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Alabama is now requiring parental consent before giving vaccines to school-age children at state-run clinics inside public schools, a change that could slow the vaccination rate in a state already trailing the nation.
The Alabama Department of Public Health has limited vaccine availability to teens in some school clinics after legislators complained about teens getting COVID shots without parental permission.
The new policy, crafted quietly in the middle of the summer, isn’t likely to violate state law, which permits children older than 14 to consent to routine medical treatment. But experts and physicians say it could severely limit where teens can get vaccinated and slow Alabama’s efforts to stem the pandemic.
“With all the controversy with the COVID vaccine now, we’ve definitely seen a spike in just the overall refusal of all vaccines -- and this has been in the past six months especially,” said Dr. Wayne Melvin, a pediatrician in north Alabama. “We’ve had several kids that wanted to get the COVID vaccine but the parents did not, so the kids took it at school.”
Assistant State Health Officer Dr. Karen Landers told AL.com that ADPH had heard “concerns in regards to vaccinating minors being reported” and instituted the policy after holding “internal discussions” in late June and early July.
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Landers said the reported concerns came from legislators, and not directly from parents. She did not name the legislators, but a bill already has been pre-filed by Rep. Chip Brown, R-Mobile, that would require parental consent for COVID-vaccines.
ADPH’s updated policy states that “the Alabama Department of Public Health (ADPH) requires parental consent for COVID-19 vaccine. Persons 12 years of age and above are eligible for COVID-19 vaccine, and parents must consent for a vaccine for persons under 19 years of age, unless the person meets state requirements for an emancipated minor.”
The policy applies only to ADPH clinics and outside clinics, such as some school vaccination sites, where ADPH workers administer the COVID-19 vaccine to children. It does not apply to private physicians or any other entities.
The change came this summer, about a month after Alabama Gov. Kay Ivey signed a bill in May that prohibited private businesses and public institutions from requiring COVID-19 “vaccine passports” that would bar a person from services.
“Gov. Ivey continues to encourage Alabamians who are eligible to receive the COVID-19 vaccine to talk to their doctor to make the best decision,” said Gina Maiola, Ivey’s press secretary. “In the case of a minor, parents not only have a right to be involved in decisions affecting their child’s health, but should be.”
The policy is internal and is not published anywhere on ADPH’s website. ADPH did not send any announcements to schools, according to Landers.
“If ADPH provides the clinic for the school, ADPH follows its vaccine administration policy related to consent,” Landers said. “Schools did not receive the policy as they are not the entity administering the vaccine.”
Who’s impacted?
It’s unclear how school clinics that require parental consent could be impacted by a new White House COVID-19 plan released Thursday, but schools can expect stiffer regulations and additional support for testing and vaccinations in schools.
Alabama Superintendent Eric Mackey said at a work session Thursday that he had gotten questions about parental consent and Alabama’s medical minor consent law. He said ADPH’s policy added a layer on top of the state’s minor law to require school-based clinics working in conjunction with ADPH to get parental consent.
“Our rate of student vaccinations even among students aged 12 to 17 is just extremely low, extremely low,” Mackey said. “I’m personally more concerned about adults, to be honest with you. We have had children now—and I said we’ve had children pass away, we’ve had children in serious condition at Children’s Hospital, and so I do worry about children. But there’s many more complications among adults who are unvaccinated, and so I’m really struggling with why we have any adults that work in our schools that are not vaccinated.”
Here’s where you can find Alabama school COVID cases, by district and week.
Alabama trails most of the nation in vaccination rates, just grazing past Wyoming, which holds last place at 39.8 percent. As of Saturday, 39.9 percent of Alabama’s population was fully vaccinated, according to the latest figures from the Centers for Disease Control and Prevention.
School vaccination clinics have been key in getting students -- and sometimes whole communities -- vaccinated. Some schools work with outside providers or area hospitals to administer vaccines, while others work directly with ADPH.
As of mid-summer, only schools that work with ADPH can require students to get parental permission to get the COVID-19 vaccine. It’s unclear how many school districts or future clinics the restrictions may affect.
Some worry the policy could limit options for students who might disagree with guardians about their health decisions.
This summer, ADPH worked with a handful of northeast Alabama schools to administer vaccines to children. In Clay County, ADPH nurses administered vaccines to children at a school clinic in August, about a month after the new policy was instituted. Those students each had to turn in parental consent forms.
In Bessemer last spring, a school board member brought his 16-year-old granddaughter Amiya Jones, a junior at the city’s high school, to get vaccinated at a school clinic.
Jones, who was learning remotely at the time, said she was happy the shot was offered at school.
“I just wanted to get vaccinated to keep myself and others protected and safe,” she told AL.com in April.
But not all guardians have been supportive of school vaccination efforts.
In another north Alabama district, some parents “pitched a fit” when their older children were able to get vaccinated at a school clinic without their permission, said Melvin, the pediatrician.
Because the schools were working with an area hospital instead of the health department, students older than 14 who wished to get vaccinated without a parent’s permission were protected under the state’s medical minor consent law, which allows children ages 14 and up to consent to routine medical treatment.
Melvin hadn’t heard of the policy change until an AL.com reporter notified him of it. But he said he’s seen how the law protects children who might have differing opinions from their parents.
“I think that if a kid wants to get it and if they’re over 14 and can make that decision themselves -- they’re smart enough to do that -- I think that’s a good thing,” he said.
Legal implications
Brian Abramson, a vaccine law professor at Florida International University, said that it’s unlikely the policy can be challenged successfully in court.
The executive department in a state has the ability to impose restrictions that are directed toward addressing an emergency, Abramson said, “although this sounds like something that’s kind of going in the opposite direction of addressing the emergency.”
It’s also within the power of the state to say that the physicians or other vaccine administrators who are employed by the state can have limitations on who they’re able to dispense the vaccine to, said Abramson.
But if a mandate spanned private businesses and required other non-state entities to bar minors from getting vaccinated without parental consent, that’s a different story.
“Each state has its own ability to kind of engage in the police power of protecting this population from contagious disease,” he said. “But it’s very much within the individual power of the states to make those determinations one way or the other.”
Abramson said he wasn’t aware of any other states that have imposed limitations on existing minor consent laws, but he did say that efforts to expand those doctrines in recent years have been met with fierce opposition – likely due to fear and misinformation, he said.
“This historically has been an issue where there wasn’t a political division,” he said, noting bipartisan efforts to expand vaccine access during previous epidemics. “There was uniformity in this idea that diseases are an enemy of our people, and we should take these efforts to defeat them and everyone needs to pull their weight to accomplish that.”