Republican officials in Florida announced this week that they want to eliminate all vaccine mandates for schools. It’s not that simple: It will require action from state lawmakers. But the announcement raises several questions about the future spread of infectious diseases and the disproportionate impact on infants, children, the elderly and immunocompromised people in the state and country.

In a news conference Wednesday, Florida Surgeon General Dr. Joseph Ladapo said he wanted “to end all vaccine mandates in Florida law,” calling them “wrong” despite extensive evidence that they have halted the spread of disease and prevented death.

“Who am I as a government or anyone else — who am I as a man standing here now to tell you what you should put in your body?” said Ladapo, who previously challenged the safety of mRNA COVID-19 vaccines, claims that were refuted by federal officials at the time.

In Florida, state law dictates vaccine requirements for polio, diphtheria, measles, rubella, pertussis or whooping cough, mumps, tetanus “and other communicable diseases as determined by rules of the Department of Health.” Florida is one of several states that allow children an exemption based on religious grounds.

Ladapo, who in his role oversees the Florida Department of Health, said in his public remarks that the agency has rules for certain vaccine requirements that it can remove and that others will require legislative action. Ladapo said he will work “in partnership” with the state health department and Gov. Ron DeSantis to remove vaccine mandates.

The Florida Department of Health currently requires four immunizations to attend school beyond those mandated by state law. Spokesperson Katie Young told the Miami Herald that the agency will soon initiate the process of lifting requirements for chickenpox (varicella), Hepatitis B, Haemophilus influenzae type b and pneumococcal conjugate. Once this transition begins, it is expected to take about 80 days.

The immunization division of the Florida Department of Health did not immediately respond to a request for comment and clarification to Ladapo’s remarks. 

DeSantis acknowledged that undoing vaccine mandates will require “changes from the legislature.” The Republican-controlled legislature is scheduled to be in session in January, though lawmakers can be convened for special sessions.

It’s not immediately clear whether there is enough political will to advance a complete reversal of vaccine mandates, but the Florida Senate passed a bill in the spring to restrict any future use of mRNA vaccines in fruits and vegetables, even though edible vaccines are not available. The same chamber passed another bill to make it illegal to release chemicals into the atmosphere that could supposedly manipulate the weather.

Andrew Spar, president of the Florida Education Association, the state’s largest labor union with more than 120,000 members, said that restrictions on vaccines pose a threat to students and schools. He criticized DeSantis, who appeared with Ladapo as the surgeon general announced his plans for vaccines.

“I really think this is an issue of politics at play, not what’s best for kids,” Spar told The 19th. “This is clearly the governor’s political agenda, not doing what’s best for kids based on what the medical experts [say], and the overwhelming consensus in the medical field is that vaccines are important, and mandated vaccines work.”

All 50 states and Washington, D.C., require some kind of vaccines for students to attend K-12 schools, and all allow medical exemptions. These state-level policies have been a line of defense for local public health officials, some of whom have raised concerns about Health and Human Services Secretary Robert F. Kennedy Jr. as he casts doubt on vaccine policy. President Donald Trump, despite being in office at the height of COVID-19 vaccine development, has also questioned the safety of COVID-19 vaccines, ignoring evidence that they reduce severity of the disease.

Vaccine mandates date back to the 19th century and became more widespread in the 1970s and 1980s. But politics have eroded their potency in recent years as some state legislatures expand non-medical vaccine exemptions. Lawmakers have introduced more than 2,500 vaccine-related bills since 2021, including about 400 last year, according to the National Conference of State Legislatures. During that time, vaccination rates for kindergarteners have declined.

No state has gone so far as to reverse all its vaccine mandates.

“In one sense, states having control over public health is a good thing,” said Elizabeth Jacobs, a professor emerita from the Department of Epidemiology and Biostatistics at the University of Arizona who has studied the impacts of vaccine exemptions on vaccination rates. “But in situations like this, it’s a very worrying thing.”

Ladapo’s proposal is the latest iteration of a broader policy movement among Republicans known as medical freedom, which questions the role of government in health care decisions. It gained political steam at the height of the pandemic amid misinformation and disinformation about COVID-19 vaccine shots and backlash to related mandates. It has flourished amid policy restrictions on abortion and transgender health care access.

“It’s been mainstreamed through political channels, and that’s what makes this political,” Spar said. “And I don’t think it’s so much to fall in line with the president … I think what this is is the governor again trying to get his ‘be out there in the news, be seen, be the talk of the town,’ which is what’s happening.”

But school vaccine requirements have been a target of anti-vaccine activists for years, some of whom claim that they infringe on parental rights and religious freedom. Ladapo alluded to this: “What you put into your body is because of your relationship with your body and your God,” he said in his remarks.

Dr. Rana Alissa, president of the Florida chapter of the American Academy of Pediatrics, said in a statement that routine childhood vaccinations are critical in schools, where large groups of kids are often in close contact and can spread contagious diseases. Alissa said if Florida reverses its vaccine mandates, kids in the state will be at higher risk for getting sick — which could impact the larger community. 

“When everyone in a school is vaccinated, it is harder for diseases to spread and easier for everyone to continue learning and having fun,” she said. “When children are sick and miss school, caregivers also miss work, which not only impacts those families but also the local economy.”

Spar raised similar concerns, explaining that it’s not only important for children to be “in safe, welcoming schools” but also for teachers and staff to enjoy the protections that vaccine mandates provide. When students or faculty are out sick, it puts children at risk of falling behind and suffering learning loss. 

“In all of those scenarios, kids are losing out on educational time, and that’s not good for kids,” Spar said. “So from a health perspective, it’s not good for kids. From an academic perspective, it’s not good for kids.”

An ongoing measles outbreak has already raised concerns about what happens when an infectious disease spreads among children. 

“School vaccine requirements help ensure that children receive essential vaccines to protect them from a wide range of serious diseases and have been in effect for decades,” said Amanda Jezek, a spokesperson for Infectious Diseases Society of America, in a statement. “While exemptions for rare medical reasons are important, other exemptions for personal beliefs have been shown to reduce vaccination rates, endangering children and enabling resurgences of diseases like measles.”

The potential impact on herd immunity — the indirect protection of a community from an infectious disease — is expansive, said Jacobs. Falling herd immunity is most dangerous for infants, the elderly and immunocompromised people.

“Herd immunity protects all of us by sort of creating a bubble where we don’t have to come into contact with these diseases,” she said. “It’s troubling that the right to refuse vaccines is being held up above the rest of Florida’s right to not be infected with vaccine-preventable diseases. That’s also a right. We have ‘freedom to’ and we have ‘freedom from’ and this is the destruction of ‘freedom from.’ They’re saying that the right to just not vaccinate supersedes the right of everybody else not to get infected.”

A potentially unforeseen consequence of ending school vaccine mandates would be worsening a state teacher shortage described as severe by the Florida Education Association, Spar said. As of August, the state had 5,489 instructional and support staff vacancies, which is significantly down from 9,842 the year before, but is still worrisome given that large numbers of teaching positions are being filled by personnel without certification, according to the union. Collectively, controversial policies in Florida, be they curriculum restrictions or threats to end vaccine requirements, have made it difficult to attract the personnel schools there desperately need.

“I think it all contributes to the lack of respect for our teachers,” Spar said. “All of those factors play into a role as to why teachers are not coming into the profession … We have teachers and staff who just won’t work under the conditions we have.”