We’ve come a long way since the early days of the COVID-19 pandemic. After 16 months of hand sanitizing and mask-wearing, there are now three vaccines—Pfizer-BioNTech, Moderna, and Johnson & Johnson/Janssen—in use protecting individuals from serious COVID-19 illness in the U.S. However, only one, Pfizer, is available to anyone 12 years and older.
As summer winds down and the Delta variant is causing some regions to reinstate mask and social distancing policies, even among the vaccinated, conversations about mask and vaccine mandates in schools and the workplace are growing louder—especially among people under the age of 18. Many teenagers are focused on how and where to get their vaccines, while others are wondering if they should (or even can) disobey parents or guardians who are weary of the relatively new vaccine that has yet to receive full approval from the Food and Drug Administration (FDA). (It’s currently only approved for Emergency Use Authorization [EUA], which means the FDA is allowing the use of these new and unapproved vaccines due to the potentially life-threatening consequences of COVID-19, but it doesn’t mean the vaccines are unsafe or won’t be fully approved in the future.)
But can people between the ages of 12 and 18 still get a vaccine, even if their parents or guardians aren’t on board? The answers are more legally and ethically nuanced than your average teenage rebellion, so let’s break it down even further.
Do teens really need to get vaccinated?
The short answer is yes. The CDC recommends anyone 12 years and older be vaccinated to protect themselves and others against COVID-19. Of course, there are always exceptions. Individuals with specific pre-existing conditions may be cautioned against receiving the vaccine—at least for now. But for those whose doctors give the green light, getting vaccinated is worth a sore arm (one of the most common side effects).
Arthur Caplan, the founding head of the Division of Medical Ethics at NYU School of Medicine in New York City, acknowledged that younger people are less likely to become severely ill as a result of COVID-19, but still urged caution. “They do face risks that can be serious, if rare, and we don't really understand the effects of mild or non-symptomatic infection in that younger group,” he told VICE. He said the long-term effects of COVID-19 are more concerning than potential long-term effects from the vaccine.
Caplan brought up another important point about whether it’s necessary for teens to be vaccinated: not being vaccinated could interfere with their education. Not all college students are 18 years and older and a recent report found that 588 colleges and universities across the country will require students be vaccinated in order to enroll in classes. This may change how and where you continue your education as well as your parent or guardian’s thoughts on vaccination.
What are the rules for minors getting vaccinated in each state?
The rules for minors vary depending on where you live. According to the Kaiser Family Foundation, 41 states require the consent of a parent or guardian for minors under 18 years old (in Nebraska, it’s age 19 and below). There are some notable exceptions: minors who are emancipated, unhoused, married, or living apart from their guardians can self-consent in many states. Some cities, like San Francisco and Philadelphia, allow minors 12 and older to self-consent, and Arizona allows a minor or their doctor to take the case to court if a parent refuses to consent.
Outside of those 41 states, things are more nuanced. In four states, a minor’s right to self-consent is age-dependent: In Rhode Island and South Carolina, you must be at least 16. In Oregon and Alabama, the age is 15 and 14, respectively. If you are at least 11 years old, you can self-consent in Washington D.C., but your healthcare provider is allowed to impose additional requirements and could insist your guardian is present.
The remaining five states—Arkansas, Idaho, North Carolina, Tennessee, and Washington—apply something called the “mature minor doctrine,” giving healthcare providers leeway in deciding whether a minor should be vaccinated without parental consent. In these states, a doctor would ask you questions about your interest in getting the vaccine to determine whether or not they should give it to you; if they won’t, there is nothing stopping you from checking with a different doctor. Depending on your circumstances, you might want to have this conversation alone with the doctor, or with the support of another adult or even an older sibling.
What do I do if my parents won’t give me permission to be vaccinated?
If your state or city requires that your parent or legal guardian consent, you still have options. All of the legal and health experts interviewed for this article said that before hitchhiking across state lines, you should explain to your parents why you want to be vaccinated—and even back up your decision with research from reputable sources. The experts said that vaccine hesitancy largely stems from the fact that all approved COVID-19 vaccines are still under emergency use authorization, so they expect many people to change their minds once the vaccines are fully approved by the FDA.
Jessica Malaty Rivera, an infectious disease epidemiologist and science communication lead for the COVID Tracking Project, told VICE that minors should keep the vaccine conversation going in a way that’s loving and respectful. On minors making their case for vaccination, she said, “[t]his to me doesn't seem like a rebellious thing that would be harmful. If anything, it's just a misunderstanding on the side of the parents and the kids on everything from risk to tolerance of risk.” Even if you’re prepared for a fight, try to remember that yelling will likely only hurt your case.
Caplan encouraged bringing in outside support to help win over your parents or guardians, like family friends who are already vaccinated, your family doctor or nurse, or even a religious leader from your community. “Many people think religions are opposed to vaccination but they’re not,” Caplan said. “Religions support vaccination as a community good, and I think, if you have that connection, you might be thinking about going to talk to your rabbi, priest, minister, or imam.”
If they still won’t agree after all this, you still have safe and legal options.
Only one of my parents approves. Can I still get vaccinated?
You may know that it’s fairly common for kids to go to the doctor with only one of parent or guardian there. That’s because children with parents or guardians that are married or in a relationship—and do not have a custody order—only need one person’s consent. Juanita Guillen-Mellman, a lawyer in San Diego, told VICE, “If I take my child to get vaccinated for the chickenpox, I don't need to provide anything to the doctor or when I'm scheduling confirming that my husband consents to that.”
But don’t take her anecdote as permission to pit one parent against the other. Even if consent of both parents or guardians who are married is not legally required, generally speaking, Guillen-Mellman believes that they would ideally work together to make informed decisions about your health. If they can’t come to an agreement, you and your consenting parent would need to discuss whether you’ll get it anyway, and come up with a plan for how to tell your other parent. It’s worth considering that leaving one parent in the dark about something as important as a vaccine could lead to bigger problems between your parents, or even prompt one parent to take legal action.
My parents are divorced and one of them is anti-vax. Can I still get vaccinated?
Parents and guardians who are not together likely have a formal custody agreement in place, and that agreement will include details about medical decision-making. Morgan Fraser Mouchette, a matrimonial and family attorney in New York City, explained that until the COVID-19 vaccines are mandated the way vaccines like the measles and polio vaccines are, “the custodial parent would be the parent, presumably, to decide whether or not a child is vaccinated.” She also doubts that, during this “gray period” of vaccine approval, a judge would look the other way if your non-custodial parent violated their custody agreement by taking you to be vaccinated. So, if your mom is the parent who gets to make major decisions about your health and won’t allow you to be vaccinated against COVID-19, it’s unlikely you’ll be able to get vaccinated right now, even if your other parent wants to take you.
However, when the vaccine is formally approved by the FDA, and if it becomes, say, a requirement to attend school, Mouchette believes that, in general, it will be more difficult to opt out of the vaccine, even if the parent who won’t consent to the vaccine is the custodial parent. “Most judges will look at the actual rationale that each party has for why they think this child should be vaccinated or unvaccinated, the recommendation of the CDC, statements by the FDA, the requirements of a child’s school and the recommendation of the child's treating pediatrician, for example,” she said.
Most divorced or separated parents and guardians will work with a third party mediator or parenting coordinator to help them meet in the middle. This also creates an opportunity for you to make your case—to your guardians, the third-party, or even a judge—for being vaccinated against COVID-19. If it comes to this, you and the parent who agrees to the vaccination should consult with their lawyer or social worker to figure out next steps. But you’ll need to be patient; because of the pandemic, courts are behind and it could take months to get time with a judge.
Can another adult give consent for my vaccine?
Yes and no. It’s possible that you have more than two guardians—for example, if you have a step- or adoptive parent who also has legal decision-making rights, or in some cases another relative. But again, their ability to consent would be based on legal custody agreements.
It’s in the best interest of all healthcare providers to ensure that the person signing a consent form is legally permitted to do so because it is their license on the line. That’s not to say that some clinics won’t be more lax about this in the interest of getting as many people as possible vaccinated, but they will be entering precarious territory, both ethically and legally, so they will probably be pretty strict about this. If you’re considering forging your parent’s signature, know that this isn’t like a school field trip or a bad report card. The stakes are higher, and a healthcare professional will most likely require that your parent is present if their consent is necessary.
My state requires parental consent, but the next state over doesn’t. Can I travel to a state with different requirements to get vaccinated?
Policies and best practices are still catching up with the COVID-19 vaccine. At this point, a minor can legally travel to a different city or state where they are eligible for the vaccine. There are 24 states that do not require proof of residency to be vaccinated there, and another 25 permit individuals who work in the state to also be vaccinated there. It’s not unheard of for a person to live in one state and work in another, even if that person is under 18, so this is an option worth exploring.
But this isn’t a decision to be made lightly and there are many caveats, especially in a country that loves lawsuits as much as the United States. Guillen-Mellman offered an example: “Let's say that I am 13 and I go to Washington to get the vaccine and it's determined that I'm mature enough to make this decision. Well, my parents, when I come back to California, are probably going to be really upset. So is it illegal for minors to travel to another state and do this? I haven't come across anything that says that. However… if I were the doctor, I would be very concerned that this minor from a different state has traveled to come and see me specifically for this.”
There’s also the question of transportation. If you don’t have your license or access to a car, getting to another state for your appointments—because, remember, the Pfizer vaccine requires two doses at least 21 days apart— might mean you’re entangling a friend, aunt or uncle, Uber driver, or train conductor in your inter-state adventure. Still, Guillen-Mellman doubts that the person transporting you (a minor) across state lines is opening themselves up to any legal or civil liability because it’s not their job to make sure you get vaccinated or not.
Do I need to tell my parents I was vaccinated?
You’re under no obligation to tell your parents or guardian you were vaccinated, but the truth isn’t likely to stay hidden for long. Side-effects from the vaccine might give the game away pretty easily. But there are other ways for your parents to come upon this information. For example, as a minor, your legal guardian can access your medical records, which will include proof of vaccination, and the healthcare provider who administered your vaccine could be compelled by a judge to inform your guardian.
Then there’s the possibility that the COVID-19 vaccine is made mandatory while you’re still a minor, and you’ll need to explain how you’re already vaccinated. Depending on your parents’ reason for not wanting you to be vaccinated, this could be a minor hiccup or an all-out fight. This is something to be especially careful about if you live in a household where fights can turn physical or if you generally feel unsafe. To be clear, such a situation is expressly not your fault, but it’s reasonable to think about protecting yourself (and if this is the case, know that there are organizations whose priority it is to keep kids safe).
When asked for her take, Rivera, the epidemiologist who is also a mother of two, said, “I would never compel a minor to defy their parents in that way. But I also think that in situations like this, I believe a 16 or 17 year old should be able to make that choice on their own.” But if you can legally get vaccinated somehow without your parents’ permission, we do recommend looking at all the possible outcomes before moving forward with your vaccination.
I still can’t get vaccinated. Now what do I do?
No matter the reason, if you’re unvaccinated, you should operate out of an abundance of caution. This means, according to Rivera, “always wearing your mask, keeping your physical distance, [and] being very mindful of hand hygiene because that’s, at the very least, what you can do to prevent your own infection and infection of other people around you.”
The other thing you can do is to continue making the case for being vaccinated—and try to get to the root of why your parents or guardian don’t agree. Vaccine hesitancy can stem from something as benign as FDA approvals or as extreme as conspiracy theories that the government is inserting microchips into our arms to track our movements (they aren’t).
These situations won’t improve if other states adopt policies similar to the Tennessee Department of Health, which recently abandoned all vaccine outreach to minors and scrubbed their website and materials of the subject. So following experts like Rivera, who uses her platform to share up-to-date studies and debunk disinformation, on social media, and Vaxteen, which houses a bevvy of information on the rules for all vaccines, as well as staying up to date on the latest CDC and FDA guidelines for the vaccine are some of the best ways to change minds.
The COVID-19 vaccine is likely to be a turning point for who can make decisions about a person’s health. Caplan believes that the age of consent for vaccines requires fresh eyes and better data. “They’re not really linked up to psychological data. It’s not like somebody said we’re going to make it 14 [years-old] because we’ve looked at the studies… That tells me that strict age cut-offs don’t make sense and I would like to see them challenged in court.”
While you wait for legislation to change, spend time informing yourself and exploring your safe and legal options for getting this vaccine.
Follow Suzanne Zuppello on Twitter.