Doctors are tight-lipped as Florida moves to end decades of child vaccination mandates

SARASOTA, Fla. – Florida plans to end nearly half a century of required childhood vaccinations 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 announced on September 3 his plan to end all school-age vaccinations in the state.

“Every one of them is wrong and dripping with contempt and slavery,” he told a cheering crowd of anti-vaxxers in Tallahassee. “Who am I, as a government or anyone else, to tell you what to put in your body?” he said.

History shows that mandates increase the use of vaccines. Lower vaccination rates will mean increased rates of diseases such as measles, hepatitis, meningitis, and pneumonia – and even the return of diphtheria and polio. Many of these diseases threaten not only unvaccinated people, but also people who come into contact with them, including children and immunocompromised elderly people.

But this scientific fact was not said in Florida. Health officials have been largely silent in the face of Ladapo’s campaign — and not because they agree with him. Professor Emeritus Doug Barrett, former chair of the university’s pediatrics department and senior vice president for health affairs, said the University of Florida had muzzled infectious disease experts.

“They are asked not to talk to anyone without permission from supervisors,” he said. University spokesmen did not respond to requests for comment.

County health department officials across the state have received the same message, said John Sinnott, a retired University of South Florida professor who is 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 that vaccines “will continue to be available” to families who want them. The state did not respond to further requests for comment or an interview with Ladapo.

Many pediatricians are also silent, at least in public.

“A lot of them don’t take a strong position on whether kids need to be vaccinated,” said Neil Manimala, a urologist and president-elect of the Hillsborough County Medical Society. “They don’t want to lose business. There are enough anti-vaccine people who can criticize you on Google, posting stories about doctors who ‘want to infuse venom injections.’

History of modern vaccine mandates

Several states ended vaccination mandates early in the last century when smallpox was the only widely administered vaccine, said historian Robert Johnston of the University of Illinois-Chicago. No one has done so since other vaccines were added to the schedule. (Routine smallpox vaccination ended in 1972.)

In the 1970s, persistent measles outbreaks prompted officials to strengthen child protection by imposing school mandates in every state. Today, the partisan divide over vaccine policy in the wake of the coronavirus outbreak has changed the equation. That’s more the case in Florida than elsewhere, though lawmakers in Texas and Louisiana are also considering ending mandatory vaccination, and Idaho enables parents to get an exemption once they request it.

“This will truly be a watershed moment for families who weren’t already sure they wanted the 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 know how quickly vaccine-preventable diseases might return if Florida ends its mandates — or how the public will respond. to request In an interview Asked whether his office had modeled the disease’s outcomes before announcing it in September, Ladapo said, “Not at all.” He said that parents’ freedom of choice is not a scientific issue. “It’s a question of right and wrong.”

The Ladapo Ministry of Health did not respond a month later when asked if it was making contingency plans for the outbreak. During a 2024 measles outbreak In Broward County, Ladapo sent parents a letter giving them permission to send unvaccinated children to school, in defiance of science-backed advice from the federal Centers for Disease Control and Prevention.

In 1977, a measles epidemic that killed two children in Los Angeles County sparked a nationwide crackdown on vaccine avoidance. But during the pandemic this year that claimed the lives of two Texas children and… 14 people in MexicoRepublican Governor Greg Abbott of Texas signed a bill that makes it easier for parents to opt out of getting required doses.

Takagishi said: “When will we have enough of a massive wave of deaths or serious illnesses that prompt people to respond and say: No, no, we want vaccines?” “I don’t know if we know the tipping point yet.”

“I don’t have the answer,” said Walter Orenstein, a professor emeritus at Emory University, who worked on measles for his 26 years at the CDC and led the agency’s immunization program from 1988 to 2004. “The resurgence of measles created the political will to support our mass immunization program. For some reason, it didn’t work this time. It’s sad.”

Young people in Florida are already among the least vaccinated in the country, due to relative lax enforcement, a post-coronavirus backlash against vaccinations, and the liberal stance of state officials. Statewide, only about 89% of kindergartners are fully vaccinated, with the lowest rate in Sarasota County, at about 80%. For a community to be safe from a measles outbreak, the community must be 95% immune.

With Health and Human Services Secretary Robert F. Kennedy Jr. By cutting back on vaccine research, filling the health agency with anti-vaccine activists and spreading doubt about the safety and value of vaccination, little stands in the way of decisions made by Florida officials that are likely to cause rates to decline even further.

Ladapo department is ending authorizations for shots against hepatitis B, chickenpox, bacteria causing meningitis and pneumonia. Early next year, the Florida Legislature is expected to adopt a repeal of a 1977 law requiring school and day care children to be vaccinated against seven other diseases that can kill children: whooping cough, measles, polio, rubella, mumps, diphtheria and tetanus.

After measles, what disease comes back next?

In the face of these attacks, scientists are trying to predict which diseases are likely to reappear and when.

A A study published in April Matthew Kiang, an epidemiologist at Stanford University, and his colleagues estimate that even at current vaccination levels, measles, which was declared eliminated in the United States in 2000, is likely to become a routine disease again. If measles vaccination rates fell by a further 10%, there could be an average of about 450,000 cases per year, with hundreds of deaths and cases of brain damage.

But the study may exaggerate the threat, said Sean Truelove, an epidemiological modeler at Johns Hopkins University, who said he is concerned about losing public trust because of the alarmist projections. However, he said an intensification of the measles outbreak appears certain. The country is already in the midst of its worst year for measles in three decades, with more than 1,500 cases and current outbreaks in South Carolina and Minnesota.

“You don’t really need to model measles if vaccines stop,” Truelove said. “In pockets where the disease is endemic, every unvaccinated child will become infected.”

Measles is the “canary in the coal mine” for other vaccine-preventable diseases, said Sal Anzalone, a pediatrician at Healthcare Network in Naples, Florida. “When you start seeing measles, there’s more to come beyond that.”

People who want vaccinations will still be able to get them if the mandates are lifted, Ladapo said.

Anzalone said the state’s message confuses parents, especially the poor and disadvantaged. It’s usually difficult for them to take children to appointments unless they have to, he said, noting that 80% of his patients are insured through Medicaid. He said that if policies put more of the burden of paying on parents, fewer people would vaccinate.

If vaccinations decrease and infections increase, children will not be the only people affected. Cancer patients and people in Florida’s many senior living communities will be at risk. Schools and businesses will be closed. The disease could disrupt the tourism industry that brought 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 vaccine scientist at the University of Maryland. Because of its unpredictable spread, “in the case of an infectious disease, vaccination is never an individual choice,” she said.

Doctors fear that ending the mandates would allow hepatitis B, a chronic liver disease, to make a comeback with a vengeance, as an estimated 2 million Americans carry the virus. They also anticipate a return to the days when infants with a high temperature underwent a painful and risky lumbar puncture and blood draw to rule out meningitis, as well as blood infections caused by bacteria. Haemophilus influenzae Type B, which has been prevented by routine vaccination since the 1990s.

Barbara Lou Fisher, who co-founded the modern anti-vaccination movement in the early 1980s after her son suffered a reaction to the then-use pertussis vaccine (which has since been replaced by a safer shot), doubts that Floridians will abandon vaccination en masse, even though the mandate ends.

Fisher, president of the National Vaccine Information Center, moved from Virginia to Southwest Florida in 2020. She said she believes infections caused by vaccines are undercounted and that children are being vaccinated without informed consent. She acknowledged that mandates had increased coverage but said removing it would increase confidence in public health and medicine.

“It is time to allow biological products such as vaccines to be subject to the law of supply and demand, just like any other product sold on the market,” she said.

Sinnott, for his part, expects measles to return, along with intense whooping cough, influenza and coronavirus outbreaks.

“They think nothing will happen,” said Sinnott, the retired professor. “Maybe they’re right.” “It’s an experience.”

It is possible that polio will return, but this is not just an illusion for the 77-year-old Sinnott.

He was 7 years old when he became ill, and spent six months in a wheelchair. In recent years, he suffered from post-polio syndrome — difficulty swallowing, tightness and pain in his limbs.

The first polio vaccine was licensed in 1955, the year he became ill. “I remember my mother once told me, ‘The line is so long,’” he said.

Sinnott forgives his parents and parents today who are hesitant to get vaccinated. He’s less forgiving with some public health leaders. He said they should know better.