SARASOTA, Fla. — Florida plans to eliminate nearly half a century of mandatory childhood vaccines against diseases that have killed and left millions of children sick. Many critics, including medical professionals, are afraid to publicly oppose the decision.
With the support of Republican Gov. Ron DeSantis, Joseph Ladapo, the state's surgeon general, announced on Sept. 3 his intention to eliminate all vaccination requirements for school-age children.
“Every one of these rules is wrong and exudes contempt and slavery,” he told a crowd of anti-vaxxers in Tallahassee. “Who am I, as a government or as a person, to tell you what you should put into your body?” he added.
History shows that mandates increase vaccine uptake.
However, if vaccination rates decline, cases of diseases such as measles, hepatitis, meningitis and pneumonia will increase, and diseases such as diphtheria and polio may even return.
Many of these diseases pose a threat not only to those who are not vaccinated, but also to others, including infants and older adults with weakened immune systems.
But this scientific fact was ignored in Florida. Health authorities have remained silent in the face of Ladapo's campaign – and not because they agree. The University of Florida has silenced infectious disease experts, according to Professor Emeritus Doug Barrett, former chief of pediatrics and senior vice president for health affairs at the university.
“They tell them not to talk to anyone without permission from their superiors,” he said. University officials did not respond to requests for comment.
The same goes for county health department officials, according to John Sinnott, a retired University of South Florida professor who is friends with one of those local leaders.
The Sarasota County Health Department referred a reporter to Tallahassee state officials, who responded with a statement noting that vaccines “will continue to be available” to families who need them. The state did not respond to other requests for an interview with Ladapo or other questions.
Many pediatricians are also silent, at least publicly.
“Many people are confused about whether children should be vaccinated,” said Neil Manimala, a urologist and president-elect of the Hillsborough County Medical Association. “They don't want to lose patients. And there are enough anti-vaxxers to destroy you with Google reviews saying doctors want to 'inject poison.'
History of modern vaccination requirements
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 state did so as other vaccines were added to the list. (Routine vaccination against smallpox ended in 1972.)
In the 1970s, persistent outbreaks of measles led authorities to strengthen child protection by establishing compulsory schooling in all states. Today, political polarization over vaccines in the wake of the Covid pandemic has changed the landscape.
And that's especially true in Florida, although lawmakers in Texas and Louisiana are also considering eliminating vaccine requirements, and in Idaho, parents just need to ask for an exemption.
“This is a turning point for many families who were already hesitant about vaccinating their children and are now getting the message that it is not necessary,” said Jennifer Takagishi, vice president of the Florida chapter of the American Academy of Pediatrics.
It's unclear how quickly vaccine-preventable diseases could return if Florida lifts mandates, or how the public will react.
consulted with interview Asked whether his office had developed possible epidemiological scenarios before the September announcement, Ladapo replied: “Absolutely not.” According to the Surgeon General, parental freedom is not a scientific issue, but rather a matter of “what is right and what is wrong.”
A month later, the Florida Department of Health has not responded to questions about whether it is developing plans to deal with possible outbreaks. For measles outbreak In Broward County, Ladapo sent a letter to parents in 2024 allowing unvaccinated children to attend school, ignoring evidence-based recommendations from the Centers for Disease Control and Prevention (CDC).
In 1977, a measles outbreak that killed two children in Los Angeles County sparked a strong national backlash against vaccine refusers.
But during the recent epidemic that resulted in the deaths of two minors in Texas and 14 people in MexicoRepublican Texas Gov. Greg Abbott signed legislation making it easier for parents to avoid mandatory vaccinations.
“How many deaths or serious illnesses will it take for people to say, 'No, we need vaccines,'” Takagishi asked. “We don’t know what that tipping point will be.”
“I don't have the answer,” said Walter Orenstein, a professor emeritus at Emory University who worked on measles during his 26 years at the Centers for Disease Control and Prevention (CDC) and led the agency's immunization program from 1988 to 2004. “In the past, measles outbreaks have generated political will to support vaccination programs. This time that's not the case. It's very sad.”
Children in Florida are already among the least vaccinated in the country due to lax enforcement of requirements, vaccine refusal in the wake of the pandemic and the libertarian stance of state officials.
Statewide, only about 89% of child care centers are fully vaccinated, with Sarasota County having the lowest rate at about 80%. To prevent the spread of measles, at least 95% of the community must be vaccinated.
With Health and Human Services Secretary Robert F. Kennedy Jr. slashing funding for vaccine research, bringing anti-vaccination activists into the agency and increasing distrust in the safety and usefulness of vaccines, there is little standing in the way of decisions that could lead to even lower vaccination rates in Florida.
Ladapo's Department of Health is already waiving vaccination requirements for 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 that requires children in schools and day care centers to be vaccinated against seven other life-threatening childhood diseases: whooping cough, measles, polio, rubella, mumps, diphtheria and tetanus.
What disease will return after measles?
Faced with these attacks, the scientific community is trying to predict which diseases might reappear and when.
AND study published in April Epidemiologist Matthew Kiang of Stanford University estimates that even with current vaccination levels, measles, declared eliminated in the United States in 2000, could become a common disease again. If measles coverage dropped another 10%, there could be about 450,000 cases each year, with hundreds of deaths and brain injuries.
But the study may overstate the threat, said Sean Truelove, an expert in epidemic disease modeling at Johns Hopkins University, who has expressed concern about the loss of public confidence in alarmist forecasts.
However, he warned that measles outbreaks were likely to worsen. The country is already experiencing its worst year in three decades, with more than 1,500 cases and active outbreaks in South Carolina and Minnesota.
“There is no need to model measles if vaccination is stopped,” Truelove said. “In places where there are outbreaks, every unvaccinated child will be infected.”
Measles is the “canary in the coal mine” among other preventable diseases, says Sal Anzalone, a pediatrician at Healthcare Network in Naples, Florida. “When measles starts to appear, other diseases appear.”
Ladapo said those who want to get vaccinated will be able to continue to do so even without mandates.
However, Anzalone said the state's messaging is confusing for families, especially low-income or low-income families. Many of them find it difficult to take their children to doctor's appointments unless it is mandatory, she explained. In his practice, 80% of his patients have Medicaid. If the policy shifts more costs to parents, fewer children will be vaccinated, he added.
And if vaccination rates drop and infections increase, it's not just children who will suffer. People with cancer and the elderly, of whom there are many in Florida, will also be at risk.
Schools and businesses may experience disruption. The tourism industry, which attracted 143 million visitors last year, could also be hit. (The Florida Chamber of Commerce did not respond to requests for comment.)
“Infectious diseases don't stop with those who say they're willing to take risks,” said Megan Fitzpatrick, a vaccine expert at the University of Maryland. Because of its ability to spread, he explained, “In the case of a contagious disease, vaccination is never simply an individual decision.”
Health workers fear lifting the mandates will lead to a return of hepatitis B, a chronic liver disease, as an estimated 2 million people in the country have the virus.
There may also be a return to the days when babies with fevers had to undergo painful spinal taps and blood tests to rule out meningitis or bacterial infections, which vaccines have prevented since the 1990s.
Barbara Loe Fisher, who co-founded the modern anti-mandatory vaccination movement in the early 1980s after her son had an adverse reaction to the whooping cough vaccine (which has since been replaced by a safer one), doubts Floridians will stop getting vaccinated en masse despite the removal of the requirement.
Fisher, president of the National Vaccine Information Center, moved from Virginia to Southwest Florida in 2020. She believes vaccine-related injuries are under-reported and children are being vaccinated without informed consent. He acknowledged that mandates increase coverage, but believed that eliminating them would bolster confidence in public health and medicine.
“It’s time for biological products like vaccines to be subject to the law of supply and demand,” he said, “just like every other product on the market.”
For his part, Sinnott expects a return of measles, accompanied by more intense outbreaks of whooping cough, influenza and Covid.
“They think nothing will happen. They might be right,” said Sinnott, a retired teacher. “This is an experiment.”
Polio may also return. But for Sinnott, 77, it's not a theory.
He was 7 years old when he became infected and spent six months in a wheelchair. In recent years, he suffered from post-polio syndrome: difficulty swallowing, stiffness 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, as well as current parents, who are hesitant to vaccinate their children. He is less tolerant of some public health leaders. “They should know,” he said.
