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.
Vinay, Excellent piece. Probably the part that most needs retelling is that the CDC and the FDA and the NIH are all entirely unreliable and cannot be trusted, at all, for anything. The FDA is even worse than the CDC if such a thing can be believed. At least the CDC still meets its expert committees, not that those meetings have any value.
If judges understood that this is all a sham, they would come down more often on the side of "the right decision". You are in California -- under 2098 what you just wrote will cost you your license. You should write about that, too. We need to change the general societal understanding of how badly everyone has been had by corrupt bureaucracy to make decisions like this, often decided by the courts, be more correct, more often.
You have the forum and I am thrilled when you use it. But a frontal assault on the disseminators of misinformation, and I specifically mean the White House, the CDC, the FDA and the NIH will have to be won before the underlying social pressures that are going to kill some number of children have the proper denouement. So please...more of that.
I appreciate this piece, Dr. Prasad. My brother was in exactly this predicament with his ex-wife; my brother did not want the children to have the Covid vax, but their mom decided that the 8 and 10 year olds should make this decision (they both got the vaccine due to peer pressure). I throughly agree with you, that under 12s should not make this decision.
I question the assumptions here - "Ultimately, parents who don't get their way...should feel some solace that the decision is not that important in the grand scheme of life." This assumes the short- and long-term risks are extremely minimal. Can we really be sure of that? What if there are long-term risks, that will show up in 5-10 years? Has anyone done a thorough study on the short term risks in children? (E.g. more studies like the Thailand study, which found additional cardiovascular risks when they bothered to look.) Until these vaccines are proven safe, how do we know that myocarditis is the only risk?
Given that the effectiveness in healthy children is questionable, and we are lacking important safety studies, I don't think we can assume them to be safe NOR effective in children.
I am not a doctor, but until we know the safety and effectiveness, I would think we need to lean on no intervention (first, do no ham).