Two divorced parents can't decide on kids vaccination

How should we decide?

Throughout the COVID-19 pandemic, I've been asked to weigh in on legal cases. I have never done so. I have no interest in litigating scientific or public health matters in an arena that I view as incapable of adhering to the highest levels of scientific thinking. Asking a court to make a medical decision is like asking a butcher to repair your car.

But one question comes up often in my inbox, and I thought a bit about it. What happens when two parents, typically, but not always, divorced, can't agree on vaccinating kids?

In order to think clearly about this issue, I think we have to put it in perspective. Let's consider a healthy child between the ages of 6 months to 18 years old. The truth is across all these ages, the risk of COVID-19 is very low. Sero prevalence is very high. You put those facts together, and the upper bound absolute risk reduction for anyone facing this choice is very small. It's so small, that I wouldn't lose sleep over it.

Having said that, the first way I think we can solve this conundrum applies to older kids. I don't have the magic number, but, above some age, kids should have some say in their own health care choices. Not complete say (no!), but some say. This decision falls squarely within the 'some say’ category for older kids. So if the parents can't decide, and the kid is 16, they should be the tiebreaker. Of course, this doesn't apply if the kid is five.

Ironically, the kids with the greatest COVID-19 risks and those who face the highest risks of vaccine induced myocarditis (teenage boys, it is rare prepubescent) are also those most suited to weigh in on the decision to vaccinate themselves. Risk rises with age, and the lowest risks from the virus are among three to eight-year-olds.

Of course there will always be situations where one parent may have an undue influence on a teenage child, and that parent may coerce the child to their point of view. But the sad reality is this is true for everything that happens to an adolescent, including much more consequential things. Like who they hang out with, how late they stay out, and what they do. In the grand scheme of a teenager's life, this decision is hardly the most important.

Now what about younger kids? Kids too young to have an opinion themselves. In my mind, this would be the vast majority of kids under the age of 12.

My general view is: given that the sero prevalence is so high in this age group, the possibility to benefit a child who already had and recovered from COVID-19 is so low, the absolute risks are astonishingly low, and many European nations have not aggressively pursued vaccination in this age group, citing unknown unknowns-- The default should be *not* to vaccinate unless both parents agree.

My view is different for other medical interventions. Show me a child who needs a liver transplant, facing imminent death, and I would argue you only need the consent of one parent, or perhaps no parent at all. For interventions with clear and demonstrable efficacy, large effect size, my standard would be different. But this simply isn't one of those decisions. This is really the kind of decision both parents should agree with.

The unintended consequence of my policy would be that parents use vaccination as a bargaining chip for other divorce proceedings. This would be an unfortunate unintended consequence, but one that can be anticipated. Insofar as is possible, to limit this, I would ask for parents to state in writing at the earliest opportunity their preference for vaccinating children, so that they cannot waffle later. I also suspect that this concern can be extended to many other points of negotiation in a divorce proceeding.

Ultimately, parents who don't get their way-- in either direction-- should feel some solace that the decision is not that important in the grand scheme of life. They should be careful that they are not transferring their anxiety about other life challenges to this decision, giving it false grandeur and importance.

I don't know, but I suspect, most judges don't see it this way. That's because they don't know anything about medicine. They merely know the curated medicine that they get from places like the CDC. Once upon a time that agency was competent. Those days are over. The agency is entirely incompetent. I wouldn't trust their opinion on anything. If there's ever a new plague, I will have to read everything myself. Can't trust those people. Many may still be working from home with their n95 on. If MMWR is reflective of their quality of their work: It's clear. They're doing a terrible job. Meanwhile, judges probably defer to them.

I don't claim to be Solomon, but this is how I would sort this issue. It isn't perfect, but nothing ever is when it comes to these types of interpersonal disputes. You may disagree. Good, I'd love to read some other thoughts. But this is what you get on Vinay Prasad's observation and thoughts. You can't claim false advertising.