H (A Child Parental Responsibility : Vaccination)

A local authority holding a care order may, under section 33(3)(b) of the Children Act 1989, consent to routine vaccination despite parental objection. It must first make an individual welfare decision, consult the parents and consider any specific contraindication.

Routine vaccination under the national programme is neither serious nor grave in the jurisdictional sense. Unless unusual features suggest that vaccination may not serve the child’s best interests, a local authority need not seek High Court approval. Current scientific evidence establishes that routine vaccination generally serves the medical interests of a healthy child. Parental views always require consideration, but their weight depends on their substance and bearing on welfare, not the strength with which they are expressed.

A baby subject to care and placement orders had not received routine vaccinations because his parents objected. Hayden J declared in [2020] EWHC 220 (Fam) that the local authority could consent under section 33(3) of the Children Act 1989. He also declared, under the inherent jurisdiction, that vaccination was lawful and in the child’s best interests.

The parents appealed on the grounds that the local authority lacked that statutory power and that vaccination should not have been authorised. They abandoned the challenge to the merits, so vaccination would proceed. The remaining issue was whether parental opposition requires a local authority caring for a child to seek permission to invoke the High Court’s inherent jurisdiction, or whether it may use its parental responsibility under section 33(3).

1. Appeal dismissed. A local authority holding a care order may use section 33(3)(b) of the Children Act 1989 to consent to and arrange standard or routine vaccination despite parental objection. The declaration made below therefore stood.
2. Section 33 gives the authority parental responsibility and power to determine the extent to which a parent may exercise parental responsibility. That power is subject to statutory safeguards. The authority must safeguard and promote the child’s welfare, ascertain parental and child views where reasonably practicable, and be satisfied that overriding the parent is necessary for welfare. It must make an individualised decision and consider the child’s health record and any contraindication.
3. Routine vaccination under current public-health guidance is not, in itself, a serious or grave decision requiring High Court approval. Scientific evidence establishes that its benefits generally outweigh recognised side effects for an otherwise healthy child. Expert evidence should ordinarily be confined to an unusual medical history or a possible individual contraindication.
4. The distinction between “medical treatment” and “preventative health care” did not determine jurisdiction. Those concepts overlap. Section 45E of the Public Health (Control of Disease) Act 1984, which includes vaccination within medical treatment for its own regulatory purpose, did not supply a universal definition or make vaccination grave.
5. The inherent-jurisdiction route under section 100 of the Children Act 1989 is appropriate for decisions of profound or enduring consequence. It is generally unsuitable for routine vaccination because refusal alone by an otherwise satisfactory parent is unlikely to establish the likelihood of significant harm required by section 100(4)(b). The contrary approach in Re SL was rejected.
6. Public-law cases differ from disputes between parents. Parents ordinarily have equal parental responsibility, but a care order expressly gives the local authority statutory power to override parental views, subject to safeguards. Parents must still be involved. Their views carry weight according to their substance and welfare relevance, not their vehemence. A challenge to routine vaccination is unlikely to succeed without cogent objective medical or welfare evidence of a genuine contraindication.

1. Court of Appeal (Civil Division): Dismissed the parents’ appeal and upheld the declaration that the local authority could consent to routine vaccination under section 33(3) of the Children Act 1989.
2. High Court (Family Division): In [2020] EWHC 220 (Fam), Hayden J declared that the local authority could consent under section 33(3), and additionally declared under the inherent jurisdiction that vaccination was lawful and in the child’s best interests.