents play a key role in making decisions about medical treatment and procedures in their children. Except in an emergency, informed consent is always sought from a caregiver with parental responsibility prior to significant medical interventions. For childhood vaccinations in the UK, consent from parents is currently routinely required, although some groups have argued that mandatory vaccination would promote children’s best interests. If parents decline immunisations after being counselled about the evidence for vaccine safety and efficacy, their decision would usually be respected. Rarely vaccination may proceed against parental wishes; for example, for a child in care, or a child at particularly high …
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Twitter @NeonatalEthics
Contributors DW conceived of the article and wrote the first draft. AKSM performed a literature search and edited the manuscript. Both approved of the final version.
Funding This research was funded in whole, or in part, by the Wellcome Trust [203132/Z/16/Z] and by the Arts and Humanities Research Council (AHRC) as part of the UK Research and Innovation rapid response to COVID-19 [AH/V013947/1].
Disclaimer The funders had no role in the preparation of this manuscript or the decision to submit for publication.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.