Intended for healthcare professionals

Rapid response to:


Parents of US boy who survived tetanus after nearly $1m of care refuse vaccine

BMJ 2019; 364 doi: (Published 13 March 2019) Cite this as: BMJ 2019;364:l1172

Rapid Response:

Vaccination, Parental Autonomy and the Best Interests of the Child

This unfortunate case, described by Tanne, of a child in the US becoming extremely unwell whilst suffering from tetanus [1] raises an important question about our priorities when it comes to the level of state and medical involvement into how parents choose to raise their children. With the worrying rise of the anti-vaccine movement,[2] this is becoming an ever more relevant issue that needs to be addressed.

It is well established in English Law that when parents and doctors disagree over the treatment of children, the child's best interests must always come first.[3] It is understandable why vaccination is not currently treated in the same way as other medical interventions; not vaccinating a currently healthy child clearly does not have the same urgency as a dispute over acute life-saving interventions. However with a rise in the prevalence of many preventable illnesses [4], maybe now is the time when the urgency is sufficient to question whether it is appropriate to take more extreme measures to prevent any more tragic cases from occurring.

It is important to note that every parent has the right to raise their children in whichever way they wish and there is arguably no best way in which to do so. We should always aim to promote diversity and individualism for it is what makes life and society thrive. Furthermore this important right is safeguarded by the European Convention on Human Rights with Article 8 promoting the Right to Private and Family Life.[5] However important this right may be though, if it is used to put a child at risk then we must question where the line is drawn about when to stop prioritising a parent's autonomy over their child's welfare.

There are already cases in which parental autonomy is overridden in medicine. A commonly used example in this area is that of a parent refusing to consent to their child receiving a blood transfusion due to religious objections. It is well-established that these refusals can be overridden if it is deemed to be in the best-interests of a child [6] highlighting the prioritisation of a child's best interests over their parents' autonomy. Furthermore, the courts have already set a precedent in which they show willingness to confirm that being vaccinated is in the best interest of children. In four separate cases where parents had conflicting views about vaccinating their child, the court ruled in favour of the parent seeking vaccination stating that it was in the child's best interests. [7] This precedent shows that a movement which overrides a parent's wishes about vaccines would likely be openly considered by law makers.

We must therefore consider the best way to go about ensuring maximum vaccine uptake whilst attempting not to infringe parental autonomy as much as possible. Cases such as that described by Tanne have only further emphasised the need for this. Italy has recently taken an extreme approach by preventing unvaccinated children from starting school as well as fining their parents. Although it is still too early to make firm conclusions about the effectiveness of this strategy, it was predicted to be a successful approach for progressing back towards a sufficient vaccine uptake.[8]

If we were to follow this strategy in the UK there would undoubtedly be a high level of backlash so it would be essential in doing so that the opinions of the public were considered and balanced with the urgency of the vaccination crisis. There is no solution to this problem that will please everybody but either way, something needs to be done to protect the health and welfare of our children.

1) Tanne JH. Parents of US boy who survived tetanus after nearly $1m of care refuse vaccine. BMJ 2019; 364:l1172
2) Hussain A, Ali S, Ahmed M, Hussain S. The Anti-vaccination movement: a regression in modern medicine. Cureus 2018; 10(7):e2919
3) See for example: Re B (A Minor) (Wardship: Medical Treatment) [1981] 1 WLR 1421, Kings College Hospital NHS Trust v Y and MH [2015] EWHC 1966, Great Ormond Street Hospital v Yates and Gard [2017] EWHC 1909 (Fam) etc.
4) Dubé E, Vivion M, MacDonald N. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications. Expert Review of Vaccines 2015; 14(1): 99-117.
5) ECHR Article 8 - Right to Private and Family Life -
6) As per Re E (A Minor) (Wardship: Medical Treatment) [1993] 1 FLR 386.
7) Weamouth EM. Children Vaccination and UK Law. Arch Dis Child 2014; 99:A193.
8) Chirico F. The new Italian mandatory vaccine law as a health policy instrument against the anti-vaccination movement. Ann Ig 2018; 30: 251-256.

Competing interests: No competing interests

16 March 2019
Katie M Spencer
Medical Student
University of Manchester
Manchester, UK