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Staff photo by Troy Stolt / Joel Pedro, 13, looks at nurse practitioner Meghan Whitehead before receiving a dose of the COVID-19 vaccine at LifeSpring Community Health on Wednesday, July 21, 2021, in Chattanooga, Tenn.

Tennessee will resume vaccine outreach — paused earlier this month amid pressure from some conservative state legislators — except for social media marketing aimed specifically at children, according to Tennessee's top health official.

Dr. Lisa Piercey, commissioner of the Tennessee Department of Health, said during a news briefing Friday that the agency "took the pause to look at our marketing materials, to look at our flyers and postcards, and all of the other public-facing materials to make sure they were appropriately directed at parents."

Earlier this month, department emails and reports obtained by The Tennessean of Nashville revealed agency leaders had instructed the state's 89 primarily rural health departments to halt all vaccine outreach to minors, including promotion of routine childhood vaccines and school-based vaccination events. Staff were also instructed to strip the state's logo from any vaccine-related materials, and Piercey fired Dr. Michelle "Shelley" Fiscus, the state's immunization programs director.

Fiscus' dismissal came after she cited to physicians and other health providers that a 34-year-old Tennessee Supreme Court ruling established a doctrine in which minors age 14 and older could seek treatments on their own if the medical provider felt they were mature enough to decide. The doctrine is rarely invoked and in place primarily for minors whose parents are unable to consent due to their life circumstances, such as incarceration or severe mental illness or substance use.

Those events, which drew a flurry of national media attention, came two weeks after some Republican members of the General Assembly blistered the state department during a legislative committee meeting.

The lawmakers' chief complaints involved tax dollars spent to promote the COVID-19 vaccine for eligible children, including a social media post featuring a photo of an adolescent with a Band-Aid on his arm, saying, "Tennesseans 12+ are eligible for vaccines. Give COVID-19 vaccines a shot."

"While we never intended to target children, I understand that there was a gap in the perception of how it was being received," Piercey said. " We all agree and have always agreed that parents are the authority on medical decision making for children, and so we wanted to take the pause to make sure that our marketing materials and our forward-facing documents reflected such."

(READ MORE: Tennessee governor says state will work through parents, not children, to promote vaccines)

As far as allowing the rare event of a minor over the age of 14 to be vaccinated without parental consent, Piercey said the "mature minor doctrine" is still applicable in Tennessee.

"There are very nuanced and fringe situations where that might occur," she said, noting the statute applies to all providers, not just the Department of Health.

Now the review is complete, she said the department has vaccination events with schools scheduled in the coming days, and its county-level health departments — which exclude Hamilton County and Tennessee's five other major metro counties that function independently of the state — are conducting child vaccine outreach, including for the COVID-19 vaccines.

Tennesseans may notice new social media or marketing materials related to vaccines that contain pictures of children, but parents will be included in those pictures, she said.

"My message to those six metro health departments would be for them to re-examine their materials to make sure they are also appropriately targeting adults and not children," Piercey said.

Hamilton County Health Department Administrator Becky Barnes said via email that parental consent has always been required for minors to receive the COVID-19 vaccine at health department events.

"The Mature Minor Doctrine leaves treatment to the discretion of the provider. We have always required parental consent for immunizations of minors," Barnes said. "Anyone under the age of 18 must have parental consent. In the case of a child whose parent is incarcerated, a legal caretaker may consent."

Contact Elizabeth Fite at efite@timesfreepress.com or follow her on Twitter @ecfite.

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