SARASOTA, Fla. — Florida plans to end childhood vaccinations that have been required for nearly half a century against diseases that have killed and maimed millions of children. Many critics of this decision, including doctors, are afraid to speak out.
With the support of Republican Gov. Ron DeSantis, Surgeon General Joseph Ladapo announced plans Sept. 3 to end all school-age vaccination mandates in the state.
“Every last one of them is wrong and dripping with contempt and slavery,” he told a cheering crowd of anti-vaccination opponents in Tallahassee. “Who am I, as a government or anyone else, to tell you what you should put in your body?” he said.
History shows that mandates increase vaccine use. Lower immunization rates can increase the incidence of diseases such as measles, hepatitis, meningitis and pneumonia, and may lead to a return of diphtheria and polio. Many of these diseases pose a threat not only to unvaccinated people but also to those they come into contact with, including babies and the elderly with weakened immune systems.
But in Florida, the science remains unknown. Health officials have remained largely silent about Radapo’s campaign. This is not because I agree with Radapo. Doug Barrett, professor emeritus and former senior vice president for health and chief of pediatrics at the University of Florida, said the university has confused infectious disease experts.
“I was told not to tell anyone without permission from my supervisor,” he said. A university spokesperson did not respond to a request for comment.
County health department officials across the state have received the same message, said John Sinnott, a retired professor at the University of South Florida and a friend of one of the county’s health leaders.
The Sarasota County Health Department referred a reporter to state officials in Tallahassee, who responded with a statement saying the vaccine “will continue to be available” to families who want it. The state did not respond to requests for further comment or an interview with Ladapo.
Many pediatricians also remain silent, at least publicly.
“A lot of people don’t take a strong position on 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 business, and there are a lot of anti-vaccine people out there who will Google you and spread stories about clinicians who ‘want to inject you with poison.’”
History of modern vaccine mandates
Several states ended their vaccination mandates early in the last century, when smallpox was the only widely administered vaccine, said Robert Johnston, a historian at the University of Illinois-Chicago. No one has done so since another vaccine was added to the schedule. (Routine smallpox vaccination ended in 1972.)
As measles outbreaks continued in the 1970s, officials increased school mandates in every state to better protect children. Today, the partisan divide over vaccine policy caused by the COVID-19 outbreak has changed the equation. Legislators in Texas and Louisiana are also considering ending mandatory vaccinations, and in Idaho, where parents can obtain exemptions simply by request, this is not the case as much as in Florida.
“This is really a watershed moment for families who were already unsure if they wanted to get the vaccine and are now being told they don’t need it,” said Jennifer Takagishi, vice president of the Florida chapter of the American Academy of Pediatrics.
It’s difficult to know how quickly vaccine-preventable diseases could return if Florida ends its order, or how the public will react. Asked in an interview “Absolutely not,” Ladapo said, if his office had modeled the disease outcome before the September announcement. He said parental freedom of choice is not a scientific issue. “It’s a question of right and wrong.”
Radapo’s health ministry did not respond when asked whether it was making contingency plans for an outbreak a month later. During a measles outbreak in Broward County in 2024, Ladapo ignored scientifically based advice from the federal Centers for Disease Control and Prevention and sent letters to parents authorizing them to send unvaccinated children to school.
A 1977 measles epidemic that killed two children in Los Angeles County sparked a dramatic crackdown on vaccine avoidance across the country. But this year, two Texas children have died due to the pandemic. Mexico 14In Texas, Republican Gov. Greg Abbott signed a bill that would make it easier for parents to opt out of required vaccinations.
“When will we have enough people dying or getting seriously ill to make us step back and say, ‘No, no, we want a vaccine,’” Takagishi said. “I don’t know if we know the tipping point yet.”
“I don’t know the answer,” said Walter Orenstein, a professor emeritus at Emory University who worked on measles treatment at CDC from 1988 to 2004 and led CDC’s immunization program from 1988 to 2004. “The resurgence of measles has created the political will to support our overall immunization program. For some reason it didn’t work this time. It’s just sad.”
Florida’s young people are already among the least vaccinated in the country due to relatively lax enforcement, the post-COVID backlash over the shootings and the liberal attitudes of state officials. Statewide, only about 89% of kindergartners are fully vaccinated, with Sarasota County having the lowest rate at about 80%. To be safe from the spread of measles, 95% of a community must be vaccinated.
With Health and Human Services Secretary Robert F. Kennedy Jr. halting vaccine research, filling health agencies with anti-vaccination activists and spreading doubts about the safety and value of vaccinations, there is little standing in the way of decisions by Florida officials that are likely to further reduce vaccination rates.
Ladapo’s department will end vaccination obligations for hepatitis B, chicken pox, the bacteria that cause meningitis and pneumonia. Early next year, Florida lawmakers are expected to overturn a 1977 law requiring children attending school and day care to be vaccinated against seven diseases that can kill children, including whooping cough, measles, polio, rubella, mumps, diphtheria and tetanus.
What diseases come back after measles?
In the face of these attacks, scientists are attempting to predict which diseases will reemerge and when.
no way Study published in April Stanford epidemiologist Mathew Kiang and colleagues estimated that even with current vaccination levels, measles, which was declared eliminated from the United States in 2000, is likely to become a routine disease again. A further 10% drop in measles vaccination coverage could result in an average of about 450,000 cases per year, hundreds of deaths and brain damage.
But Shaun Truelove, an infectious disease modeler at Johns Hopkins University, said he was worried that alarmist forecasts would lose public trust. Nonetheless, he said it seemed certain that the measles outbreak would intensify. The United States is already experiencing its worst measles outbreak in 30 years, with more than 1,500 cases now in South Carolina and Minnesota.
“If the vaccine is discontinued, there is no need to model measles,” Truelove said. “In areas where there is an outbreak, every unvaccinated child will be infected.”
Measles is a “canary in the coal mine” for other vaccine-preventable diseases, said Sal Anzalone, a pediatrician at Healthcare Network in Naples, Florida. “Once you start seeing measles, there will be more to follow.”
Ladapo said people who want to be vaccinated will still be able to get vaccinated even if the mandate is repealed.
But the state’s message confuses parents, especially the poor and underserved, Anzalone said. He pointed out that 80% of his patients are insured through Medicaid, and said it is generally difficult to bring children to appointments unless absolutely necessary. If the policy places a greater burden on parents to pay, fewer people will get vaccinated, he said.
And if vaccinations decline and infections rise, children will not be the only ones affected. Cancer patients and people in Florida’s numerous senior communities will be at risk. Schools and businesses will be disrupted. The disease could hamper the tourism industry, which brought 143 million people to the state last year. (The Florida Chamber of Commerce did not respond to a request for comment.)
“The epidemic is not limited to people who say they are willing to take the risk,” said Meagan Fitzpatrick, a vaccinologist at the University of Maryland. She said that because of the unpredictable spread, “vaccination is never a personal choice in the case of a pandemic.”
Clinicians worry that the chronic liver disease hepatitis B could return once the mandate ends, as about 2 million Americans carry the virus. They also foresee a return to the days when infants with high fevers had to undergo painful and risky lumbar punctures and blood draws to rule out meningitis and bacterial blood infections. Haemophilus influenzae Type B has been prevented through routine vaccination since the 1990s.
Barbara Loe Fisher, who co-founded the modern movement against vaccine mandates in the early 1980s after her son suffered a reaction to the whooping cough vaccine he was using at the time (and was later replaced by a safer vaccine), feared that Floridians would abandon vaccinations en masse despite the end of mandates. I’m skeptical.
Fisher, director of the National Vaccine Information Center, moved from Virginia to Southwest Florida in 2020. She said she believes vaccine injuries are undercounted and children are vaccinated without informed consent. She acknowledged that the order increased coverage, but said eliminating it would increase public health and trust in health care.
“It is time to allow the laws of supply and demand to apply to biological products such as vaccines as they do to other products sold on the market,” she said.
Sinnott expects measles to return as pertussis, influenza and COVID-19 outbreaks intensify.
“They think nothing will happen. Maybe they’re right,” said Sinnott, a retired professor. “It’s an experiment.”
Polio can recur, and this is not an abstract concept for Sinnott (77).
He was seven years old when he contracted the disease and spent six months in a wheelchair. In recent years, he has suffered from post-polio syndrome (difficulty swallowing, pressure 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 time, ‘The line is too long,’” he said.
Sinnott forgives his parents and those today who are hesitant about vaccinations. He is less tolerant of certain public health leaders. They should know better, he said.
