How the anti-vaccine movement pits parental rights against public health
Gayle Borne has fostered more than 300 children in Springfield, Tennessee. She's cared for kids who have rarely seen a doctor — kids so neglected that they cannot speak. Such children are now even more vulnerable because of a law Tennessee passed last year that requires the direct consent of birth parents or legal guardians for every routine childhood vaccination. Foster parents, social workers, and other caregivers cannot provide 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 hasn't been located, so a social worker is now seeking a court order to permit immunizations. “We are just waiting,” Borne said. “Our hands are tied.”
Tennessee's law has also stymied 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 claims to “give parents back the right to make medical decisions for their children.”
Framed in the rhetoric 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 actuality, they create obstacles to vaccination, the foundation of pediatric care.
Such policies have another effect. They seed doubt about vaccine safety in a climate rife with medical misinformation. The trend has exploded as politicians and social media influencers make false claims about risks, despite studies showing otherwise.
Doctors traditionally give caregivers vaccine information and get their permission before delivering more than a dozen childhood immunizations that defend against measles, polio, and other debilitating diseases.
But now, Tennessee's law demands that birth parents 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 promote parental rights on vaccines tend to downplay the rights of children,” said Dorit Reiss, a vaccine policy researcher at the University of California LawSan Francisco.
Drop in Routine Vaccination Rates
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.
This year, legislators in Arizona, Iowa, and West Virginia have introduced related consent bills. A “Parents' Bill of Rights” amendment in Oklahoma seeks to ensure that parents know they can exempt their children from school vaccine mandates along with lessons on sex education and AIDS. In Florida, the medical skeptic leading the state's health department recently defied guidance from the Centers for Disease Control and Prevention by telling parents they could send unvaccinated children to a school during a measles outbreak.
Last year, Mississippi began allowing exemptions from school vaccine requirements for religious reasons because of a lawsuit funded by the Informed Consent Action Network, which is listed as a leading source of anti-vaccine disinformation 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 railed against the state's health department in 2021 when it recommended COVID vaccines to minors, following CDC guidance. Gary Humble, executive director of the conservative group Tennessee Stands, asked legislators to blast 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.