Florida is about to see a much larger number of sick children

Florida Surgeon General Dr. Joseph Ladabaugh is planning to lift the state’s vaccination requirement, a move that will lead to more infections, hospitalizations, and possibly even some deaths among young children in the state.

Removing the requirement will almost certainly lead to a decline in vaccination uptake in Florida and will have ramifications for Americans more broadly. Florida will be the first state to formally lift the vaccination requirement and could inspire other states to lift the requirement for children to be vaccinated before they start school. It will also exacerbate the declining confidence in vaccines that a growing number of Americans are experiencing, influenced by the vaccine-skeptical rhetoric of Ladabaugh, Secretary of Health and Human Services Robert F. Kennedy Jr., and other officials.

Requiring vaccinations for school attendance has helped the United States maintain relatively high vaccination coverage against many serious diseases, including measles, mumps, rubella, tetanus, diphtheria, pertussis, and others.

But this situation could quickly change. The United States has already begun to see a growth in the percentage of parents requesting non-medical exemptions, where they can choose to exempt their children from mandatory vaccines for philosophical or religious reasons. The increasing number of non-medical exemptions is one reason why national measles, mumps, and rubella (MMR) rates for kindergarteners fell below 95%—the recommended threshold for achieving herd immunity—in 2023 and continued to decline. The state has seen similar declines in vaccination coverage and increases in exemptions for other childhood vaccines.

There is ample evidence that communities with a greater number of non-medical exemptions from mandatory vaccination are more vulnerable to disease outbreaks. The relatively high coverage at the national and state levels masks the fact that vaccine coverage in some local areas is low due to the high number of exemptions, increasing the risk of clusters of children becoming ill.

Florida currently has a less than favorable vaccination record. 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 that more than 5% of them are currently exempt from vaccination. Both numbers are higher than the national average (though some states are much higher, with exemptions in states like Utah and Idaho being two and three times higher, respectively, than Florida). Vaccination coverage in some counties is even lower. In Sarasota County, for example, less than 80% of kindergarteners are vaccinated, in part because non-medical exemptions are more than double the state average, leaving schools and childcare centers vulnerable to outbreaks.

Limiting vaccination requirements would exacerbate this problem, making it easier for hesitant parents to opt out of vaccinating their children. While it is the responsibility of medical practitioners and public health agencies to understand and respond to parents’ concerns by discussing the safety and effectiveness of vaccines, it is also essential to make vaccination as easy as possible for children. Lifting the vaccination requirement would signal to some parents that vaccines aren’t that important.

This comes at a time when there is a lot of medical misinformation about vaccines spreading throughout the United States and abroad, particularly by prominent figures like Ladabbo and Kennedy. Ladabbo has a history of controversial, and sometimes misleading, views, particularly regarding COVID-19 vaccines and preventative policies. He has cited falsehoods about vaccines from the National Institute of Allergy and Infectious Diseases (NIA) and spread false claims about disproven COVID-19 “cures” like ivermectin. Kennedy attacks vaccinations on a much broader scale, promoting an anti-vaccine agenda, according to senior CDC officials who resigned over Kennedy’s leadership.

The crux of the matter is whether vaccination is an individual choice or a collective responsibility. When announcing the plans, Ladabbo asked, “Who am I to tell you what your child should be getting?” However, reducing, and perhaps even eliminating, infectious diseases is a collective effort that requires almost everyone to do their part.

Perhaps the most concerning aspect is that the rhetoric surrounding rescinding these measures will likely exacerbate the declining confidence in childhood vaccines we are already witnessing. A poll conducted last year showed that only four in ten Americans see it as “very important” for parents to vaccinate their children, compared to six in ten just five years ago. This aligns with global trends that are seeing declining confidence in vaccines in many countries.

There are several reasons for the decline in the perceived importance of vaccines. Ironically, one of them is their success. Globally, vaccines have saved more than 150 million lives over the past 50 years. In the United States and other countries, most people, including many doctors, rarely encounter cases of diseases like polio. If the United States fails to maintain high vaccination coverage, we risk seeing more outbreaks of infectious diseases among children—and learning the hard way why vaccines were such a celebrated public health invention in the first place.