Florida’s Surgeon General, Dr. Joseph Ladapo, plans to remove the state’s vaccine mandates—a move that will lead to more infections, hospitalizations, and likely even some deaths of young children in the state.
Lifting the mandate would almost certainly lead to lower vaccine uptake in Florida, and it will have implications for Americans more widely. Florida would be the first state to formally lift the vaccine mandate and may inspire other states to drop the requirement for children to get vaccinated before being able to attend school. It will also worsen the declining confidence in vaccines that a growing number of Americans are experiencing, influenced by the vaccine-skeptical rhetoric of Ladapo, Secretary of Health and Human Services Robert F. Kennedy Jr., and other officials.
The requirement for children to have vaccines in order to attend school has helped the U.S. maintain relatively high vaccine coverage against many terrible diseases, including measles, mumps, rubella, tetanus, diphtheria, pertussis, and more.
But that can quickly go away. The U.S. has already started seeing a growth in the proportion of parents requesting non-medical exemptions, where they can opt their children out of required vaccines on philosophical or religious grounds. The increasing number of non-medical exemptions is one reason why the national MMR rates for kindergarteners dropped below 95%—the recommended threshold for herd immunity—in 2023 and continues to decline. There have been similar drops in vaccination coverage and increases in exemptions for other childhood vaccines.
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There is a lot of evidence that communities with more non-medical exemptions from vaccine mandates have a higher risk of disease outbreaks. Relatively high coverage at the national and state levels obscures the fact that in some local areas, vaccine coverage is low due to high numbers of exemptions, putting clusters of children at greater risk of disease.
Florida doesn’t have the best record on vaccination as it stands. The latest data from the U.S. Centers for Disease Control and Prevention (CDC) shows that 11.2% of eligible children in the state have not received both doses of the MMR vaccine, and more than 5% of eligible children are currently exempted from vaccination. Both figures are higher than the national average (although some states are much higher, with exemptions in states like Utah and Idaho being two and three times higher, respectively, than in Florida). Vaccine coverage in some counties is lower still. In Sarasota County for example, less than 80% of kindergartners are vaccinated, partly because non-medical exemptions are more than double the state average—leaving schools and child-care centers vulnerable to outbreaks.
Lifting the vaccine mandate will compound this problem, making it much easier for hesitant parents to not get their children vaccinated. While it is incumbent on medical practitioners and public-health authorities to understand and respond to parents’ concerns by discussing why vaccines are safe and effective, it’s also crucial to make it as easy as possible to get children vaccinated. Lifting the vaccine requirement will signal to some parents that vaccines aren’t that important.
This comes at a time when much medical misinformation about vaccines is spread across and beyond the U.S.—not least by key figures like Ladapo and Kennedy. Lapado has a history of controversial and sometimes misinformed views, especially around COVID-19 vaccines and preventative policies. He has cited falsehoods around mNRA vaccines and spread spurious claims around debunked COVID-19 “treatments” like ivermectin. Kennedy is attacking immunizations on a much larger scale, pushing an anti-vaccine agenda, according to top CDC officials who resigned over Kennedy’s leadership.
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At the heart of the matter is the question of whether vaccination is to be seen as individual choice or collective responsibility. In announcing the plans, Ladapo asked, “Who am I to tell you what your child should put in their body?” Yet minimizing and possibly even eradicating infectious diseases is a collective act that requires nearly everyone to play their part.
Perhaps the biggest concern is that the rhetoric around the removal of the mandates will likely worsen the declining confidence in childhood vaccines we are seeing. A poll from last year found that only four-in-ten Americans felt that it was “extremely important” that parents get their children vaccinated, compared to six-in-ten just five years ago. This aligns with global trends where confidence in vaccines has been declining in many countries.
There are a number of reasons why the perceived importance of vaccines has declined. One, ironically, is their success. Globally, vaccines have saved over 150 million lives in the past 50 years. In the U.S. and other countries, most people, including many doctors, rarely if ever encounter cases of diseases like polio. If the U.S. fails to keep vaccine coverage high, we risk seeing more infectious disease outbreaks amongst children—and learning the hard way why vaccines were such a celebrated public-health invention in the first place.
