HomeMy WebLinkAbout07.16.21 S. F. Area Health Order
From:lance dreiss
To:Lucero, Debra;Ritter, Tami;Clerk of the Board;Teeter, Doug;Kimmelshue, Tod;Connelly, Bill
Subject:S. F. Area Health Order
Date:Friday, July 16, 2021 10:37:04 AM
Attachments:Order-C19-19-Vaccination-Minors.pdf
.ATTENTION: This message originated from outside Butte County. Please exercise judgment before opening attachments, clicking on
links, or replying..
Board of Supervisors, Clerk of the Board, Public Record:
Here is the Public Health Order from San Francisco...It allows minors in the City and County of San Francisco who are 12 years old or
older to consent to receive any vaccine against Covid that has been authorized by the FDA (whether authorized on an emergency use basis
or fully approved)...
This health Order is frightening to the residents of Butte County and their families. We see other places in California (and other states)
allowing children 12 years and older to consent to the COVID-19 vaccine without permission from their parents.
Why aren’t you willing to put in writing (resolution) that we in Butte County will not allow this? You claim this verbally. We ask that you
also put this is writing.
Thank you,
Diana Dreiss
https://urldefense.com/v3/__https://www.sfdph.org/dph/alerts/files/Order-C19-19-Vaccination-
Minors.pdf__;!!KNMwiTCp4spf!SrSy1BL6UnuUKhcQMbtbMQtx_pSDTt4amrliM6JG2LmVDEm4mWxcN7X4guJwLmHIuEl9qKeAxhI$
Sent from my iPad
City and County of Department of Public Health
San FranciscoOrder of the Health Officer
ORDEROF THE HEALTH OFFICERNo. C19-19
ORDER OF THE HEALTH OFFICER
OF THE CITY AND COUNTY OF SAN FRANCISCO ALLOWINGMINORS TO
CONSENT TO RECEIVETHE COVID-19 VACCINEAND ALLOWING VACCINE
PROVIDERS IN THE CITY TO RELY ON THAT CONSENT
(PUBLICHEALTH EMERGENCY ORDER)
DATE OF ORDER: April28, 2021
Please read this Order carefully. Violation of or failure to comply with this Order is a
misdemeanor punishable by fine, imprisonment, or both. (California Health and Safety
Code §120295,et seq.; California Penal Code §§69, 148(a)(1); andSan Francisco
Administrative Code §7.17(b)).
Summary:The ongoing Coronavirus Disease 2019 (“COVID-19”)pandemic has caused
untold social and economic consequences across the world. At this point in the
pandemic, there are multiple vaccines that have been authorized by the United States
Food and Drug Administration (the “FDA”) for emergency use to protect against
moderate to severe clinical outcomes of infection by SARS-CoV-2, the virus that causes
COVID-19. In the coming months, not only is it likely that the authorization for such
vaccines will be expanded (both in terms of the numbers of vaccines but also in terms of
non-emergency approval), but it is also likely that the age range of those who are
authorized to receive the vaccine in the United States will be expanded to allow for more
minors to receive the vaccine. And although many people have received the COVID-19
vaccines, it is critical from a public health perspective that as many people as possible,
including minors, receive the vaccine. Minors under the age of 18 are showing
increasing numbers of infections, and California law does not generallyallow such
minors to consent to receipt of the vaccine eventhoughthe State considersthe vaccine to
be general medicalcareand national pediatric groups recommend the vaccine for those
16 years of age and older. Many minors have a parent, guardian, or other person with
legal authority who will consent to their receipt of the vaccine, but that is not true in all
situations. It remains vital to the health of all in the community—including adults who
cannot or will not receive the vaccine as well as people who have been fully vaccinated
(due to the ongoing possibility of breakthrough infections)—that every person, including
minors, who wants to receive the vaccine be given the opportunity.
For thosereasons, this Order does two things. First, it allows minors in the City and
County of San Francisco (the “City”) who are 12 years old or older to consent to receive
any vaccine against COVID-19 that has been authorized by the FDA(whether authorized
on an emergency use basis or fully approved)for receiptby someone who is the age of
that minor.The healthcare provider administering the vaccine dose must reasonably
attempt to notify aperson with legal authority to consent to medical care for that minor,
such as a parent or guardian, and allowthat personthe opportunity to object to
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City and County of Department of Public Health
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administration of that dose.This ability to consent is similar tothe concept used
elsewhere in state law that minors 12 years old or older may consent to the diagnosis or
treatment of infectious diseases, including specifically COVID-19, without parental
consent. Allowing prevention of the disease via vaccination is just as important as
allowing a minor to be tested for that disease or to be treated for it. Second,this Order
allows but does not require providers who are authorized by the State of California to
administer an FDA-authorizedor approvedCOVID-19 vaccine to administer such a
vaccine to any minor in the City who is 12 years old or olderand who provides consent
consistent with this Order.For sake of clarity, this Order only applies to minors 12 years
old or older and healthcare providers who are in the City at the time the vaccine is
administered. This Order does not authorize giving a vaccine to a minor if the vaccine is
not authorized or approved by the FDA for a person that age. And this Order does not
mandate notice to a parent or guardian in the case of a minor who is emancipated or self-
sufficient and is otherwise allowed by California law to consent to receipt of a COVID-
19 vaccine.
UNDER THE AUTHORITY OFCALIFORNIA HEALTH AND SAFETY CODE
SECTIONS101040, 101085,120175,AND120176,THE HEALTHOFFICER OF THE
CITY AND COUNTY OF SAN FRANCISCOORDERS:
1.Purpose and Findings.
a.Purposeand Intent.The City, in cooperation with the federal government, the State
of California, and private healthcare providers, is administering vaccines to combat
COVID-19.As of April 28, 2021, the FDAhas issuedan EmergencyUse
Authorization(“EUA”)forthree COVID-19 vaccines, including the Pfizer-BioNTech
COVID-19vaccine for use in people 16 years of age or older.Pfizer has also applied
to the FDAforanEUAto administerits vaccine in adolescents between the ages of
12 to 15 years. Other vaccine manufacturers are conducting clinical trials for
administration of COVID-19 vaccines in youth and adolescents. Scientific evidence
submitted to the FDA indicatesthat thevaccinecurrently approvedfor use in minors
between 16 and 17 years of ageissafe andhighly effective in preventing infections,
and any future FDA authorizations forvaccinations used to prevent COVID-19 in
minors should similarly meet those standards. Although serious illness from COVID-
19 is less common in minors than in older adults, vaccinating minors is necessary to
prevent as many infections as possible. Scientific evidence further indicates that
broad community access to COVID-19 vaccines offers the clearest and quickest path
to reduce the number of COVID-19 cases and to bring the pandemic to an end.This
is essential for many reasons, including that some adults either cannot or will not be
vaccinated, and in addition there are documented cases of breakthrough infections
where people contract COVID-19despite being fully vaccinated.Broad community
accessmust include children and adolescentsonce the FDA approves a COVID-19
vaccine for those ages.
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With some exceptions, a parent orguardian must consent to a minor’s medical care in
order for a healthcare provider to treat that minor. In many cases, a parent or
guardian will be available to provide the consent necessary to allow healthcare
providers to administer a COVID-19 vaccine.But in some cases,it may be difficult
to obtain the consent of a minor’s parent or guardian. For example, consent may not
be easily obtainable if theparent or guardian resides outside the City’s jurisdiction
(including outside the United States) or the minor resides with a relative who does not
have authority to consent to a minor’s medical careand the parent or guardian cannot
be reached.Accordingly, if children and adolescents are unable to consent to receive
an FDA-approved or authorized COVID-19vaccine, then a segment of the population
will remain at risk forcontracting COVID-19, especially if and when children and
youth return to in-person schooling.There is also a concern that new variants of the
virus, such as those found in the United Kingdom, Brazil, and South Africa, are
spreading in California, which in turn puts unvaccinated people, including children
and adolescents,at risk.
The intent of this Order is to allow minors 12 years of age and older who desire to
receive,and are otherwise eligible to receive,a COVID-19 vaccine to consent to a
COVID-19 vaccine, even if they lack the consent of a person who is legally
authorized to make healthcare decisions for the minor, such as a parent or guardian.
This Order is necessaryto effectively prevent and control the spread of COVID-19 in
our community and reduce barriers to accessing approved or authorized vaccines.
b.Interpretation. All provisions of this Order must be interpreted to effectuate the
purpose and intent of this Order,as described in subsection1.aabove. Certain
initially capitalizedtermsused in this Order have the meanings given them in
Section4belowor elsewhere in this Order.Initially capitalized terms not otherwise
defined in this Order are defined in Health Officer Order No. C19-07v(the “Stay-
Safer-at-Home Order”), including as it may later be amended.
c.Continuing Severe Health and Safety Risk Posed by COVID-19. This Order is issued
based on evidence of continuedcommunity transmission of COVID-19 within the
City,throughout the Bay Area, across California, and across the United States;
evidence that most COVID-19 infections are caused by people who have no
symptoms atallof illness; scientific evidence and best practices regarding the most
effective approaches to slow the transmission of communicable diseases generally
and COVID-19 specifically, including broad distribution of effective vaccinations
throughout the community; evidence that the age, condition, and health of a
significant portion of the population of the Cityplaces it at risk for serious health
complications, including death, from COVID-19; further evidence that others,
including younger and otherwise healthy people, are also at risk for serious outcomes
including death;evidence that breakthrough infections can occur in fully vaccinated
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people; andthe reality that SARS-CoV-2infections and COVID-19 diagnoses remain
prevalent throughout the world. Due to the outbreak of COVID-19 in the general
public, which is apandemic according to the World Health Organization, there is a
public health emergency throughout the City, region,State, and nation. That
immediate threat to public health and safety is also reflected in the continuing
declarations of emergency referenced in Section 5below.
d.Cases, Hospitalizations,and Deaths. As of April 23, 2021, there were 36,044
confirmed cases of COVID-19 in the City(up from 37 on March 16, 2020, the day
before the first shelter-in-place order in the Citywent into effect) as well as at least
531deaths (up from a single death on March 17, 2020).This information, as well as
information regarding hospitalizations and hospital capacity, is regularly updated on
the San Francisco Department of Public Health’s website at
https://data.sfgov.org/stories/s/fjki-2faband incorporated into this Order by this
reference.
2.Minor ConsentRequirements.
a.AnyVaccineProvider within the City may accept the consent of a Minorto
receive any FDA-authorizedor approved COVID-19Vaccine that is authorized
or approved to be received by someone their age, provided that the Vaccine
Provider reasonably attempts to notify aLegally Responsible Adultasdescribed
in Section 3 belowand there is no objection from that Legally Responsible
Adult.If consent from aLegally Responsible Adultcannot reasonably be
obtained, then the Vaccine Provider may administer a COVID-19Vaccine to
the Minor upon receipt of a Minor’s consent.
b.Notwithstanding any other provision of this Order, this Order does not authorize
the administration of any COVID-19Vaccine to a Minor if that persondoes not
meet the minimum age requirement mandated by the FDA’s current approval or
EUA for the specific COVID-19Vaccine being offered.This Order also does
not require administration of a COVID-19Vaccine if receipt of the vaccine by
the Minoris medically contraindicated.
c.This Order is expressly issued to invoke the protections of Section 8659 of the
California Government Code for any physician or surgeon, hospital, pharmacist,
respiratorycare practitioner, nurse, or dentist who administers a COVID-19
Vaccineto a Minor as a Vaccine Providerunderthis Order.
3.NotificationRequirements.
a.Beforeany vaccination authorized by this Order, theVaccine Providermust
reasonably attempt to obtain the consent of any Legally Responsible Adult,
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either in person, in writing, or by telephone.
b.IfaLegally Responsible Adultobjects to the Minor’s receipt of the COVID-19
Vaccine, then the Vaccine Provider may not relyon this Order to obtain the
consent of the Minor toadminister the vaccine to that Minor.This Order does
not alter other avenues for obtaining minor consent under California law.
Nothing in this Order prohibits a Minor from seeking an order of a court of law
with jurisdiction to authorize receipt of a COVID-19Vaccine by the Minor.
4.Definitions.
For purposes of this Order, the following initially capitalized terms have the meanings
given below.
a.Vaccine Provider.“Vaccine Provider” meansany entityor personproviding
vaccinations of a COVID-19Vaccinein the Citywho is authorized by the State of
California to provide such vaccination.
b.COVID-19 Vaccine.“COVID-19 Vaccine” means any vaccine that is either
authorized for emergency use by the FDA or approved by the FDA for introduction
into interstate commercefor the prevention ofCOVID-19.
c.Minor.“Minor” means any person who is 12 years to 17 years oldand is located
within the jurisdiction of the City. Any person who is an emancipated minor under
Section 7050 of the California Family Code and who may consent to medical care
without parental consent, knowledge, or liability may consent to receipt of a COVID-
19 Vaccine. Similarly, any person who is a self-sufficient minor underSection 6922
of the Family Code and who may consent to medical care without parental consent or
liability may also consent to receipt of a COVID-19 Vaccine. Any such emancipated
minor or self-sufficient minor may consent to receiving a COVID-19 Vaccine without
the notice required by Section 3 above.
d.Legally Responsible Adult.“Legally Responsible Adult” means a person,such as a
parent or guardian, who has the legal authority to consent to the specific Minor’s
receipt of health care, including receipt of a COVID-19Vaccine.
5.Incorporation of State and Local Emergency Proclamations and State Health
Orders.
a.State and Local Emergency Proclamations.This Order is issued in accordance with,
and incorporates by reference, the March4, 2020 Proclamation of a State of
Emergency issued by Governor Gavin Newsom, the March 12, 2020 Executive Order
(Executive Order N-25-20) issued by Governor Gavin Newsom, the February 25,
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2020 Proclamation by the Mayor Declaring the Existence of a Local Emergency
issued by Mayor London Breed, as supplemented on March 11, 2020, the March 6,
2020 Declaration of Local Health Emergency Regarding Novel Coronavirus 2019
(COVID-19) issued by the Health Officer, and COVID-19-related guidance issued by
the California Department of Public Health, as each of them have been and may be
supplementedin the future.
b.State Health Orders.This Order is also issued in light of the ordersof the State
Public Health Officerand the Governor and other State guidelinesrelated to the
pandemic and the State’s response to the pandemic, including, but not limited to,
guidelines of the California Department of Public Health for allocating COVID-19
vaccines.
c.Federal Orders.This Order is also issued in light of federal orders, including the
January 20, 2021 Executive Order on Protecting the Federal Workforce and
Requiring Mask-Wearing, which requires all individuals in Federal buildings and on
Federal land to wear Face Coverings, maintain physical distance, and adhere to other
public health measures, and the February 2, 2021 Order of the United States Centers
for Disease Control and Prevention, which requires use of a Face Covering on public
transportation.
a.Health Officer Orders and Directives.This Order is also issued in light of other
orders and directives issued by the Health Officer as they relate to the pandemic and
the City’s response to the pandemic. Those ordersand directivesshow the
seriousness of the issue and the many efforts that the City, including but not limited to
the Department of Public Health, have taken to address the spread of COVID-19
within the City.ThisOrder incorporates by reference and is based in part oneach of
the other orders and directives issued by the Health Officer to this point, including as
each of them may be updated in the future. That includes, without limitation, each of
the following, including as they may be updated or amended in the future, in relation
to this Order:
i.The Stay-Safer-At-Home Order(imposing restrictions on activities outside
the home for all people in the Cityto protect all during the pandemic);
ii.Order No. C19-12e(with limited exceptions, requiring all people in the
Cityto wear Face Coveringswhen near people from different
Households);
iii.Order No. C19-15c (regarding COVID-19 testing); and
iv.Order No. C19-18(requiring large healthcare providers to share COVID-
19 vaccination plans and share vaccination data).
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6.Effective Date.
This Order becomes effective at 8:00 a.m. on April 29, 2021, and will continue in effect
(as it may be updated) until the Health Officer rescinds, supersedes, or amends it in
writing.
7.Copies.
The Citymust promptly provide copies of this Order as follows: (1) by posting on the
Department of Public Health website (www.sfdph.org/healthorders); (2) by posting at
City Hall, located at 1 Dr. Carlton B. Goodlett Pl., San Francisco, CA 94102; and (3) by
providing to any member of the public requesting a copy.
8.Severability.
If any provision of this Order or its application to any person or circumstance is held to
be invalid, the remainder of the Order, including the application of such part or provision
to other persons or circumstances, shall not be affected and shall continue in full force
and effect. To this end, the provisions of this Order are severable.
IT IS SO ORDERED:
Susan Philip, MD, MPH,Date: April28, 2021
Acting Health Officer of the
City and County of San Francisco
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