Court of Protection authorises vaccination of autistic boy despite parental objections

The benefits of vaccination against Covid-19 for a child with autism, severe learning disability and asthma "significantly outweigh" the possible risks, the Court of Protection has found, despite objections from the boy's parents.

In Royal Borough of Greenwich v IOSK & Ors [2021] EWCOP 65 (22 August 2021), HHJ Carolyn Hilder dismissed the parent's fears concerning vaccine side-effects and cited medical evidence in support of the vaccination of children from the boy's doctor, a Consultant Child & Adolescent Psychiatrist, and the Joint Committee on Vaccination and Immunisation (JCVI).

The boy, referred to as 'IOSK' by the court, is 17 years of age, non-verbal and lacks capacity to make a decision as to vaccination himself.

The second respondents, the mother and father respectively, both opposed IOSK receiving the Covid-19 vaccine. The parent's scepticism of the Covid-19 vaccine stems from their belief that IOSK's health problems result from a reaction to the MMR vaccine.

IOSK currently lives at a placement after being made the subject of a care order when he was aged 15. His parents strongly opposed the care proceedings and remain opposed to their local authority's intervention in the care of their son. "Relations between them and the local authority are, to put it mildly, very strained," the judge said.

IOSK's doctor told the judge that he is classed as high risk for Covid-19 infection. "It is recommended that such patients have the Covid-19 vaccination for their own protection, the benefits of which are considered to outweigh the risks," the doctor added.

The judge also took a statement from Dr Mona Botros, Consultant Child & Adolescent Psychiatrist, who said there is no known interaction between the vaccine and the medication IOSK takes. She added that the vaccine will protect him from contracting the infection, and "even if he was infected with COVID-19, it will be unlikely that he will need hospitalisation".

Finally, the judge considered a statement from the JCVI on Covid-19 vaccination of children and young people aged 12 – 17 years made in July 2021 which said there is "good evidence" the vaccine has short-lived side effects. The statement noted that serious adverse events in younger adults are rare.

It added: "JCVI advises that children and young people aged 12 years and over with specific underlying health conditions that put them at risk of serious COVID-19, should be offered COVID-19 vaccination."

The local authority contended that IOSK's overall health conditions, including severe learning disability and asthma, made him particularly vulnerable to the virus.

As a result of his disabilities - the council said - he cannot understand the need to avoid contact to minimise the chance of infection, and he cannot communicate if he feels unwell.

The council also argued that the vaccination of IOSK would minimise the risk to his carers. Under cross-examination, this was expressed as an indirect benefit to IOSK since reducing the chance of his carers catching the virus meant his care was less likely to be disrupted.

A solicitor representing IOSK visited him before the hearing to make a statement on his behalf. The solicitor said: "He has had vaccinations recently without difficulty. In contrast, he has no comprehension of the virus, is unable to mitigate the risks and would find it challenging to cope with symptoms and treatment if he did contract the virus."

The mother and father told the court that they feared the possible side-effects of the vaccine and feared that carers would not be able to spot if IOSK is experiencing a bad reaction to the jab.

Counsel's submissions on the father's behalf focussed on there being a real risk of negative reaction to the vaccination and serious side-effects.

In considering the parent's views, the judge said that underlying their objection is the belief that IOSK's current presentation and needs were caused by MMR vaccination. "However, the medical establishment has gone to considerable lengths to debunk this belief".

He added: "I acknowledge that that is their view, and that it will give rise to anxiety for them if IOSK is given the Covid-19 vaccine but, particularly given IOSK's current living arrangements, I am satisfied that neither their view itself nor any anxiety it causes them is likely to have any adverse effect of IOSK's welfare." Accordingly, he gave no weight to this aspect of their objection.

The judge also gave no weight to the distrust of the care that IOSK is receiving. He said that the social worker had addressed their concerns, and the independent observations of IOSK's own representatives presented a "very different view".

Overall he was "satisfied that her fears cannot be determinative of the vaccination issue".

The judge approved a written plan for IOSK's vaccination.

He said: "Taking all the circumstances of this matter into account, provided that the process is undertaken with full regard to IOSK's individual needs as summarised in the written plan attached to this judgment, I am satisfied that the potential benefits of vaccination for IOSK significantly outweigh the possible risks.

"I am satisfied that it is in the best interests of IOSK that he has vaccination of a type which complies with JCVI recommendation, and make an order accordingly."

Adam Carey