Vaccination has long been established as a cornerstone of public health policy, contributing significantly to the prevention of infectious diseases and the reduction of child mortality. Despite overwhelming scientific consensus regarding its effectiveness and safety, vaccination remains a legally and socially contested issue in many European states. The tension primarily arises from conflicts between individual autonomy, parental decision-making authority and the state's obligation to protect public health and the rights of children Cabinet of Ministers of the Republic of Latvia, 2000).
Within the European human rights framework, these tensions are addressed through a complex balance of competing interests. Article 8 of the European Convention on Human Rights (ECHR) protects the right to respect for private and family life, encompassing bodily integrity and parental authority. At the same time, Article 8(2) permits state interference where it is lawful, necessary and proportionate in the interests of public health. Parallel to this, the United Nations Convention on the Rights of the Child (CRC) and European Union instruments emphasise the primacy of the child's best interests and the child's right to the highest attainable standard of health (United Nations, 1989; European Union, 2000).
The Republic of Latvia represents a particularly relevant case study in this context. Latvian law provides for mandatory vaccination of children against certain infectious diseases, yet allows legal representatives to refuse such vaccination with limited legal consequences (Cabinet of Ministers of the Republic of Latvia, 2000). This regulatory approach raises questions about whether the state adequately fulfills its positive obligations to protect children's health and life, especially when parental decisions expose minors to serious and preventable risks.
The significance of this topic has been underscored by recent events in Latvia, including the death of an unvaccinated minor in 2024 from a disease covered by mandatory vaccination. This case triggered public and professional debate on the responsibility of parents, healthcare providers and state institutions, as well as the adequacy of existing legal safeguards.
The existing academic literature extensively discusses mandatory vaccination from ethical and constitutional perspectives, often focusing on proportionality and individual rights. However, there is a relative lack of in-depth analysis addressing the specific legal mechanisms for protecting minor patients when parental refusal conflicts with public health objectives and children's best interests. This article seeks to address this gap by examining Latvian vaccination regulation through the lens of European human rights doctrine.
The objectives of this study are threefold:
- (1)
To analyse the Latvian legal framework governing vaccination and minor patients' rights;
- (2)
To assess how parental autonomy is balanced against the child's best interests under national and European law;
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To evaluate recent legislative amendments and propose improvements consistent with European human rights standards.
The research employs doctrinal legal analysis, drawing on national legislation, ECHR case law, EU and Council of Europe instruments, and international children's rights standards.
European human rights law recognises public health protection as a legitimate aim that may justify limitations on individual rights. The European Court of Human Rights has consistently held that states enjoy a margin of appreciation in designing public health policies, particularly where scientific uncertainty and social considerations are involved (European Court of Human Rights [ECHR], 2021).
The landmark judgement in Vavřička and Others v. the Czech Republic represents the Court's most authoritative statement on mandatory childhood vaccination. In this case, the Court found that compulsory vaccination schemes, linked to access to preschool education, constituted an interference with private life under Article 8 ECHR, but that such interference was justified and proportionate (ECHR, 2021). Crucially, the Court emphasised the principle of social solidarity and the need to protect vulnerable individuals who cannot be vaccinated for medical reasons.
The Court also highlighted the child-centred nature of vaccination policies, noting that compulsory vaccination ultimately serves the best interests of children by protecting their health and lives. Importantly, the absence of forced physical vaccination and the existence of procedural safeguards were decisive in establishing proportionality.
This jurisprudence sets a clear framework within which national vaccination policies must operate: mandatory vaccination is not per se incompatible with human rights, provided that it is lawful, proportionate and oriented towards child protection and public health.
Beyond the ECHR, European Union law and Council of Europe instruments provide additional normative guidance. Article 24 of the Charter of Fundamental Rights of the European Union explicitly recognises that children's best interests must be a primary consideration in all actions concerning them (European Union, 2000). Furthermore, Article 35 of the Charter guarantees a high level of human health protection in the definition and implementation of all Union policies.
The Council of Europe's Convention on Human Rights and Biomedicine (Oviedo Convention) reinforces these principles by requiring that medical interventions involving minors be carried out in their best interests and with appropriate safeguards (Council of Europe, 1997). Similarly, the Guidelines on Child-Friendly Healthcare stress the importance of children's participation in health-related decision-making, in accordance with their age and maturity (Council of Europe, 2012).
At the international level, the CRC obliges states to ensure that children enjoy the highest attainable standard of health and that parents receive appropriate guidance in fulfilling their responsibilities (United Nations, 1989). The Committee on the Rights of the Child has clarified that states must intervene when parental decisions seriously endanger a child's health or life (Committee on the Rights of the Child, 2013).
Together, these instruments establish a coherent European and international standard that prioritises children's health and best interests while recognising the evolving capacities of minors.
Article 177 of the Latvian Civil Law provides that a child remains under parental custody until reaching the age of majority, which in Latvia generally occurs at 18 years of age (Civil Law, 1937). Parental custody is defined as both a right and a duty, encompassing care for the child's personal well-being, health, upbringing, education and legal representation. In the context of healthcare, this provision establishes the legal foundation for parental involvement in medical decision-making on behalf of minor children, including decisions concerning preventive healthcare measures such as vaccination.
Historically, the original version of the Latvian Civil Law, adopted in the 1930s, reflected the prevailing legal traditions of its time. Although parental authority was formally exercised jointly by both parents, the father was granted the decisive voice in the event of disagreement. At the same time, the law already incorporated early mechanisms of state oversight: the mother was entitled to apply to the Orphan's Court if she believed that the father's decisions were detrimental to the child's interests. This demonstrates that even at an early stage, Latvian law recognised that parental authority was not absolute and could be subject to public intervention where the child's welfare was at risk.
From a modern legal perspective, this hierarchical model of parental authority is widely regarded as an anachronism rooted in Roman law concepts of patria potestas, where paternal power was nearly unlimited. Contemporary Latvian legal doctrine has clearly moved away from this model. As emphasised by Konstantīns Čakste (1937/2011), parental authority is not based on the idea of power or domination, but on the idea of guardianship. Parental rights exist solely as instruments for fulfilling parental responsibilities and ensuring the protection of the child's interests.
This doctrinal shift has been consistently reinforced by Latvian judicial practice. The Supreme Court of the Republic of Latvia (Senāts) has clarified that parental custody must be understood broadly as a set of interrelated rights and duties, including care, supervision, healthcare decisions, daily custody and representation of the child (Supreme Court of the Republic of Latvia, 2012). Importantly, the Court has stressed that parental discretion is conditional upon compliance with the child's best interests and cannot be exercised in a manner that endangers the child's health or development.
In cases involving disputes over medical treatment of minors, Latvian courts have recognised that parental refusal of necessary healthcare may justify state intervention. The Supreme Court has confirmed that Orphan's and Custody Courts are competent to authorise medical treatment where legal representatives refuse consent and such refusal poses a real or foreseeable risk to the child's health or life (Supreme Court of the Republic of Latvia, 2016). Administrative courts have similarly held that limiting parental authority in health-related matters does not constitute an unlawful interference with family life, but rather reflects the State's duty to protect vulnerable persons (Administrative District Court of the Republic of Latvia, 2019).
This approach is fully consistent with European human rights doctrine. Under Article 8 of the ECHR, parental decision-making forms part of the right to respect for private and family life. However, the European Court of Human Rights has consistently held that this right is not absolute and may be subject to proportionate limitations in the interests of public health and the protection of the rights of others.
The Court's judgement in Vavřička and Others v. the Czech Republic represents a pivotal development in this area. The Court confirmed that mandatory childhood vaccination constitutes an interference with private life but held that such interference may be justified where it pursues legitimate public health objectives and is accompanied by adequate procedural safeguards (European Court of Human Rights [ECHR], 2021). The Court emphasised that vaccination policies are inherently child-centred, as they aim to protect children from serious diseases and contribute to collective immunity, particularly for those who cannot be vaccinated for medical reasons.
Earlier case law further supports this reasoning. In Glass v. the United Kingdom, the Court held that administering medical treatment to a child against parental wishes without sufficient procedural safeguards violated Article 8, while simultaneously affirming the State's positive obligation to establish clear mechanisms for resolving conflicts between parents and healthcare professionals (ECHR, 2004). In Jehovah's Witnesses of Moscow v. Russia, the Court recognised that parental freedom to raise children in accordance with personal beliefs may be restricted where a child's health or life is seriously endangered (ECHR, 2010).
Moreover, the Court has repeatedly emphasised that the best interests of the child must be a primary consideration in all decisions affecting children. In Neulinger and Shuruk v. Switzerland and Elsholz v. Germany, the Court underlined that parental rights exist primarily to protect the child and may be limited where necessary to secure the child's welfare (ECHR, 2000; ECHR, 2010).
These principles are reinforced by European Union and international children's rights instruments. Article 24 of the Charter of Fundamental Rights of the European Union requires that the child's best interests be a primary consideration in all actions concerning children (European Union, 2000). Similarly, the United Nations CRC obliges states to ensure the highest attainable standard of health for children and to intervene where parental decisions expose children to serious harm (United Nations, 1989). The Committee on the Rights of the Child has explicitly stated that parental authority must be exercised in a manner consistent with the child's right to health and that states must act when this right is jeopardised (Committee on the Rights of the Child, 2013).
When applied to the vaccination context in Latvia, this legal framework reveals a significant tension. Although Latvian law recognises vaccination as a public health obligation and establishes procedural mechanisms for protecting minor patients, it simultaneously permits parental refusal of mandatory vaccination without imposing substantive consequences. The tragic case of an unvaccinated minor's death in Latvia in 2024 illustrates the potential consequences of this regulatory gap and raises serious questions regarding the State's positive obligations under Articles 2 and 8 of the ECHR.
Recent amendments to the Cabinet of Ministers' Vaccination Regulations, which introduced mandatory informed refusal procedures and enhanced informational duties for healthcare professionals, represent a step towards greater accountability. However, these measures remain largely procedural and do not sufficiently ensure effective protection of the child's best interests. From a European human rights perspective, a system that allows parents to refuse mandatory vaccination without meaningful safeguards risks prioritising parental autonomy over the child's right to health and life.
Accordingly, parental responsibility in healthcare must be understood not as an unrestricted right to decide, but as a duty to act in the child's best interests, informed by medical knowledge and public health considerations. The State, in turn, bears a parallel responsibility to supervise and, where necessary, limit parental authority in order to protect children from preventable harm. A child-centred, responsibility-based approach to vaccination policy is therefore essential to ensure compliance with both Latvian constitutional values and European human rights standards.
In Latvia, patients' rights are primarily regulated by the Law on the Rights of Patients, while vaccination policy is governed by the Epidemiological Safety Law and Cabinet of Ministers Regulation No. 330 Vaccination Regulations. These acts define mandatory vaccinations, target groups, procedural standards and funding mechanisms (Law on the Rights of Patients, 2009).
Mandatory vaccination applies mainly to children and certain high-risk occupational groups. Vaccinations included in the national immunisation programme are financed by the state budget, ensuring accessibility and compliance with the principle of equality in healthcare.
The Law on the Rights of Patients adopts a differentiated approach to minor patients. Until the age of 14, medical decisions are generally made by legal representatives, whereas minors aged 14 and above may independently consent to medical treatment if deemed sufficiently mature. This reflects European standards on children's evolving capacities and participation rights (Law on the Rights of Patients, 2009).
However, Latvian law also allows legal representatives to refuse mandatory vaccination. While physicians may refer cases to the Orphan's and Custody Court if refusal endangers a child's health or life, this mechanism is discretionary and rarely applied in practice.
The permissibility of parental refusal creates a significant gap between legal regulation and effective child protection. The 2024 case involving the death of an unvaccinated minor illustrates the potential consequences of this gap. Despite clear legal grounds for intervention, the responsible healthcare provider did not involve child protection authorities.
This situation raises concerns regarding the state's positive obligations under Article 2 (right to life) and Article 8 ECHR. European human rights doctrine requires states not only to refrain from unjustified interference but also to take reasonable measures to protect individuals, particularly vulnerable children, from foreseeable harm (ECHR, 2021).
Recent amendments to the Vaccination Regulations, which entered into force in July 2024, introduced mandatory informed refusal procedures and enhanced informational duties for healthcare professionals. While these changes improve transparency and documentation, they do not introduce substantive consequences for refusal nor ensure effective protection of the child's best interests.
From a European human rights perspective, the Latvian approach appears formally compliant but substantively weak. The emphasis on parental autonomy, without sufficient safeguards, risks undermining the child-centred focus required by EU and international law.
This study argues that a more comprehensive approach is needed. Mandatory educational programmes for parents refusing vaccination, similar to those recommended in child-friendly healthcare guidelines, could enhance informed decision-making. Clearer professional obligations for healthcare providers and more consistent involvement of child protection authorities would further strengthen safeguards.
Such measures would not amount to forced vaccination but would enhance proportionality and effectiveness, aligning Latvian practice more closely with European human rights standards.
This article has examined the legal challenges of mandatory vaccination in the Republic of Latvia through a child-centred and European human rights lens. The analysis demonstrates that while Latvian law formally recognises children's rights and public health obligations, existing mechanisms inadequately protect minor patients when parental refusal of vaccination creates serious risks.
European human rights jurisprudence, EU law and international children's rights instruments consistently emphasise the primacy of the child's best interests and the legitimacy of proportionate public health measures. Latvia's current approach, which permits refusal without meaningful consequences, falls short of these standards in practice.
To address these challenges, the article recommends complementing legal regulation with educational, institutional and professional measures aimed at strengthening child protection while respecting parental autonomy. Such reforms would promote a more balanced, effective and rights-compliant vaccination framework, ensuring that the best interests of the child remain at the centre of public health policy.