Amy Maxmen | (TNS) KFF Health News
Gayle Borne has provided care for more than 300 children in Springfield, Tennessee. She has looked after kids who have hardly ever seen a doctor – kids who are so neglected that they are unable to speak. These children are now even more at risk because of a law that Tennessee passed last year. This law demands the direct permission of birth parents or legal guardians for every routine childhood vaccination. Foster parents, social workers, and other caregivers are not allowed to give permission.
In January, Borne took a foster baby, born extremely premature at just over 2 pounds, to her first doctor's appointment. The health providers said that without the consent of the child's mother, they couldn't vaccinate her against diseases like pneumonia, hepatitis B, and polio. The mother has not been found, so a social worker is now seeking a court order to allow immunizations. “We are just waiting,” Borne said. “Our hands are tied.”
Tennessee's law has also hindered grandmothers and other caregivers who accompany children to routine appointments when parents are at work, in drug and alcohol rehabilitation clinics, or otherwise unavailable. The law asserts to “give parents back the right to make medical decisions for their children.”
Framed in the language of choice and consent, it is one of more than a dozen recent and pending pieces of legislation nationwide that pit parental freedom against community and children’s health. In reality, they create obstacles to vaccination, the basis of pediatric care.
Such policies have another effect. They sow doubt about vaccine safety in a climate full of medical misinformation. The trend has grown rapidly as politicians and social media influencers make false claims about risks, despite studies showing otherwise.
Traditionally, doctors provide caregivers with vaccine information and obtain their approval before administering over a dozen childhood immunizations that protect against measles, polio, and other debilitating diseases.
But now, Tennessee’s law requires birth parents to attend routine appointments and sign consent forms for every vaccine given over two or more years. “The forms could have a chilling effect,” said Jason Yaun, a Memphis pediatrician and past president of the Tennessee chapter of the American Academy of Pediatrics.
“People who advocate for parental rights on vaccines tend to diminish the rights of children,” said Dorit Reiss, a vaccine policy researcher at the University of California Law-San Francisco.
Drop in Regular Vaccine Rates
Misinformation along with a parental rights movement that shifts decision-making away from public health expertise has contributed to the lowest childhood vaccine rates in a decade.
This year, lawmakers in Arizona, Iowa, and West Virginia have introduced related consent bills. A “Parents’ Bill of Rights” amendment in Oklahoma aims to ensure that parents are aware that they can exempt their children from school vaccine mandates along with lessons on sex education and AIDS. In Florida, the health department's leader, who doubts medical advice, recently disobeyed advice from the Centers for Disease Control and Prevention by informing parents they could send unvaccinated children to a school during a measles outbreak.
Last year, Mississippi started allowing exceptions from school vaccine requirements for religious reasons due to a lawsuit funded by the Informed Consent Action Network, which is mentioned as a leading source of anti-vaccine false information by the Center for Countering Digital Hate. A post on ICAN’s website said it “could not be more proud” in Mississippi to “restore the right of every parent in this country to have his or her convictions respected and not trampled by the government.”
Even if some bills fail, Reiss fears, the revived parental rights movement may eventually abolish policies that require routine immunizations to attend school. At a recent campaign rally, Republican presidential candidate Donald Trump said, “I will not give one penny to any school that has a vaccine mandate.”
The movement dates to the wake of the 1918 influenza pandemic, when some parents pushed back against progressive reforms that required school attendance and prohibited child labor. Since then, tensions between state measures and parental freedom have occasionally flared over a variety of issues. Vaccines became a prominent one in 2021, as the movement found common ground with people skeptical of COVID-19 vaccines.
“The parental rights movement didn’t start with vaccines,” Reiss said, “but the anti-vaccine movement has allied themselves with it and has expanded their reach by riding on its coattails.”
When Lawmakers Silence Health Experts
In Tennessee, anti-vaccine activists and libertarian-leaning organizations criticized the state’s health department in 2021 when it advised COVID vaccines to minors, following CDC guidance. Gary Humble, executive director of the conservative group Tennessee Stands, asked legislators to criticize the health department for advising masks and vaccination, suggesting the department “could be dissolved and reconstituted at your pleasure.”
Backlash also followed a notice sent to doctors from Michelle Fiscus, then the state’s immunization director. She reminded them that they didn’t need parental permission to vaccinate consenting adolescents 14 or older, according to a decades-old state rule called the Mature Minor Doctrine.
In the weeks that followed, state legislators threatened to defund the health department and pressured it into scaling back COVID vaccine promotion, as revealed by The Tennessean. Fiscus was abruptly fired.“Today I became the 25th of 64 state and territorial immunization program directors to leave their position during this pandemic,” she wrote in a statement. “That’s nearly 40% of us.” Tennessee’s COVID death rate climbed to one of the nation’s highest by mid-2022.
By the time two state legislators introduced a bill to reverse the Mature Minor Doctrine, the health department was silent on the proposal. Despite obstacles for foster children who would require a court order for routine immunizations, Tennessee’s Department of Children’s Services was silent, too.
Notably, the lawmaker who proposed the bill, Republican Rep. John Ragan, was also involved in a review of the organization that would decide its leadership and budget for the upcoming years. Ragan stated during a meeting in April 2023 that “Children belong to their families, not the state.” state hearing in April 2023.
Democratic Rep. Justin Pearson voiced opposition to the bill, expressing that it overlooks neglected people and children. He pointed out to Ragan, “We are legislating from a position of privilege and not acknowledging those who are not privileged in this way.”
Instead of addressing such concerns, Ragan referred to a Supreme Court ruling in favor of parental rights in 2000. Specifically, judges decided that a mother had the legal authority to determine who could visit her daughters. However, the Supreme Court has also ruled in the opposite manner. For instance, it ruled against a legal guardian who took her child out of school to spread the beliefs of the Jehovah’s Witnesses. Still, Ragan quickly secured the majority vote. Tennessee Gov. Bill Lee, a Republican, promptly signed the bill, making it effective immediately. Deborah Lowen, who was the deputy commissioner of child health at the Department of Children’s Services at the time, received numerous calls from doctors who now face jail time and fines for vaccinating minors without sufficient consent. “I was and remain very disheartened,” she said. A Right to Health Yaun, the Memphis pediatrician, said he was shaken as he declined to administer a first series of vaccines to an infant accompanied by a social worker. “That child is going into a situation where they are around other children and adults,” he said, “where they could be exposed to something we failed to protect them from.”
“We have had numerous angry grandparents in our waiting room who take kids to appointments because the parents are at work or down on their luck,” said Hunter Butler, a pediatrician in Springfield, Tennessee. “I once called a rehabilitation facility to find a mom and get her on the phone to get verbal consent to vaccinate her baby,” he said. “And it’s unclear if that was OK.” in MayChildhood immunization rates have
dropped for three consecutive years
in Tennessee. Nationwide, declining trends in measles vaccination
led the CDC to estimate
that a quarter million kindergartners are at risk of the highly contagious disease. Communities with low vaccination rates are vulnerable as measles surges internationally. Confirmed measles cases in 2023 were almost double those in 2022 — a year in which the World Health Organization estimates that more than 136,000 people died from the disease globally. When travelers infected abroad land in communities with low childhood vaccination rates, the highly contagious virus can spread swiftly among unvaccinated people, as well as babies too young to be vaccinated and people with weakened immune systems. “There’s a freedom piece on the other side of this argument,” said Caitlin Gilmet, communications director at the vaccine advocacy group SAFE Communities Coalition and Action Fund. “You should have the right to protect your family from preventable diseases.”
In late January, Gilmet and other advocates for children's health met in a room at the Tennessee Statehouse in Nashville, providing a free breakfast of fried chicken biscuits. They gave out flyers as legislators and their assistants came in to eat. One brochure explained the impact of a measles outbreak in Washington state in 2018-19 that affected 72 people, most of whom were not vaccinated, resulting in $76,000 in medical expenses, $2.3 million for the public health response, and an estimated $1 million in economic losses due to sickness, quarantine, and caregiving. toll of a 2018-19 measles outbreak in Washington state that sickened 72 people, most of whom were unvaccinated, costing $76,000 in medical care, $2.3 million for the public health response, and an estimated $1 million in economic losses due to illness, quarantine, and caregiving.
Barb Dentz, a supporter with the grassroots group Tennessee Families for Vaccines, reiterated that most of the residents of the state are in favor of strong policies supporting immunizations. In fact, seven out of ten U.S. adults believed that public schools should mandate vaccination against measles, mumps, and rubella, according to a
Pew Research Center poll Pew Research Center poll last year. But the numbers have been declining.
last year. But numbers have been dropping. “Safeguarding kids should be such an obvious choice,” Dentz informed Republican Rep. Sam Whitson later that morning in his office. Whitson concurred and thought about the increasing spread of false information about vaccines. “Dr. Google and Facebook have been quite a challenge,” he remarked. “Fighting ignorance has become a full-time job.” Whitson was one of the few Republicans who voted against Tennessee’s vaccine amendment last year. “The parental rights thing has really taken hold,” he stated, “and it can be used for and against us.”
KFF Health News
, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of
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(— the independent source for health policy research, polling and journalism.)©2024 KFF Health News. Distributed by Tribune Content Agency, LLC. KFF Misinformation coupled with a parental rights movement that shifts decision-making away from public health expertise has contributed to the lowest childhood vaccine rates in a decade.
©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.
