vaccination

US states have relied on vaccine mandates since the 1800s, when a smallpox vaccine offered the first successful protection against a disease that had killed millions.

More than a century later, Florida’s top public health official said vaccine requirements are unethical and unnecessary for high vaccination rates.

“You can still have high vaccination numbers, just like the other countries who don’t do any mandates like Sweden, Norway, Denmark, the [United Kingdom], most of Canada,” Florida Surgeon General Dr Joseph Ladapo said on October 16. “No mandates, really comparable vaccine uptake.”

It’s true that some countries without vaccine requirements have high vaccination rates, on a par with the United States. But experts say that fact alone does not make it a given that the US would follow the same pattern if it eliminates school vaccination requirements.

Florida state law currently requires students in public and private schools from daycare through 12th grade to have specific immunisations. Families can opt out for religious or medical reasons. About 11 percent of Florida kindergarteners are not immunised, recent data shows. With Florida Governor Ron DeSantis’s backing, Ladapo is pushing to end the state’s school vaccine requirements.

The countries Ladapo cited – Sweden, Norway, Denmark, the UK and parts of Canada – don’t have broad vaccine requirements, research shows. Their governments recommend such protections, though, and their healthcare systems offer conveniently accessible vaccines, for example.

UNICEF, a United Nations agency which calls itself the “global go-to for data on children”, measures how well countries provide routine childhood immunisations by looking at infant access to the third dose in a DTaP vaccine series that protects against diphtheria, tetanus and pertussis (whooping cough).

In 2024, UNICEF and the World Health Organization (WHO) reported that 94 percent of one-year-olds in the United States had received three doses of the DTaP vaccine. That’s compared with Canada at 92 percent, Denmark at 96 percent, Norway at 97 percent, Sweden at 96 percent and the UK at 92 percent.

Universal, government-provided healthcare and high trust in government likely influence those countries’ vaccine uptake, experts have said. In the US, many people can’t afford time off work or the cost of a doctor’s visit. There’s also less trust in the government. These factors could prevent the US from having similar participation rates should the government eliminate school vaccine mandates.

Universal healthcare, stronger government trust increase vaccination

Multiple studies have linked vaccine mandates and increased vaccination rates. Although these studies found associations between the two, the research does not prove that mandates alone cause increased vaccination rates. Association is not the same as causation.

Other factors that can affect vaccination rates often accompany mandates, including local efforts to improve vaccination access, increase documentation and combat vaccine hesitancy and refusal.

The countries Ladapo highlighted are high-income countries with policies that encourage vaccination and make vaccines accessible.

In Sweden, for example, where all vaccinations are voluntary, the vaccines included in national programmes are offered for free, according to the Public Health Agency of Sweden.

Preventive care is more accessible and routine for everyone in countries such as Canada, Denmark, Norway, Sweden and the UK with universal healthcare systems, said Dr Megan Berman of the University of Texas Medical Branch’s Sealy Institute for Vaccine Sciences.

“In the US, our healthcare system is more fragmented, and access to care can depend on insurance or cost,” she said.

More limited healthcare access, decreased institutional trust and anti-vaccine activists’ influence set the US apart from those other countries, experts said.

Some of these other countries’ cultural norms favour the collective welfare of others, which means people are more likely to get vaccinated to support the community, Berman said.

Anders Hviid, an epidemiologist at Statens Serum Institut in Copenhagen, told The Atlantic that it’s misguided to compare Denmark’s health situation with the US – in part because Danish citizens strongly trust the government to enact policies in the public interest.

By contrast, as of 2024, fewer than one in three people in the US over age 15 reported having confidence in the national government, according to data from the Organisation for Economic Co-operation and Development, a group of advanced, industrialised nations. That’s the lowest percentage of any of the countries Ladapo mentioned.

“The effectiveness of recommendations depends on faith in the government and scientific body that is making the recommendations,” said Dr Richard Rupp, of the University of Texas Medical Branch’s Sealy Institute for Vaccine Sciences.

Without mandates, vaccine education would be even more important, experts say

Experts said they believe US vaccination rates would fall if states ended school vaccine mandates.

Maintaining high vaccination rates without mandates would require health officials to focus on other policies, interventions and messaging, said Samantha Vanderslott, the leader of the Oxford Vaccine Group’s Vaccines and Society Unit, which researches attitudes and behaviour towards vaccines.

That could be especially difficult given that the United States’s top health official, Health and Human Services Secretary Robert F Kennedy Jr, has a long history of anti-vaccine activism and scepticism about vaccines.

That makes the US an outlier, Vanderslott said.

“Governments tend to promote/support vaccination as a public health good,” she said. It is unusual for someone with Kennedy’s background to hold a position where he has the power to spread misinformation, encourage vaccine hesitancy and reduce mainstream vaccine research funding and access, Vanderslott said.

Most people decide to follow recommendations based on their beliefs about a vaccine’s benefits and their child’s vulnerability to disease, Rupp said. That means countries that educate the public about vaccines and illnesses will have better success with recommendations, he said.

Ultimately, experts said that just because something worked elsewhere doesn’t mean it will work in the United States.

Matt Hitchings, a biostatistics professor at the University of Florida’s College of Public Health and Health Professions, said a vaccine policy’s viability could differ from country to country. Vaccination rates are influenced by a host of factors.

“If I said that people in the UK drink more tea than in the US and have lower rates of certain cancers, would that be convincing evidence that drinking tea reduces cancer risk?” Hitchings said.

Google Translate was used throughout the research of this story to translate websites and statements into English.

NEW YORK — For the first time in 30 years, the American Academy of Pediatrics is substantially diverging from U.S. government vaccine recommendations.

The group’s new COVID-19 recommendations — released Tuesday — come amid a tumultuous year for public health, as vaccine skeptics have come into power in the new Trump administration and government guidance has become increasingly confusing.

This isn’t going to help, acknowledged Dr. James Campbell, vice chair of the AAP infectious diseases committee.

“It is going to be somewhat confusing. But our opinion is we need to make the right choices for children to protect them,” he added.

The AAP is strongly recommending COVID-19 shots for children ages 6 months to 2 years. Shots also are advised for older children if parents want their kids vaccinated, the AAP said.

That differs from guidance established under U.S. Health Secretary Robert F. Kennedy Jr., which doesn’t recommend the shots for healthy children of any age but says kids may get the shots in consultation with physicians.

Children ages 6 months to 2 years are at high risk for severe illness from COVID-19, and it was important that recommendations continue to emphasize the need for them to get vaccinated, said Campbell, a University of Maryland infectious diseases expert.

Vaccinations also are recommended for older children who have chronic lung diseases or other conditions that put them at higher risk for severe disease, the AAP said.

In a statement, Department of Health and Human Services spokesperson Andrew Nixon said “the AAP is undermining national immunization policymaking with baseless political attacks.”

He accused the group of putting commercial interests ahead of public health, noting that vaccine manufacturers have been donors to the AAP’s Friends of Children Fund. The fund is currently paying for projects on a range of topics, including health equity and prevention of injuries and deaths from firearms.

The 95-year-old Itasca, Illinois-based organization has issued vaccination recommendations for children since the 1930s. In 1995, it synced its advice with recommendations made by the federal government’s Centers for Disease Control and Prevention.

There have been a few small differences between AAP and CDC recommendations since then. For example, the AAP has advised that children get HPV vaccinations starting at age 9; the CDC says that’s OK but has emphasized vaccinations at ages 11 and 12.

But in 30 years, this is the first time the recommendations have differed “in a significant or substantial way,” Campbell said.

Until recently, the CDC — following recommendations by infectious disease experts — has been urging annual COVID-19 boosters for all Americans ages 6 months and older.

But in May, U.S. Health Secretary Robert F. Kennedy Jr. announced that COVID-19 vaccines are no longer recommended for healthy children and pregnant women. A few days later, the CDC issued language that healthy children may get the shots, but that there was no longer a “should” recommendation.

The idea that healthy older kids may be able to skip COVID-19 boosters has been brewing for some time among public health experts. As the COVID-19 pandemic has waned, experts have increasingly discussed the possibility of focusing vaccination efforts on people 65 and older — who are among those most as risk for death and hospitalization.

A CDC expert panel in June was set to make recommendations about the fall shots. Among the options the panel was considering was whether suggest shots for high-risk groups but still giving lower-risk people the choice to get vaccinated.

But Kennedy bypassed the group, and also decided to dismiss the 17-member panel and appoint his own, smaller panel, that included vaccine skeptics. Kennedy also later excluded the AAP, the American Medical Association and other top medical organizations from working with the advisers to establish vaccination recommendations.

Kennedy’s new vaccine panel has yet to vote on COVID-19 shot recommendations.

The panel did endorse continuing to recommend fall flu vaccinations, but also made a decision that led to another notable difference with the AAP.

The new advisory panel voted that people should only get flu vaccines that are packaged as single doses and do not contain the preservative thimerosal.

The AAP said there is no evidence of harm from the preservative, and recommended doctors use any licensed flu vaccine product that’s appropriate for the patient.

Stobbe writes for the Associated Press.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

SIOUX FALLS, S.D. — In the time before widespread vaccination, death often came early.

Devastating infectious diseases ran rampant in America, killing millions of children and leaving others with lifelong health problems. These illnesses were the main reason why nearly 1 in 5 children in 1900 never made it to their 5th birthday.

Over the next century, vaccines virtually wiped out long-feared scourges like polio and measles and drastically reduced the toll of many others. Today, however, some preventable, contagious diseases are making a comeback as vaccine hesitancy — often fed by misinformation — pushes immunization rates down. And well-established vaccines are facing suspicion even from public officials, including the head of the U.S. Department of Health and Human Services, Robert F. Kennedy Jr., a longtime anti-vaccine activist.

“This concern, this hesitancy, these questions about vaccines are a consequence of the great success of the vaccines — because they eliminated the diseases,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center. “If you’re not familiar with the disease, you don’t respect or even fear it. And therefore you don’t value the vaccine.”

Anti-vaccine activists even portray the shots as a threat, focusing on the rare risk of serious side effects while ignoring the far larger risks posed by the diseases — and years of real-world data that experts say prove the vaccines are safe.

Some Americans know the reality of these preventable diseases all too well. For them, news of measles outbreaks and rising whooping cough cases brings back terrible memories of lives forever changed — and a longing to spare others from similar pain.

Getting rubella while pregnant

With a mother’s practiced, guiding hand, 80-year-old Janith Farnham helped steer her 60-year-old daughter’s walker through a Sioux Falls art center. They stopped at a painting of a cow wearing a hat.

Janith pointed to the hat, then to her daughter Jacque’s Minnesota Twins cap. Jacque did the same.

“That’s so funny!” Janith said, leaning in close to say the words in sign language too.

Jacque was born with congenital rubella syndrome, which can cause a host of issues including hearing impairment, eye problems, heart defects and intellectual disabilities. There was no vaccine against rubella back then, and Janith contracted the viral illness very early in the pregnancy, when she had up to a 90% chance of giving birth to a baby with the syndrome.

Janith recalled knowing “things weren’t right” almost immediately. The baby wouldn’t respond to sounds or look at anything but lights. She didn’t like to be held close. Her tiny heart sounded like it purred — evidence of a problem that required surgery at 4 months old.

Janith did all she could to help Jacque thrive, sending her to the Colorado School for the Deaf and the Blind and using skills she honed as a special education teacher. She and other parents of children with the syndrome shared insights in a support group.

Meanwhile, the condition kept taking its toll. As a young adult, Jacque developed diabetes, glaucoma and autistic behaviors. Eventually, arthritis set in.

Today, Jacque lives in an adult residential home a short drive from Janith’s place. Above her bed is a net overflowing with stuffed animals. On a headboard shelf are photo books Janith created, filled with memories such as birthday parties and trips to Mt. Rushmore.

Jacque’s days typically begin with an insulin shot and breakfast before she heads off to a day program. She gets together with her mom four or five days a week. They often hang out at Janith’s town home, where Jacque has another bedroom decorated with her own artwork and quilts Janith sewed for her. Jacque loves playing with Janith’s dog, watching sports on television and looking up things on her iPad.

Janith marvels at Jacque’s sense of humor, gratefulness, curiosity and affectionate nature despite all she’s endured. Jacque is generous with kisses and often signs “double I love yous” to family, friends and new people she meets.

“When you live through so much pain and so much difficulty and so much challenge, sometimes I think: Well, she doesn’t know any different,” Janith said.

Given what her family has been through, Janith believes younger people are being selfish if they choose not to get their children the MMR shot against measles, mumps and rubella.

“It’s more than frustrating. I mean, I get angry inside,” she said. “I know what can happen, and I just don’t want anybody else to go through this.”

Consequences of delaying vaccine

More than half a century has passed, but Patricia Tobin still vividly recalls getting home from work, opening the car door and hearing her mother scream. Inside the house, her little sister Karen lay unconscious on the bathroom floor.

It was 1970, and Karen was 6. She’d contracted measles shortly after Easter. Though an early vaccine was available, it wasn’t required for school in Miami where they lived. Karen’s doctor discussed immunizing the first-grader, but their mother didn’t share his sense of urgency.

“It’s not that she was against it,” Tobin said. “She just thought there was time.”

Then came a measles outbreak. Karen — whom Tobin described as a “very endearing, sweet child” who would walk around the house singing — quickly became very sick. The afternoon she collapsed in the bathroom, Tobin, then 19, called the ambulance. Karen never regained consciousness.

“She immediately went into a coma and she died of encephalitis,” said Tobin, who stayed at her bedside in the hospital. “We never did get to speak to her again.”

Today, all states require that children get certain vaccines to attend school. But a growing number of people are making use of exemptions allowed for medical, religious or philosophical reasons. Vanderbilt’s Schaffner said fading memories of measles outbreaks were exacerbated by a fraudulent, retracted study claiming a link between the MMR shot and autism.

The result? Most states are below the 95% vaccination threshold for kindergartners — the level needed to protect communities against measles outbreaks.

“I’m very upset by how cavalier people are being about the measles,” Tobin said. “I don’t think that they realize how destructive this is.”

Polio changed a life twice

One of Lora Duguay’s earliest memories is lying in a hospital isolation ward with her feverish, paralyzed body packed in ice. She was 3 years old.

“I could only see my parents through a glass window. They were crying and I was screaming my head off,” said Duguay, 68. “They told my parents I would never walk or move again.”

It was 1959, and Duguay, of Clearwater, Fla., had polio. It mostly preyed on children and was one of the most feared diseases in the U.S., experts say, causing some terrified parents to keep children inside and avoid crowds during epidemics.

Given polio’s visibility, the vaccine against it was widely and enthusiastically welcomed. But the early vaccine that Duguay got was only about 80% to 90% effective. Not enough people were vaccinated or protected yet to stop the virus from spreading.

Duguay initially defied her doctors. After intensive treatment and physical therapy, she walked and even ran — albeit with a limp. She got married, raised a son and worked as a medical transcriptionist.

But in her early 40s, she noticed she couldn’t walk as far as she used to. A doctor confirmed she was in the early stages of post-polio syndrome, a neuromuscular disorder that worsens over time.

One morning, she tried to stand up and couldn’t move her left leg.

After two weeks in a rehab facility, she started painting to stay busy. Eventually, she joined arts organizations and began showing and selling her work. Art “gives me a sense of purpose,” she said.

These days, she can’t hold up her arms long enough to create big oil paintings at an easel. So she pulls her wheelchair up to an electric desk to paint on smaller surfaces such as stones and petrified wood.

The disease that changed her life twice is no longer a widespread problem in the country.

So many children get the vaccine — which is far more effective than earlier versions — that it doesn’t just protect individuals but it prevents occasional cases that arrive in the U.S. from spreading further. “Herd immunity” keeps everyone safe by preventing outbreaks that can sicken the vulnerable.

But after three decades of eradication, the U.S. has seen isolated polio outbreaks in recent years, typically in communities with low vaccination rates.

After whooping cough, ‘she was gone’

Every night, Katie Van Tornhout rubs a plaster cast of a tiny foot, a vestige of the daughter she lost to whooping cough at just 37 days old.

Callie Grace was born on Christmas Eve 2009 after Van Tornhout and her husband tried five years for a baby. She arrived six weeks early but healthy.

“She loved to have her feet rubbed,” said the 40-year-old Lakeville, Ind., mother. “She was this perfect baby.”

When Callie turned a month old, she began to cough, prompting a visit to the doctor, who didn’t suspect anything serious. By the next night, Callie was doing worse. They went back.

In the waiting room, she became blue and limp in Van Tornhout’s arms. The medical team whisked her away and beat lightly on her back. She took a deep breath and giggled.

Though the giggle was reassuring, the Van Tornhouts went to the ER, where Callie’s skin turned blue again. For a while, medical treatment helped. But at one point she started squirming, and medical staff frantically tried to save her.

“Within minutes,” Van Tornhout said, “she was gone.”

Van Tornhout recalled sitting with her husband and their lifeless baby for four hours, “just talking to her, thinking about what could have been.”

Callie’s viewing was held on her original due date — the same day the Centers for Disease Control and Prevention called to confirm she had pertussis, or whooping cough. She was too young for the Tdap vaccine against it and was exposed to someone who hadn’t gotten their booster shot.

Today, next to the cast of Callie’s foot is an urn with her ashes and a glass curio cabinet filled with mementos including baby shoes.

“My kids to this day will still look up and say, ‘Hey, Callie, how are you?’” said Van Tornhout, who has four children and a stepson. “She’s part of all of us every day.”

Van Tornhout now advocates for childhood immunization through the nonprofit Vaccinate Your Family. She also shares her story with people she meets, including a pregnant customer who came into the restaurant her family ran saying she didn’t want to immunize her baby. She later returned with her vaccinated 4-month-old.

“It’s up to us as adults to protect our children — like, that’s what a parent’s job is,” Van Tornhout said. “I watched my daughter die from something that was preventable.… You don’t want to walk in my shoes.”

Ungar writes for the Associated Press.

NEW YORK — All 17 experts recently dismissed from a government vaccine advisory panel published an essay Monday decrying “destabilizing decisions” made by U.S. Health Secretary Robert F. Kennedy Jr. that could lead to more preventable disease spread.

Kennedy last week announced he would “retire” the entire panel that guides U.S. vaccine policy. He also quietly removed Dr. Melinda Wharton — the veteran Centers for Disease Control and Prevention official who coordinated the committee’s meetings.

Two days later, he named eight new people to the influential panel. The list included a scientist who criticized COVID-19 vaccines, a leading critic of pandemic-era lockdowns and someone who worked with a group widely considered to be a leading source of vaccine misinformation.

“We are deeply concerned that these destabilizing decisions, made without clear rationale, may roll back the achievements of U.S. immunization policy, impact people’s access to lifesaving vaccines, and ultimately put U.S. families at risk of dangerous and preventable illnesses,” the 17 panelists wrote in the Journal of the American Medical Assn.

The new committee is scheduled to meet next week. The agenda for that meeting has not yet been posted, but a recent federal notice said votes are expected on vaccinations against flu, COVID-19, HPV, RSV and meningococcal bacteria.

In addition to Wharton’s removal, CDC immunization staff have been cut and agency experts who gather or present data to committee members have resigned.

One, Dr. Lakshmi Panagiotakopoulos, resigned after 12 years at CDC, disclosing her decision early this month in a note to members of a COVID-19 vaccines work group. Her decision came after Kennedy decided — without consulting the vaccine advisers — to pull back COVID-19 vaccination recommendations for healthy children and pregnant women.

“My career in public health and vaccinology started with a deep-seated desire to help the most vulnerable members of our population, and that is not something I am able to continue doing in this role,” she wrote in a message viewed by the Associated Press.

Those CDC personnel losses will make it hard for a group of new outside advisers to quickly come up to speed and make fact-based decisions about which vaccines to recommend to the public, the former committee members said.

“The termination of all members and its leadership in a single action undermines the committee’s capacity to operate effectively and efficiently, aside from raising questions about competence,” they wrote.

A spokesperson for the U.S. Department of Health and Human Services did not respond to the JAMA commentary, but instead pointed to Kennedy’s previous comments on the committee.

Kennedy, a leading voice in the anti-vaccine movement before becoming the U.S. government’s top health official, has accused the committee of being too closely aligned with vaccine manufacturers and of rubber-stamping vaccines.

The Advisory Committee on Immunization Practices, created in 1964, makes recommendations to the CDC director on how vaccines that have been approved by the Food and Drug Administration should be used. CDC directors almost always approve those recommendations, which are widely heeded by doctors and guide vaccination programs.

ACIP policies require members to state past collaborations with vaccine companies and to recuse themselves from votes in which they had a conflict of interest, but Kennedy has dismissed those safeguards as weak.

Stobbe writes for the Associated Press.