Minor Consent For Vaccinations Amendment Act Of 2019

By: Sarah Johnson

This week we’ll take a closer look at a bill that has been getting a lot of attention over the last few months, DC B23-0171, the Minor Consent For Vaccinations Amendment Act Of 2019. We are all familiar with the debate around immunizations, but it is even more interesting given our current situation with a pandemic and high hopes of vaccines allowing us to return to “normal” life.

A little background.

In 2015 we posted  Vaccination Nation, containing a brief explanation of the two sides of the vaccination debate which has only intensified in the years since. Every year, more research is published showing vaccines work; and many of the commonly cited “cons” to vaccination are not valid. One of the most common concerns people have about vaccinations is they believe vaccines are linked to Autism. In 2011, a special series of articles published by BMJ exposed the false data behind the claim from Andrew Wakefield connecting vaccination to autism, which launched a worldwide scare over the MMR (measles, mumps, and rubella) vaccine. These articles, accompanied by this editorial, showcase how the appearance of a link with autism was manufactured at a medical school in London and the “link” was based not only on bad science, but on a deliberate fraud.

Here is an article from PublicHealth.org which also debunks other popular vaccination “drawbacks”. Not only have many of these “reasons” for not getting vaccinated been debunked, but New York experienced a massive measles outbreak in 2019, showcasing the importance of people partaking in vaccination. There were 1,249 confirmed cases of measles between January 1 and October 4, 2019, marking the greatest number of measles cases in the US since 1992. Although measles rarely results in death in the United States, an estimated 207,500 people died from measles around the world (mostly young children) in 2019. Last year, the United States came close to losing their measles elimination status. To lose our status, one strain of measles would have to circulate in a country for 12 months or more, meaning measles would be considered re-established.

An emerging trend in legislation.

A popular trend we have seen surfacing throughout the country is states allowing minors to get vaccinated and receive medical treatment without parental consent. Some states have enacted legislation to allow minors to choose to get vaccinated against sexually transmitted diseases, like the human papillomavirus and hepatitis B. A California bill, passed in 2011, states “A minor who is 12 years of age or older may consent to medical care related to the prevention of a sexually transmitted disease. The minor’s parents or guardian are not liable for payment for medical care provided pursuant to this section”. Alabama, Alaska, Idaho, Oregon, and South Carolina give minors the right to make all health care decisions.

Eighteen states (Alabama, Alaska, Arkansas, Delaware, Idaho, Illinois, Kansas, Louisiana, Maine, Massachusetts, Montana, Nevada, Oregon, Pennsylvania, South Carolina, Tennessee, Washington, and West Virginia) have allowed for “mature minors” to independently consent to vaccinations without parental approval. A “mature minor” is defined as “Any teenager who can demonstrate competence to consent to or refuse treatment. In the common law, a teenager who demonstrates adequate maturity may choose or reject some forms of care, including contraceptive and pregnancy care, mental health and chemical dependency consultations, and treatments for sexually transmitted diseases. In these instances the consent of the parent or guardian is not necessarily needed.”

Last year, New Jersey proposed a bill that “would provide that a minor who is 14 years of age or older has the right to consent to vaccination for certain communicable diseases.” The bill would have allowed minors to get vaccines for poliomyelitis, mumps, measles, diphtheria, rubella, varicella, Haemophilus influenza type b (Hib), pertussis, tetanus, pneumococcal disease, meningococcal disease, human papillomavirus (HPV), or hepatitis B, regardless of whether the minor’s parent or guardian consents to the administration of the immunizing agent, vaccine, or booster shot. New York also proposed a similar bill last year. The latest bill making waves is one that comes out of Washington D.C. Before we look at that bill, let us look at how a bill becomes a law in a federal district, which is somewhat different to the legislative process in a state.

How does a Bill Becomes a Law in Washington D.C.?

Because D.C. is not a state, their process differs from that of how a bill becomes a law in a state in the United States. Some big differences are that the DC City Council doesn’t have two chambers, and their bills must also be reviewed by congress. Let’s step through the whole process.

First, a bill is introduced by an elected member of the D.C. Council. The District’s Charter allows the Mayor to introduce bills before the Council as well, but no one else can introduce legislation within the district. After a bill is introduced, it is assigned to a committee. The committee is under no obligation to take the bill up, and if it does not take it up in the two year period the Council is convened, the bill dies. If it is taken up, the committee holds hearings on the bill, makes any changes they see fit, and votes to see if it should be presented to the thirteen members of the Council. If it is passed out of committee, the bill is considered by a special committee comprised of all 13 members of the Council where they will “agendize” the bill. This committee is called the Committee of the Whole, or “COW”.

The COW will then have one or two votes on the bill. If the bill is passed during its first reading, it is put on the agenda again for the next Council legislative meeting at least 14 days after the meeting where the bill passed. If it does not pass the first reading, it is dead. If the bill is approved a second time, it goes to the Mayor for their consideration. If it is not passed the second time, the bill dies.

During the Mayor’s review of the bill, the Mayor may take one of three actions: 1) sign the legislation; 2) allow the legislation to become effective without their signature; or 3) veto the legislation. If a Mayor vetoes the bill, the Council can decide if they want to reconsider the legislation. The COW must approve the bill by two-thirds vote to override the Mayor’s veto; if not, the bill dies. If Mayor either approves the legislation, allows it to become effective without their signature, or the Council overrides a Mayoral veto, the legislation is assigned an Act number. But we’re not done yet.

After the bill becomes an Act, it is sent to the United States House of Representatives and the United States Senate for a waiting period of 30 days before if can become a law. Congress may enact into law a joint resolution disapproving the Council’s Act during this period. If the President approves the joint resolution opposing the Act during the review period, the Council’s Act is prevented from becoming law. If the President does not approve the resolution before the congressional review period is over, or no joint resolution disapproving the Council’s Act is passed, the bill finally becomes a law and is assigned a law number.

Here is a diagram of this process from the Council of the District of Columbia.

What the Minor Consent for Vaccinations Amendment Act says.

The “Minor Consent for Vaccinations Amendment Act” would allow children 11 and older to decide if they want to be vaccinated. Doctors would be required to ensure each child is “capable of meeting the informed consent standard.” To assist in this, the Department of Health would provide age-appropriate information about vaccines. Informed consent is the “communication between a patient and physician which results in the patient’s authorization or agreement to undergo a specific medical intervention.” Basically, it is ensuring that a patient understands medical procedures and treatments, the side effects, and knowing this, consents to the treatment.

Under the legislation, if a doctor determines a minor is capable of informed consent, they would be able to seek vaccinations recommended by the United States Advisory Committee on Immunization Practices even if the minor’s parents object to vaccinations on religious grounds. The bill also requires the doctor send the vaccination record in such cases to the child’s school, rather than to the parents. Doctors must seek compensation for the vaccinations directly from the insurance company without involving the parents.

Status of the Minor Consent for Vaccinations Amendment Act.

On October 20th, 2020 the D.C. Council (COW) passed the bill in a 12-to-1 vote and it was sent to the Mayor with a response due Dec 22. The Mayor chose not to act so the bill was assigned an Act Number, A23-0532 on Dec 23, and it was published in the DC Register  on Dec 24 starting the clock for Congress to object. As of the writing of this post Congress has not taken any action.

Conclusion

There is no doubt in my mind that people should be vaccinating their children. I do wonder what kind of future this legislation and this idea has. On one hand, the diseases childhood vaccines are meant to prevent are most likely to occur when a child is very young and the risk of complications is greatest. If you cannot get these vaccinations when you are young and they have the greatest probability to protect you, does that mean it’s all for naught? On the other hand, I have friends that were not vaccinated when they were children and chose to get vaccinated the day they turned 18, who would have gotten vaccinated sooner had they had the option. I guess sooner is better than later, and later is better than not at all.

The other item to think about with this entire issue is that not only are parents able to endanger their child’s life based off inaccurate and misleading information, but they are also endangering the public at large. Universal immunization is a public good. When people who choose to not vaccinate for personal reasons participate in other public goods (eg public school, day care, summer camp) they need to immunize their children so all children are protected. If we allow for parents to choose not to immunize their children for nonmedical reasons, should they also have the right to these public goods where their uninformed decisions could have deadly consequences for others?

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