Florida’s anti-vaccine push leads dangerous shift for US public health

Scepticism around vaccines has reached new heights in the US, with Florida officials pushing to eliminate all vaccine mandates, including those for schoolchildren. The move may embolden other states to follow suit, and also risks triggering a resurgence in childhood illnesses long kept at bay.

“If I were a virus, I would throw a party right now,” says Cynthia Leifer at Cornell University in New York state. “The potential removal of all vaccine mandates in Florida will allow diseases that have been kept in check for decades to rear their ugly heads again.”

Once relegated to the sidelines, the anti-vaccine movement has become a significant force in the US since the covid-19 pandemic. Florida is a prime example. In 2022, it became the first state to recommend against covid-19 mRNA vaccination for most children. Two years later, it extended that guidance to everyone. Now, it could become the only state to eliminate vaccine mandates entirely.

“The Florida Department of Health, in partnership with the governor, is going to be working to end all vaccine mandates in Florida law,” announced Joseph Ladapo, the state’s top public health official, on 3 September. “Every last one of them is wrong and drips with disdain and slavery.”

Like every US state, Florida legally requires children to be vaccinated against several diseases before they enter school. While the Florida Department of Health, which Ladapo oversees, has significant authority when it comes to school vaccine mandates, state lawmakers are the only ones who can repeal all vaccine requirements.

In a statement to the Associated Press, the state health department said the planned rule change would affect vaccines for hepatitis B, chickenpox, Haemophilus influenzae type b (Hib) and pneumococcal diseases. Other vaccines, including those for polio and measles, are still required for school attendance under state law, unless lawmakers repeal legislation.

Vaccine mandates are a large reason why the US has one of the highest immunisation rates in the world – and why outbreaks of illnesses such as polio, diphtheria and whooping cough are a distant memory. Doing away with them would jeopardise decades of public health progress and place lives at risk. A 2024 report from the US Centers for Disease Control and Prevention (CDC) estimates that routine childhood immunisations saved nearly 1.13 million lives and prevented about 508 million infections among children born between 1994 and 2023.

“Vaccines have become a victim of their own success, because people stopped seeing the suffering of children from vaccine-preventable diseases,” says Leifer.

Much of the pushback against vaccines stems from concerns about their side effects. But studies show these risks pale in comparison with those posed by infection. For instance, the likelihood of developing myocarditis, or inflammation of the heart, is about seven times higher with a previous covid-19 infection than from vaccination. Meanwhile, 1 in 1000 people with measles will develop dangerous inflammation in the brain, called encephalitis, compared with only 1 in 1 million children who are immunised.

During a press conference, Ladapo didn’t provide a scientific justification for repealing vaccine mandates. The Florida Department of Public Health also didn’t respond to questions from New Scientist about whether he had one. Instead, he appealed to individuals’ religious freedoms.

“Who am I as a man standing here now to tell you what you should put into your body? Who am I to tell you what your child should put in [their] body?” he said. “I don’t have that right. Your body is a gift from God.”

But this explanation overlooks the fact that more than half of states, including Florida, allow people to forego mandated vaccines for religious reasons. Sixteen states also allow exemptions for personal reasons, such as philosophical disagreements, and all states have medical exemptions.

It is difficult to know how far immunisation rates would fall if school mandates were repealed. But the data is clear that doing the opposite – strengthening requirements – boosts vaccine uptake. For instance, Maine removed personal and religious exemptions for mandated vaccines in 2019. As a result, more than 95 per cent of school-aged children had received all required vaccines by 2024. That is the threshold at which herd immunity is achieved for measles, or when most people in a community are protected from infection.

Less than 89 per cent of children starting kindergarten – which usually begins at about age 5 – in Florida were vaccinated during the 2024-2025 school year. To achieve herd immunity, the state should be working to increase immunisation rates if it wants to protect public health. Instead, it is undermining them.