SARASOTA, Fla. — Florida plans to end nearly half a century of mandatory childhood immunizations against diseases that have killed and maimed millions of children. Many critics of the decision, including doctors, are afraid to speak out against it.
With the support of Republican Gov. Ron DeSantis, Surgeon General Joseph Ladapo on Sept. 3 announced his plan to eliminate all school-age vaccination requirements in the state.
“Every single one of them is wrong and riddled with disdain and slavery,” he told a cheering crowd of anti-vaxxers in Tallahassee. “Who am I, the government or anyone else,” he said, “to tell you what you should put in your body?”
History shows that mandates increase vaccine uptake. Reduced vaccination rates will mean an increase in diseases such as measles, hepatitis, meningitis and pneumonia, and even the return of diphtheria and polio. Many of these diseases threaten not only the unvaccinated, but also those they come into contact with, including infants and the elderly with weakened immune systems.
But in Florida, this scientific fact remains unspoken. Health officials have remained largely silent in the face of Ladapo's campaign—and not because they agree with him. The University of Florida has silenced infectious disease experts, said professor emeritus Doug Barrett, the university's former chief of pediatrics and senior vice president for health affairs.
“They are ordered not to talk to anyone without permission from their superiors,” he said. University officials did not respond to requests for comment.
County health officials across the state have received the same message, said John Sinnott, a retired University of South Florida professor who is friends with one of the county's health officials.
The Sarasota County Health Department referred a reporter to Tallahassee state officials, who responded with a statement that vaccines “remain available” to families who need them. The state did not respond to other requests for comment or to interview Ladapo.
Many pediatricians are also silent, at least publicly.
“A lot of them don't take a strong stance on whether their children should be vaccinated,” said Neil Manimala, a urologist and president-elect of the Hillsborough County Medical Association. “They don't want to lose business. And there are enough anti-vaxxers who can criticize you on Google, spreading stories about doctors who 'want to give poison shots.'
History of modern vaccination mandates
According to historian Robert Johnston of the University of Illinois-Chicago, several states abolished vaccination mandates early in the last century, when smallpox was the only widely used vaccine. No one did because other vaccines were added to the list. (Routine vaccination against smallpox ended in 1972.)
In the 1970s, persistent outbreaks of measles prompted officials to strengthen protections for children by introducing school requirements in every state. Today, controversies in vaccine policy following the coronavirus outbreak have changed the equation. Nowhere is this truer than in Florida, although lawmakers in Texas and Louisiana are also considering eliminating mandatory vaccinations, and Idaho is allowing parents to get a vaccine exemption simply by asking for it.
“This is really going to be a game-changer for families who were already unsure they wanted vaccines and are now being told they don't need them,” said Jennifer Takagishi, vice president of the Florida chapter of the American Academy of Pediatrics.
It's difficult to predict how quickly vaccine-preventable diseases could return if Florida ends its mandates, or how the public will react. asked in an interview Ladapo responded, “Absolutely not,” whether his office had modeled disease outcomes before his September statement. Parental freedom of choice is not a scientific issue, he said. “It's a matter of good and evil.”
A month later, Ladapo's health department had not responded to a question about whether it was making plans for outbreaks. During Measles outbreak in 2024 In Broward County, Ladapo sent a letter to parents giving them permission to send unvaccinated children to school, ignoring science-based recommendations from the federal Centers for Disease Control and Prevention.
In 1977, a measles epidemic that killed two children in Los Angeles County prompted a surge in vaccine refusal efforts across the country. But during this year's epidemic, which killed two Texas children and 14 people in MexicoRepublican Gov. Greg Abbott of Texas signed a bill making it easier for parents to opt out of required vaccinations.
“When are we going to have enough people dying or seriously ill that people are going to resist and say, 'No, no, we need vaccines?' – Takagishi said. “I don’t know if we know the tipping point yet.”
“I don't have the answer,” said Emory University professor emeritus Walter Orenstein, who worked on measles for many of his 26 years at the CDC and headed the agency's immunization program from 1988 to 2004. “The resurgence of measles created the political will to support our overall immunization program. For some reason, it didn't work this time. It's just sad.”
Youth in Florida are already among the least vaccinated in the country due to relatively lax enforcement, a post-Covid backlash to vaccinations and the libertarian attitudes of government officials. Statewide, only about 89% of child care centers are fully vaccinated, with Sarasota County having the lowest rate at about 80%. To be safe from the spread of measles, a community must be 95% immunized.
As Health and Human Services Secretary Robert F. Kennedy Jr. cuts vaccine research, fills the health agency with anti-vaccination activists and spreads doubts about the safety and value of vaccination, there is little standing in the way of decisions by Florida officials that are likely to cause rates to fall further.
The Ladapo Department is ending mandates for vaccinations against hepatitis B, chickenpox, and the bacteria that cause meningitis and pneumonia. Early next year, the Florida Legislature is expected to consider repealing a 1977 law requiring children in schools and day care centers to be vaccinated against seven other diseases that can kill children: whooping cough, measles, polio, rubella, mumps, diphtheria and tetanus.
What disease comes back after measles?
In the face of these attacks, scientists are trying to predict which diseases might return and when.
A study published in April Stanford epidemiologist Matthew Kiang and colleagues estimate that even with current vaccination levels, measles, declared eliminated in the United States in 2000, is likely to become a common disease again. If measles vaccination rates dropped another 10%, there would be an average of about 450,000 cases each year, with hundreds of deaths and cases of brain damage.
But the study may overstate the threat, says Sean Truelove, an epidemic disease modeler at Johns Hopkins University who worries about the loss of public confidence due to alarmist forecasts. Still, he said, increasing measles outbreaks seem inevitable. The country is already experiencing its worst year for measles in three decades, with more than 1,500 cases reported and ongoing outbreaks in South Carolina and Minnesota.
“You don't really need to model measles if vaccination stops,” Truelove said. “In areas where there are outbreaks, every child who is not vaccinated will become infected.”
Measles is “the canary in the coal mine” for other vaccine-preventable diseases, says Sal Anzalone, a pediatrician at Health Network in Naples, Florida. “When you start getting measles, there's something more behind it.”
People who want shots will still be able to get them even if mandates are lifted, Ladapo said.
But the state's message is confusing for parents, especially poor and low-income parents, Anzalone says. They typically have a hard time bringing children to appointments unnecessarily, he said, noting that 80% of his patients are insured through Medicaid. If policies place more of the payment burden on parents, fewer people will get vaccinated, he said.
And if the number of vaccinations falls and the number of infections increases, it is not only children who will suffer. Cancer patients and people in Florida's many elderly communities will be at risk. Schools and businesses will be destroyed. The disease could derail the tourism industry, which attracted 143 million people to the state last year. (The Florida Chamber of Commerce did not respond to requests for comment.)
“Infectious diseases don't stop with people who say they're willing to take risks,” said Megan Fitzpatrick, a vaccinologist at the University of Maryland. Because of their unpredictable spread, she said, “for infectious diseases, vaccination is never an individual choice.”
Clinicians fear that lifting the mandates could cause hepatitis B, a chronic liver disease, to come back with a force, as an estimated 2 million Americans carry the virus. They also envision a return to the days when babies with a high fever had to undergo a painful and risky lumbar puncture and have blood drawn to rule out meningitis, a blood poisoning caused by bacteria. Haemophilus influenzae infection type B, which has been prevented by routine vaccination since the 1990s.
Barbara Loe Fisher, who co-founded the modern anti-mandatory vaccination movement in the early 1980s after her son had a reaction to the whooping cough vaccine then in use (and since replaced by a safer shot), is skeptical that Floridians will refuse vaccination in droves despite the lifting of mandates.
Fisher, president of the National Vaccine Information Center, moved from Virginia to southwest Florida in 2020. She said she believes vaccine injuries are underreported and that children are being vaccinated without informed consent. She acknowledged that mandates have increased coverage, but said eliminating them would increase confidence in public health and medicine.
“It is time to allow biological products such as vaccines to be subject to the laws of supply and demand,” she said, “just like any other product sold on the market.”
Sinnott, for his part, expects measles to return with a vengeance, along with worsening outbreaks of whooping cough, flu and Covid.
“They think nothing will happen. They may be right,” said Sinnott, a retired professor. “This is an experiment.”
Polio could come back, and for 77-year-old Sinnott, that's not an abstraction.
He was 7 years old when he became infected, spending six months in a wheelchair. In recent years, he suffered from post-polio syndrome – difficulty swallowing, tightness and pain in the limbs.
The first polio vaccine was licensed in 1955, the year he became ill. “I remember my mother telling me one day, ‘The line is too long,’” he said.
Sinnott forgives her parents and today's parents who are hesitant about vaccinations. He is less tolerant of some public health leaders. They should know better, he said.
