vaccine

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.

Former US vaccine chief Demetre Daskalakis says the country’s health department is being led by a ‘chaos agent’ who is putting vulnerable people in harm’s way.

Dr Daskalakis was one of three directors to resign in August, following a decision to fire the head of the Centres for Disease Control, Susan Monarez, after her months-long dispute with health secretary Robert F Kennedy Jr.

Since then, Dr Daskalakis has publicly criticised Kennedy, saying he is knowingly dismantling the country’s vaccine programme by sidelining experts and pushing his own ideology.

WASHINGTON — America’s public health system is headed to a “very dangerous place” with Health Secretary Robert F. Kennedy Jr. and his team of anti-vaccine advisors in charge, fired Centers for Disease Control and Prevention chief Susan Monarez warned senators on Wednesday.

Describing extraordinary turmoil inside the nation’s health agencies, Monarez and former CDC Chief Medical Officer Debra Houry described exchanges in which Kennedy or political advisors rebuffed data supporting the safety and efficacy of vaccines.

Monarez, who was fired after just 29 days on the job following disagreements with Kennedy, told senators deadly diseases like polio and whooping cough, long contained, are poised to make a comeback in the U.S.

“I believe preventable diseases will return, and I believe we will have our children harmed by things they don’t need to be harmed by,” Monarez said before the Senate health committee.

Monarez describes her firing by RFK Jr.

Monarez said she was ordered by Kennedy to resign if she did not sign off on new vaccine recommendations, which are expected to be released later this week by an advisory panel that Kennedy has stocked with medical experts and vaccine skeptics. She said that when she asked for data or science to back up Kennedy’s request to change the childhood vaccination schedule, he offered none.

She added that Kennedy told her “he spoke to the president every day about changing the childhood vaccination schedule.”

Republican Sen. Bill Cassidy (R-La.), a physician who chairs the powerful health committee, listened intently as Monarez and Houry described conversations with Kennedy and his advisers.

“To be clear, he said there was not science or data, but he still expected you to change schedule?” Cassidy asked.

Cassidy carefully praised President Trump for his commitment to promoting health policies but made it clear he was concerned about the circumstances surrounding Monarez’s removal.

Houry, meanwhile, described similar exchanges with Kennedy’s political advisors, who took an unprecedented role in preparing materials for meetings of the CDC’s advisory vaccine panel.

Ahead of this week’s meeting of the panel, Houry offered to include data around the hepatitis B shot that is administered to newborns to prevent spread of the deadly disease from the mother. She said a Kennedy advisor dismissed the data as biased because it might support keeping the shots on the schedule.

“You’re suggesting that they wanted to move away from the birth dose, but they were afraid that your data would say that they should retain it?” Cassidy asked.

Critical vaccine decisions are ahead

During the Senate hearing, Democrats, all of whom opposed Monarez’s nomination, also questioned Kennedy’s motives for firing Monarez, who was approved for the job unanimously by Republicans.

“Frankly, she stood up for protecting the well-being of the American people, and for that reason she was fired,” said Sen. Bernie Sanders, an independent from Vermont who caucuses with Democrats.

Monarez said it was both her refusal to sign off on new vaccination recommendations without scientific evidence and her unwillingness to fire high-ranking career CDC officials without cause that led to her ousting.

Kennedy has denied Monarez’s accusations that he ordered “rubber-stamped” vaccine recommendations but has acknowledged he demanded firings. He has described Monarez as admitting to him that she is “untrustworthy,” a claim Monarez has denied through her attorney.

While Senate Republicans have been mostly loath to challenge Trump or even Kennedy, many of them have expressed concerns about the lack of availability of COVID-19 vaccines and the health department’s decisions to scale back some childhood vaccines.

Others have backed up Kennedy’s distrust of the nation’s health agencies.

Kansas Republican Sen. Roger Marshall, a doctor, aggressively questioned Monarez about her “philosophy” on vaccines as she explained that her decisions were based on science. Alabama GOP Sen. Tommy Tuberville said Trump was elected to make change and suggested Monarez’s job was to be loyal to Kennedy.

“America needs better than this,” Tuberville said.

The Senate hearing was taking place just a day before the vaccine panel starts its two-day session in Atlanta to discuss shots against COVID-19, hepatitis B and chickenpox. It’s unclear how the panel might vote on the recommendations, though members have raised doubts about whether hepatitis B shots administered to newborns are necessary and have suggested COVID-19 recommendations should be more restricted.

The CDC director must endorse those recommendations before they become official. Health and Human Services Deputy Secretary Jim O’Neill, now serving as the CDC’s acting director, will be responsible for that.

“I’m very nervous about it,” Monarez said of the meeting.

Seitz and Jalonick write for the Associated Press. AP writers Mike Stobbe in New York and Lauran Neergaard in Washington contributed to this report.

SACRAMENTO — Gov. Gavin Newsom signed a law giving California the power to set its own immunization schedules based on state health experts and independent medical groups — a sharp break from decades of reliance on guidance from the federal government.

The move came the same day that California and its West Coast allies issued joint recommendations for COVID-19, flu and RSV vaccines, part of a regional alliance formed to counter what they say is a politicized U.S. Centers for Disease Control.

“Our states are united in putting science, safety, and transparency first — and in protecting families with clear, credible vaccine guidance,” said the governors of California, Oregon, Washington and Hawaii, which make up the West Coast Health Alliance.

The flurry of vaccine actions came as lawmakers and the University of California proposed a $23-billion ballot measure to replace federal research dollars lost to Trump-era cuts, underscoring efforts by Democrats in the state to shield science and public health from shifting federal policies. The measure, if passed by the California Legislature when lawmakers return in January, would go before voters in November 2026.

“The loss of critical federal funding awarded to the University of California presents an unprecedented and perilous moment for the state and its communities,” Theresa Maldonado, UC vice president for research and innovation, said in a statement.

The healthcare clash comes following a wave of COVID cases and as the annual flu season nears. For decades, the CDC has been the nation’s trusted authority on vaccines — setting childhood immunization schedules, guiding which shots adults should receive and shaping state health policies across the country.

Now, at the direction of Health and Human Services Secretary Robert F. Kennedy Jr., a Trump ally, the CDC fired top leadership, lost senior scientific advisors and remade its vaccine advisory committee with members who the Associated Press found spread misinformation and conspiracy theories about immunizations.

Kennedy, a longtime vaccine skeptic, has defended the shakeup as necessary to create trust and “eliminate politics from science.”

“They deserve the truth and that’s what we’re going to give them for the first time in the history of the agency,” Kennedy told the Senate Finance Committee earlier this month during a contentious hearing.

The overhaul triggered a fierce backlash as more than 1,000 employees at the health agency and national health organizations have called on Kennedy to resign. Some states, however, have embraced the approach — Florida announced plans to become the first state to end all vaccines mandated, including for schoolchildren.

The polarization is taking a toll. A recent KFF poll found Americans are increasingly uncertain about public health guidance and whether new recommendations from the administration will make them more or less safe.

Public health experts say that not only are vaccines crucial for the health of individuals and the community but they also ultimately save money — preventing sickness and the rise in healthcare costs that would accompany widespread disease outbreaks.

The changes in federal vaccine recommendations have been sweeping. The Food and Drug Administration, which falls under Kennedy’s purview, now requires adults 65 and younger and otherwise healthy — who report no underlying health issues — to consult with a healthcare provider before getting the COVID vaccine. Similarly, the CDC requires parents of healthy children to talk to a healthcare provider before their child can receive the COVID vaccine, a barrier the American Academy of Pediatrics called “deeply troubling.”

The American Academy of Pediatrics issued its own COVID vaccine guidance, countering what the CDC recommended, that says all young children 6 months to 23 months should be vaccinated, as well as certain high-risk older children. The group has also said that older children should be offered the vaccine if their parents request it.

The CDC also changed its vaccine schedule from recommending the COVID vaccine to all pregnant women to offering “no guidance” as to whether healthy pregnant women should get the vaccine. In response, the American College of Obstetricians and Gynecologists recommended that people receive the updated COVID-19 vaccine at any point during their pregnancy.

California said it too will reject CDC guidance, starting with the recommendations released Wednesday from the West Coast Health Alliance. Those recommendations were developed by health officers and subject matter experts from each state, who considered guidelines from medical organizations such as the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians.

The COVID-19 vaccine recommendations from the West Coast Health Alliance include vaccinating all children 6 months to 23 months and those 2 years old to 64 years old with risk factors. The alliance also recommended all pregnant and postpartum women or those planning to become pregnant to be vaccinated.

The alliance recommended children 6 months and older and all adults and pregnant women to receive the flu shot. For the RSV vaccine, the alliance recommends it for children younger than 8 months, as well as anyone 75 years or older. The alliance recommends the RSV vaccine for all other ages if a person has risk factors.

“We want the people who live and work in our states to know that there is a strong public health, healthcare and scientific community that will continue to stand together to provide and use the data and evidence needed for you to make healthy choices, and we are here to protect our communities,” said Dr. Erica Pan, director of the California Department of Public Health, in a statement.

“Eureka Day,” a comedy by Jonathan Spector that wades into the debate on vaccine mandates, has only become more explosively topical since its 2018 premiere at Aurora Theatre Company, in Berkeley, Calif.

The play, which is having its Los Angeles premiere at Pasadena Playhouse, seems like it could have been commissioned to skewer this destructive, benighted and completely mortifying anti-science moment. But Spector wrote the work before the COVID-19 pandemic unleashed our political demons and made stupid great again.

“Eureka Day” takes its name from the fictional private elementary school in Berkeley that is the setting for what is both a satire of anti-vaccine culture and a comedy of woke manners. Held in a determinedly cheerful Bay Area classroom (brightly summoned with all the necessary social justice touches by set designer Wilson Chin), the play unfolds as a series of meetings of the school’s executive committee.

Don (Rick Holmes), the head of school, is ostensibly in charge, though his duck-and-cover strategy for dealing with conflict has a way of protracting problems. Four parents, one a newcomer still acclimating to the school’s strenuously progressive rules, are part of the executive brain trust.

The first discussion of the new school year is relatively innocuous though no less testing for being so. Eli (Nate Corddry), a stay-at-home dad who made a fortune at Facebook, has proposed adding “Transracial Adoptee” to a drop-down menu on an admissions form already burgeoning with identity subcategories.

Suzanne (Mia Barron), a mother who has sent so many children through Eureka Day that she has a proprietary attitude about the place, doesn’t think this additional category is necessary. She’s sensitive — self-consciously so — to Eli’s good intentions, but she persuades the group that no changes are necessary at this time.

“Persuades” might be a euphemism. Suzanne has an iron will that she thinly veils with a solicitous smile.

One of the quirks of the executive committee is that it operates by consensus rather than a majority vote. This can lead to some “very long meetings,” Suzanne informs Carina (Cherise Boothe), the new Black lesbian mom who recently moved from Maryland.

Suzanne claims to want everyone to feel “empowered,” though her controlling temperament pokes through her welcoming facade. Meiko (Camille Chen), who knits during meetings with a subtle air of annoyance, has to loudly ask Suzanne to please stop speaking on her behalf.

Cherise Boothe in “Eureka Day” at Pasadena Playhouse.

(Jeff Lorch)

These blind spots, a standard ingredient of comic characters, are particularly glaring in Suzanne’s case. When Carina tells her that she didn’t homeschool her son for kindergarten but sent him to public school, Suzanne is mildly horrified. She also makes the assumption that Carina is not a “full pay” family.

There’s even something passive-aggressive about Suzanne’s show of concern for all viewpoints, a trait that becomes all the more conspicuous after a crisis erupts at the school. A mumps outbreak forces Eureka Day to temporarily close its doors.

Don informs the executive committee that the health department has issued a letter stipulating what parents must do for their child to return to school. The subject isn’t open for debate, but Suzanne is uneasy about how this letter is being “framed.”

She’s an advocate of parental choice when it comes to vaccines, not trusting the experts who have determined that only children who are vaccinated can return to school when there’s a risk of infection. She believes vaccines stand in the way of natural herd immunity.

Mia Barron, left, Rick Holmes, Cherise Boothe, and Camille Chen in “Eureka Day” at Pasadena Playhouse.

(Jeff Lorch)

Meiko is less vociferous in her anti-vaccine stance than Suzanne, but she has her own skepticism about modern medicine and doesn’t want to be told what to do. When her daughter develops mumps, it becomes an emergency for Eli, who’s been having an affair with Meiko. The two arrange their assignations around playdates, and their kids were recently in contact.

Eli, who’s married but in a complicated open relationship situation with his increasingly resentful wife, would rather not have to choose sides in the vaccine mandate debate. But when his son gets sick after spending time with Meiko’s unvaccinated daughter, he finds he can no longer stay on the fence.

The well-programmed comedy hilariously runs its course in the leadership vacuum created by the school’s over-accommodating culture. Don is so worried about seeming to favor one parental faction over another that he allows Suzanne to become the dominant voice in the room.

The production, directed by Teddy Bergman, has a field day with the woke-run-amok ethos of Eureka Day, where kids at the school cheer the other team’s goals at soccer games. But Bergman’s approach is more schematic than Anna D. Shapiro’s Tony-winning Broadway revival.

Perhaps the urgency of the moment calls for a clearer moral stand, but the comedy has lost some nuance. On Broadway, Jessica Hecht made Suzanne seem totally oblivious to her own rage. She really believed that she was seeking consensus, tolerant of all perspectives as long as they didn’t impinge on her beliefs, the origins of which are poignantly related later in the play.

The fury of Barron’s Suzanne is much more on the surface. The humor is more direct — Barron can be very funny — but the debate is less trenchant. Bergman’s production, marred by blasts of jarring folk music between scene transitions, is a little too on the nose.

Boothe’s Carina, by far the strongest performance in the cast, is our rational surrogate in the play — a parent trying to fit in without betraying her intelligence or child’s welfare. I appreciated the way Holmes lets us come to our own conclusions about Don’s go-along-to-get-along style of running the ship.

Meiko is woefully underwritten, and Chen’s performance, while amusing when Meiko erupts, sometimes seems disconnected. Corddry refuses to play a tech industry cliché, but Eli, a bland creep, comes off as unnecessarily vague.

Bergman has trouble locating that sweet spot between jokey exaggeration and multidimensional authenticity. Comedy trades in types, but the cast could have benefited from more fine-tuning.

Perhaps that’s why the funniest scene in the play involves the live chat portion of a virtual meeting that’s organized for Eureka Day parents alarmed about the quarantine situation. Avatars square off against one another in a vaccine debate free-for-all that puts the lie to the school’s “community of respect” motto with uncensored savagery punctuated by missile-like emoticons.

“Eureka Day” will make you laugh, but how much this production will make you think is an open question.

A series of federal actions aimed at pressuring states to allow parents to opt out of school vaccine mandates for religious or personal reasons threatens to undermine California’s ironclad ban on such exemptions.

California is one of just five states that bans any non-medical exemptions, the result of a landmark 2015 law passed in the wake of the Disneyland measles outbreak. Connecticut, New York, Maine, and West Virginia have similar statutes.

The law is credited with bringing California’s rate of kindergartners vaccinated against the measles to 96.1% in the 2024-25 school year, up from 92.6% in 2014-15, even as the national rate declined. California is one of just 10 states with a kindergarten measles vaccination rate that exceeds the 95% threshold experts say is needed to achieve herd immunity.

If vaccine mandates are weakened, “we’re going to have more outbreaks, and schools are going to be less safe for the families who have children who are vulnerable,” said Dr. Eric Ball, a pediatrician in Orange County and chair of the American Academy of Pediatrics California.

Engage with our community-funded journalism as we delve into child care, transitional kindergarten, health and other issues affecting children from birth through age 5.

Key actions to allow for vaccine exemptions include:

• Legislation introduced in Congress last month would withhold federal education funding from states without religious exemptions.
• A letter from the Department of Health and Human Services threatened to withhold federal vaccine funding from states that have any form of religious freedom or personal conscience laws but do not allow exemptions to vaccines. The move is “part of a larger effort by HHS to strengthen enforcement of laws protecting conscience and religious exercise.”
• Several lawsuits winding their way through the courts from parents — including in California — seek the right to a religious exemption, which may eventually come before the Supreme Court.

Legal experts say that taken together, these moves reveal a concerted effort to chip away at limits states like California have placed on parents’ ability to send their unvaccinated children to school.

“We should assume that every aspect of the administration, at least three justices of the Supreme Court, and a significant contingent in Congress are actively trying to implement changes to the law that would invalidate California’s … approach to not allowing non-medical exemptions,” said Lindsay Wiley, a law professor at UCLA.

In West Virginia, the approach is already proving successful. Despite the state legislature recently rejecting a bill that would have permitted religious exemptions for the first time, Republican Gov. Patrick Morrisey signed an executive order allowing them, bolstered by a letter of support from HHS.

Vaccinations and syringes at Larchmont Pediatrics in Los Angeles.

(Allen J. Schaben/Los Angeles Times)

“Vaccination is considered one of public health’s greatest achievements, preventing the spread of serious illnesses, reducing hospitalizations and saving lives,” the statement said. “CDPH remains committed to ensuring that all Californians continue to have access to safe and effective vaccines that are based on credible, transparent and science-based evidence.”

The federal actions are occurring in a moment of growing anti-vaccine fervor within the Trump administration. HHS Secretary Robert F. Kennedy, Jr. has long been an outspoken critic of vaccines, including the vaccine to prevent measles. As secretary of HHS, he has defunded mRNA research, limited COVID-19 shots to the elderly and those with preexisting medical conditions, and pledged to reveal a link between vaccines and autism.

California’s evolution on vaccine mandates

In 1961, California became one of the first states to permit residents to opt out of vaccines for a broad range of personal beliefs, as part of a law mandating the polio vaccine for school attendance.

For decades, few parents claimed the exemption, and the rate of children opting out of vaccines for non-medical reasons stayed around 0.5%, said Dr. Richard Pan, the former state senator who authored the 2015 law eliminating non-medical exemptions.

Pan said the rate of exemptions began to climb in the mid-2000s, when actress Jenny McCarthy appeared on Oprah and claimed that vaccines had caused her son’s autism. “But what really gave fuel” was the advent of Facebook and Twitter, said Pan. “Social media really connected people who are anti-vax and created an echo chamber.”

By the 2013-14 school year, 3.1% of California kindergartners were receiving a non-medical exemption to at least one required vaccine. The rate of kindergarteners fully vaccinated against the measles slipped to 92.3% — well below the 95% required for herd immunity.

In 2014, a single measles case at Disneyland spread to more than 140 people across the country, an outbreak that epidemiologists said was fueled by vaccine refusals. In this moment of crisis, Pan introduced SB277, making California the first state in nearly 35 years to eliminate non-medical vaccine exemptions.

The legislation received the support of many parents, especially those whose children could not be vaccinated for medical reasons and relied on the immunity of people around them. “The whole purpose of 277 was actually to protect the rights and the freedoms of families and their children to get an education who could not get vaccinated,” said Pan.

Despite bitter debate, no major religious denominations opposed the bill, Pan said.

“This really isn’t about religion,” Pan said. “This is about trying to find a loophole or an excuse for someone who doesn’t want to vaccinate their child.”

Parents say California’s mandate violates religious beliefs

A contingent of parents say their sincere religious beliefs prevent them from getting their children vaccinated.

In 2023, Amy and Steve Doescher of Placerville brought a federal lawsuit, along with two other families, against California claiming that SB277 had violated their right to freely exercise their religion by preventing them from sending their 16-year-old daughter to public school.

The Doeschers, who attend a church near their home, “prayed extensively and consulted the Bible when deciding whether to vaccinate their children, and they arrived at the firm religious conviction that vaccinations violate their creed,” according to a complaint filed as part of the lawsuit.

Their daughter, who is enrolled in a charter school independent study program, is unable to have “the typical interactions with children that ‘normal’ children get. This has caused much stigma.”

The lawsuit alleges that her parents have had to enroll her in gymnastics classes and spend $10,000 per year on independent study costs, “to make up for the socialization shortcomings caused by SB277.”

While the lawsuit was dismissed in June, it is now on appeal at the 9th Circuit Court of Appeals. Lawyers in a similar New York lawsuit brought by Amish parents have requested review from the Supreme Court.

“I do think it’s a cumulative moment of change,” said Christina Hildebrand, president and founder of A Voice for Choice, an advocacy group that sponsored the California lawsuit.

“If vaccines are so effective and they don’t have risk involved, then people should want to get them,” she said. “How good really is the product if you’re having to put a mandate on them?”

UCLA Law’s Wiley said she is sympathetic to sincere religious objectors, and herd immunity can still be reached even if a small number of people opt out. The problem, she said, is that they’re difficult for states to police for validity and “can really open the floodgates to vastly diminished vaccination rates.”

Dorit Reiss, a law professor at the University of California at San Francisco who studies vaccines, said religious exemptions are often “used as a fig leaf for people who have safety concerns. The way the system works is that it privileges the good liars.”

As part of her research, she has found “a whole industry of people trying to help each other get exemptions” online, including those who offer sample requests to parents and workshops on how to claim a religious exemption for non-religious reasons.

Reiss points to numerous studies finding that making exemptions broader and easier to get tends to lead to lower vaccination rates and more outbreaks.

The volatile landscape for vaccine mandates

Since the COVID pandemic, states across the country have experienced a decline in the rate of kindergartners who are fully vaccinated, and an increase in parents seeking exemptions, according to a recent report from KFF, a nonprofit health research group.

Last week, Florida’s surgeon general announced the state would no longer require children to be vaccinated in order to attend public school, something that all 50 states currently require.

Threats are also mounting from Washington, D.C. The GRACE Act, which was introduced in Congress last month by Rep. Greg Steube (R-FL), would withhold federal education funding from any state that does not offer parents the right to opt out of vaccines for religious reasons.

The bill, if eventually approved and signed into law by President Trump, would also explicitly prevent states, including California, from requiring any documentation from parents to prove a sincere religious conviction against vaccines.

“Freedom of speech and religion is the most sacred right guaranteed under our Constitution,” Rep. Steube said in a statement to The Times. “No student or their family should ever be coerced into sacrificing their faith or jumping through loopholes to comply with a vaccine requirement.”

Last week, Kennedy weighed in on the issue. He said in a letter that if a state already has statutes on the books protecting religious freedom or personal conscience in any form, those laws must extend to vaccine opt-outs. If states with such laws do not comply with the directive, they could lose funding for the federal Vaccines for Children Program, which funds vaccines for low-income children.

California does not have religious freedom or personal conscience statues. But 29 other states have passed religious freedom laws, and 18 have parental rights laws, which legal experts said could be used by the federal government to compel states to offer vaccine opt-outs.

“States have the authority to balance public health goals with individual freedom, and honoring those decisions builds trust” Kennedy wrote. “Protecting both public health and personal liberty is how we restore faith in our institutions and Make America Healthy Again.”

Several legal experts said the approach was alarming.

“I’m very concerned that this is part of a playbook where they’re going on a state and federal level, to push on these laws,” said Richard Hughes, a lawyer with Epstein Becker Green in Washington, D.C., who has been working on vaccine law for two decades. “This is a massive federal overreach, and it’s incredibly inappropriate.”

This article is part of The Times’ early childhood education initiative, focusing on the learning and development of California children from birth to age 5. For more information about the initiative and its philanthropic funders, go to latimes.com/earlyed.

Seniors in some parts of the country say they are being denied COVID-19 vaccinations amid an ongoing spike in cases, leading to rising frustration over new Trump administration policies that are making it harder to get the shots.

Matthew D’Amico, 67, of New York City, said a Walgreens declined to administer COVID-19 vaccines to him and his 75-year-old wife on Friday because they didn’t have a prescription. They’re trying to get vaccinated ahead of a trip.

“I can’t believe we can’t get” the vaccine, D’Amico said in an interview. “I’ve been inoculated a number of times and never had to get a prescription. And it’s just very frustrating that this is where we are.”

He’s not alone in his exasperation. Under the leadership of the vaccine skeptic Health and Human Services Secretary Robert F. Kennedy Jr., federal agencies have effectively made it more difficult to get vaccinated against COVID-19 this year. The Food and Drug Administration has only “approved” COVID-19 vaccines for those age 65 and up, as well as younger people with underlying health conditions.

That means across the country, people younger than 65 interested in getting the COVID-19 vaccine must now either consult with a healthcare provider or “attest” to a pharmacy that they have an underlying health condition. It’s a potential hurdle that can make getting the vaccine more difficult and, some health experts worry, prompt even more Americans to eschew getting vaccinated.

As D’Amico can attest, though, being part of a group for whom the COVID vaccine is “approved” doesn’t necessarily guarantee easy access.

“For me to go to my primary [healthcare provider] now and get a prescription, it’s just kind of ridiculous,” D’Amico said.

At least some people younger than 65 are encountering pharmacy staff asking probing questions about their medical conditions.

That happened Friday at a CVS in Orange County, according to 34-year-old Alex Benson, who takes medication that can suppress his immune system.

Besides just protecting himself, he wanted to get vaccinated as he has family members who are at high risk should they get COVID — his mother is immunocompromised, and his mother-in-law had open-heart surgery on Thursday night.

Benson said an employee asked why he thought he was eligible for the vaccine.

“They asked me for either a prescription or they wanted to know … why I felt I needed the vaccination,” Benson said. At one point, a staffer offered to call his doctor to get an authorization for the vaccine.

Benson said he was alarmed by the questions, and started to “feel kind of some desperation to plead my case to the pharmacist.” Another CVS staffer later came over and said further answers weren’t necessary and simply attesting he was eligible was good enough. He eventually got the vaccine.

Still, he felt the experience was dismaying.

“I think easy access should be the policy,” Benson said. “I tend not to get too political, but it seems just rather juxtaposed to me that an anti-regulation administration is using regulation in this way. They’re supposed to be removing barriers to healthcare.”

The vaccine chaos comes as COVID-19 is either increasing or starting to hit its late summer peak. According to data released Friday, there are now 14 states with “very high” levels of coronavirus detected in their wastewater — California, Texas, Florida, North Carolina, Indiana, South Carolina, Alabama, Louisiana, Connecticut, Utah, Nevada, Idaho, Hawaii and Alaska, as well as the District of Columbia.

Dr. Elizabeth Hudson, the regional physician chief of infectious diseases for Kaiser Permanente Southern California, said data continue to show an increase in coronavirus cases.

“Over this past week, we’ve seen an increase in the number of outpatient COVID cases, and even a smattering of inpatient cases,” Hudson said. “It appears that we may be nearing the top of the wave, but it may be another two weeks or so until we truly know if we’re there.”

The rate at which coronavirus lab tests are confirming infection also continues to rise statewide and in the Los Angeles area. For the week ending Aug. 30, California’s COVID test positivity rate was 12.83%, up from 7.05% for the week ending Aug. 2. In L.A. County, the positive test rate was 14.83%, up from 9.33%.

Other data, however, suggest some areas may have reached their summer COVID peak.

In Orange County, the COVID positive test rate was 13.1%. That’s below the prior week’s rate of 18%, but still higher than the rate for the week that ended Aug. 2, which was 10.8%.

In San Francisco, the test positivity rate has been hovering around 9% for the last week of reliable data available. It’s up from 7% a month earlier.

In addition, wastewater data in L.A. County show coronavirus levels declined slightly from the prior week.

“It’s too early to know if this decrease in wastewater viral concentrations is the first sign that COVID-19 activity is peaking or is regular variation typical of this data source,” the L.A. County Department of Public Health said.

COVID hospital admissions in California are increasing — with the latest rate of 3.93 admissions per 100,000 residents, up from 2.38.

But they remain relatively low statewide and in L.A. County. The number of L.A. County residents seeking care for COVID-related illness, or who have been hospitalized, “is quite a bit lower than during summer surges in 2023 and 2024,” the public health department said.

A relatively mild summer wave, however, could mean that the annual fall-and-winter COVID wave might be stronger. In July, the state Department of Public Health said that scientists anticipate California would see either a stronger summer COVID wave or a more significant winter wave.

The current confusion over federal COVID vaccine policy has been exacerbated by the chaos at the U.S. Centers for Disease Control and Prevention, where Kennedy earlier this year fired everyone on the influential Advisory Committee on Immunization Practices, and orchestrated the firing of CDC Director Susan Monarez just 29 days after she was confirmed to the post by the Senate.

Some of Kennedy’s handpicked replacements on the ACIP have criticized vaccines and spread misinformation, according to the Associated Press. And the new interim CDC director — Jim O’Neill, a Kennedy deputy — is a critic of health regulations and has no training in medicine or healthcare, the AP reported.

The CDC hasn’t issued its own recommendations on who should get vaccinated, and that inaction has resulted in residents of a number of states needing to get prescriptions from a healthcare provider for at least the next couple of weeks. In some cases, that’s true even for seniors, as D’Amico found out.

As of Friday, CVS said people need a prescription to get a COVID-19 vaccine, sometimes depending on their age, in Arizona, Florida, Georgia, Louisiana, Maine, North Carolina, New Mexico, New York, Pennsylvania, Utah, Virginia and West Virginia, as well as the District of Columbia.

CVS couldn’t even offer the COVID-19 at its pharmacies in Nevada as of Friday; they were only available at the company’s MinuteClinic sites, according to spokesperson Amy Thibault.

CVS said it expects to offer COVID-19 vaccines without prescriptions at its pharmacies in New Mexico, Nevada, New York and Pennsylvania “soon,” due to recent regulatory changes in each state.

“Right now, all patients in all states need to attest to being eligible for the vaccine in order to schedule an appointment online,” Thibault said. If an adult says they have no underlying health conditions, but do have a prescription from a healthcare provider for “off-label” use of the vaccine, they can get the shot, Thibault confirmed.

On Thursday, Hawaii joined California, Washington and Oregon in launching the West Coast Health Alliance: an interstate compact meant to provide science-based immunization guidance as an alternative to the CDC.

“Together, these states will provide evidence-based immunization guidance rooted in safety, efficacy, and transparency — ensuring residents receive credible information free from political interference,” according to a statement from Gov. Gavin Newsom’s office.

The statement suggested that the Trump administration was essentially “dismantling” the CDC.

“The absence of consistent, science-based federal leadership poses a direct threat to our nation’s health security,” the statement said. “To protect the health of our communities, the West Coast Health Alliance will continue to ensure that our public health strategies are based on best available science.”

It was not immediately clear, however, whether the formation of the West Coast Health Alliance would make it easier for people to get COVID-19 vaccines at the nation’s largest pharmacy retailers, where many people get their shots.

Mainstream medical groups, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, are also offering their own recommendations to advise individuals and families on what vaccines they should get.

Robert F. Kennedy Jr., the nation’s health secretary and a longtime vaccine skeptic, struck a defiant tone Thursday as he faced bipartisan criticism over changes he has made to reorganize federal health agencies and vaccine policies, telling senators that he is determined to “eliminate politics from science.”

In the testy appearance before the Senate Finance Committee, Kennedy repeatedly defended his record in heated exchanges with senators from both parties and questioned data that show the effectiveness of vaccines. In turn, senators accused him of taking actions that contradict his promise seven months earlier that he would do “nothing that makes it difficult or discourages people from taking vaccines.”

“Secretary Kennedy, in your confirmation hearing you promised to uphold the highest standard for vaccines. Since then, I’ve grown deeply concerned,” Sen. John Barrasso of Wyoming, a top-ranking Senate Republican and a physician, said during the hearing.

Kennedy forcefully denied that he has limited access to vaccines and defended his record in restoring trust in federal healthcare agencies under the umbrella of the U.S. Department of Health and Human Services.

“They deserve the truth and that’s what we’re going to give them for the first time in the history of the agency,” Kennedy told senators.

From the outset, it was expected that Democrats would slam Kennedy’s record. Some of them called on him to resign and accused him of politicizing federal health policy decisions. But three other Republicans, including Sen. Bill Cassidy of Louisiana, who was key in advancing Kennedy’s nomination, joined Democrats in criticizing Kennedy’s actions, mostly pertaining to vaccine policy changes.

Thursday’s session marked a peak of bipartisan frustration over a string of controversial decisions by Kennedy that have thrown his department into disarray. Kennedy dismissed an entire advisory panel responsible for vaccine recommendations and replaced its members with known vaccine skeptics. He withdrew $500 million in funding earmarked for developing vaccines against respiratory viruses. And, just last week, he ousted the newly appointed director of the Centers for Disease Control and Prevention following disagreements over vaccine policy.

In an op-ed published in the Wall Street Journal on Thursday, Susan Monarez, the former CDC director, wrote that she was forced out after she declined to recommend people “who have publicly expressed antivaccine rhetoric” to an influential vaccine advisory panel.

At the hearing, Kennedy said Monarez was lying. Instead, he said he fired her because he asked her if she was trustworthy, and she told him, “no.”

He added that he fired all the members of the vaccine panel because it was “plagued with persistent conflicts of interest.”

“We depoliticized it and put great scientists on it from a very diverse group, very, very pro-vaccine,” he claimed.

In questioning, however, members of his own party questioned his support for vaccines. At one point, Cassidy, a physician, read an email from a physician friend who said patients 65 and older need a prescription to get a COVID-19 shot.

“I would say effectively we are denying people vaccines,” Cassidy said.

“You’re wrong,” Kennedy responded.

In that same exchange, Cassidy asked Kennedy if he believed President Trump deserved a Nobel Prize for his administration’s work on Operation Warp Speed, the initiative that sped the development of the COVID-19 vaccine and treatments.

“Absolutely,” Kennedy said.

Cassidy said he was surprised at his answer because he believes Kennedy is trying to restrict access to the COVID-19 vaccine. He also expressed dismay at Kennedy’s decision to cancel $500 million in contracts to develop vaccines using mRNA technology, which Cassidy said was key to the operation.

Kennedy’s position on vaccines have reverberated beyond Capitol Hill.

Ahead of the hearing, more than 1,000 employees at the health agency and national health organizations called on Kennedy to resign. Seemingly in support of Kennedy’s direction, Florida announced plans to become the first state to end all vaccines mandated, including for schoolchildren. And three Democratic-led states — California, Washington and Oregon — have created an alliance to counter turmoil within the federal public health agency.

The states said the focus of their health alliance will be on ensuring the public has access to credible information about the safety and efficacy of vaccines.

Almost as if in a parallel universe, Kennedy told senators on Thursday that his goal was to achieve the same thing, after facing hours of criticism on his vaccine policies.

“I am not going to sign on to something if I can’t make it with scientific certainty,” he said. “It doesn’t mean I am antivax, it just means I am pro-science.”

ST. PETERSBURG, Fla. — Florida will work to phase out all childhood vaccine mandates in the state, building on the effort by Republican Gov. Ron DeSantis to curb vaccine requirements and other health mandates during the COVID-19 pandemic.

DeSantis also announced on Wednesday the creation of a state-level “Make America Healthy Again” commission modeled after similar initiatives pushed at the federal level by Health and Human Services Secretary Robert F. Kennedy Jr.

On the vaccines, state Surgeon General Dr. Joseph Ladapo cast current requirements in schools and elsewhere as an “immoral” intrusion on people’s rights bordering on “slavery,” and hampers parents’ ability to make health decisions for their children.

“People have a right to make their own decisions, informed decisions,” said Ladapo, who has frequently clashed with the medical establishment, at a news conference in Valrico, Florida, in the Tampa area. “They don’t have the right to tell you what to put in your body. Take it away from them.”

The state Health Department, Ladapo said, can scrap its own rules for some vaccine mandates, but others would require action by the Florida Legislature. He did not specify any particular vaccines but repeated several times the effort would end “all of them. Every last one of them.”

Florida would be the first state to eliminate so many vaccine mandates, Ladapo added.

In Florida, vaccine mandates for child day care facilities and public schools include shots for measles, chickenpox, hepatitis B, Diphtheria-tetanus-acellular pertussis (DTaP), polio and other diseases, according to the state Health Department’s website.

Under DeSantis, Florida resisted imposing COVID vaccines on schoolchildren, requiring “passports” for places that draw crowds, school closures and mandates that workers get the shots to keep their jobs.

“I don’t think there’s another state that’s done as much as Florida. We want to stay ahead of the curve,” the governor said.

The state “MAHA” commission would look into such things as allowing informed consent in medical matters, promoting safe and nutritious food, boosting parental rights regarding medical decisions about their children, and eliminating “medical orthodoxy that is not supported by the data,” DeSantis said. The commission will be chaired by Lt. Gov. Jay Collins and Florida first lady Casey DeSantis.

“We’re getting government out of the way, getting government out of your lives,” Collins said.

The commission’s work will help inform a large “medical freedom package” to be introduced in the Legislature next session, which would address the vaccine mandates required by state law and make permanent the recent state COVID decisions relaxing restrictions, DeSantis said.

“There will be a broad package,” the governor said.

Anderson writes for the Associated Press.

For five years, I dodged every bullet.

I don’t know how I managed to beat COVID-19 for so long, even as family, friends and colleagues got hit with the coronavirus. Although I took precautions from the beginning, with masking and vaccinations, I was also out in public a lot for work and travel.

But my luck has finally run out, and it must have been the air travel that did me in. I returned from a cross-country trip with a razor blade sore throat and a stubborn headache, followed by aches and pains.

The first test was positive.

I figured it had to be wrong, given my super-immunity track record.

The second test was even more positive.

So I’ve been quarantined in a corner of the house, reaching alternately for Tylenol and the thermometer. Everything is a little fuzzy, making it hard to distinguish between the real and the imagined.

For instance, how can it be true that just as I get COVID for the first time, the news is suddenly dominated by COVID-related stories?

It has to be a fever-induced hallucination. There’s no other way to explain why, as COVID surges yet again with another bugger of a strain, the best tool against the virus — vaccine — is under full assault by the leaders of the nation.

They are making it harder, rather than easier, to get medicine recommended by the overwhelming majority of the legitimate, non-crackpot wing of the medical community.

Under the new vaccine policies, prices are up. Permission from doctors is needed. Depending on your age or your home state, you could be out of luck.

Meanwhile, President Trump fired Susan Monarez, the head of the U.S. Centers for Disease Control and Prevention, essentially for putting her own professional integrity and commitment to public service above crackpot directives from a cabal of vaccine skeptics.

And following Health and Human Services Secretary Robert F. Kennedy Jr.’s cancellation of $500 million in mRNA vaccine research, Trump is demanding that pharmaceutical companies show proof that vaccines work.

My eyes are red and burning, but can COVID be entirely to blame?

I got a booster before my travels, even though I knew it might not stand up to the new strain of COVID. It’s possible I have a milder case than I might have had without the vaccine. But on that question and many others, as new waves keep coming our way, wouldn’t the smart move be more research rather than less?

Trump downplayed the virus when it first surfaced in 2019 and 2020. Then he blamed it on China. He resisted masking, and lemmings by the thousands got sick and died. Then he got COVID himself. At one point, he recommended that people get the vaccine.

Now he’s putting on the brakes?

My headache is coming back, my eyes are still burning, and unless my Tylenol is laced with LSD, I think I just saw a clip in which Kennedy and Defense Secretary Pete Hegseth attempted 50 pull-ups and 100 push-ups in 10 minutes.

I appreciate the health and fitness plug, and because Kennedy and I are the same age — 71 — it’s impressive to see him in the gym.

But there’s something that has to be said about the Kennedy-Hegseth workout tape:

They’re cheating.

Take a look for yourself, and don’t be fooled by the tight T-shirts worn by these two homecoming kings.

Those were not full chin-ups or push-ups.

Not even close.

Cutting corners is the wrong message to send to the nation’s children, or to any age group. And how is anyone going to make it to the gym if they come down with COVID because they couldn’t get vaccinated?

Honestly, the whole thing has to be a fever dream I’m having, because in the middle of the workout, Kennedy said, and I quote, “It was President Trump who inspired us to do this.”

He is many things, President Trump. Fitness role model is not one of them, no matter how many times he blasts out of sand traps on company time.

Getting back to cutting corners, Kennedy said in slashing mRNA research that “we have studied the science,” with a news release link to a 181-page document purportedly supporting his claim that the vaccines “fail to protect effectively.”

That document was roundly eviscerated by hordes of scientists who were aghast at the distortions and misinterpretations by Kennedy.

“It’s either staggering incompetence or willful misrepresentation,” said Jake Scott, an infectious-disease physician and Stanford University professor, writing for the media company STAT. “Kennedy is using evidence that refutes his own position to justify dismantling tools we’ll desperately need when the next pandemic arrives.”

I lost my sense of smell a few days ago, but even I can tell you that stinks.

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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.