Despite a major measles outbreak in Texas, more states are loosening vaccine mandates, scaling back vaccine promotion efforts, and taking other steps that are likely to lower vaccination rates.
Meanwhile, public health experts are concerned that the confirmation of vaccine skeptic Robert F. Kennedy Jr. as secretary of the U.S. Department of Health and Human Services will fuel such efforts, potentially leading to the resurgence of previously controlled infectious diseases.
Kennedy has made numerous baseless or false claims about vaccines, including linking them to autism and cancer and claiming “poison” in the coronavirus vaccine.
This week, the US Food and Drug Administration, which Kennedy now oversees, canceled an upcoming meeting of a scientific panel to discuss next year’s flu vaccines. This week also saw the death of an unvaccinated child in Texas from measles, the country’s first in a decade. The outbreak, which has spread to neighboring New Mexico, has now reached more than 130 cases.
Already, vaccination rates are lower than they were prior to the pandemic. The COVID-19 vaccines saved millions of lives, but many Americans objected to vaccine mandates, and misinformation and rapidly changing public health advice eroded many people’s trust in scientific authorities.
Changing attitudes have had an impact: vaccination rates among children born in 2020 and 2021 fell by 1.3 to 7.8 percentage points for recommended shots when compared to children born in 2018 and 2019, according to a September report by the federal Centers for Disease Control and Prevention.
The anti-vaccination movement is “the antithesis of public health,” according to Dr. Scott Rivkees, a pediatric endocrinologist who served as Florida’s surgeon general and health secretary from 2019 to 2021.
“The role of people in departments of health and the role of people in health care and medicine is to promote health and make sure the public is safe,” Rivkees explained to Stateline. “There’s such a rich history of legal precedent, such a rich history of public health precedent, saying that society benefits by having individuals vaccinated.”
Children in all 50 states, plus the District of Columbia, are required to receive certain vaccines before attending school. Every state provides an exemption for children who are unable to be vaccinated due to medical conditions.
Thirty states and the District of Columbia allow families to skip vaccinations for religious reasons, 13 states grant exemptions for religious or personal reasons, and two states — Louisiana and Minnesota — do not require people to specify whether their objection is religious or personal.
Five states, including California, Connecticut, Maine, New York, and West Virginia, do not allow nonmedical exemptions.
Republican officials in more than a dozen states have introduced legislation to loosen or eliminate vaccine requirements.
Arizona legislation would make it easier to apply for a school exemption, while Republican-sponsored bills in Connecticut, Minnesota, New York, and Oregon would limit or prohibit adult vaccine mandates.
In Idaho, a Senate panel debated a bill last week that would prohibit mRNA vaccines, including COVID-19 vaccines, for ten years. Similar proposals were considered and defeated by lawmakers in Montana and Mississippi. In West Virginia, one of the five states that currently does not allow nonmedical exemptions from school vaccine requirements, lawmakers are advancing legislation that would allow religious and philosophical objections.
Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, stated that politics will always play a role in public health because it requires resources. Offit is a member of the FDA panel tasked with discussing flu vaccines for next year.
“But it doesn’t have to be partisan, which is what has happened.”
A shift in Louisiana
Earlier this month, Dr. Ralph Abraham, Louisiana’s first surgeon general, sent a memo to staff at the Louisiana Department of Health, instructing them not to recommend “any and all vaccines.” The memo also stated that the agency will “no longer promote mass vaccination.” Instead, Abraham suggested that health workers encourage residents to discuss the risks and benefits of vaccines with their doctors.
The memo effectively ends the Louisiana Health Department’s long history of promoting vaccinations through local public health departments, community health fairs, and media campaigns.
“Vaccines should be treated with nuance, recognizing the differences between seasonal vaccines and childhood immunizations, which are important in providing immunity to our children.” “Getting vaccinated, like any other health procedure, is a personal decision,” the memo states.
The agency did not respond to multiple requests for comment via email or phone. However, in a letter posted to the department’s website earlier this month, Abraham wrote that the state had made several missteps during the pandemic, including promoting “inaccurate and inconsistent guidance on masking, poor decisions to close schools, unjustifiable mandates on civil liberties, and false claims regarding natural immunity.”
Abraham wrote that vaccinations can be beneficial to some but harmful to others, and that for decades, public health has been guided by the belief that “the sacrifice of a few is acceptable and necessary for the ‘greater good.'”
“We should reject this utilitarian approach and restore medical decision-making to its proper place: between doctors and patients,” he stated.
Louisiana Republican lawmakers have embraced this sentiment, stating that following the COVID-19 pandemic, they want less government involvement in vaccinations.
“I’m pleased that Dr. Abraham has taken this approach,” said Republican state Rep. Kathy Edmonston, who authored legislation last year that prohibits Louisiana schools from requiring COVID-19 vaccinations and requires them to provide exemption information to parents. “I am not against vaccinations. He is not against vaccinations. I support people’s right to make their own decisions.”
Jill Hines, co-director of Health Freedom Louisiana, an anti-vaccine advocacy group, dismissed the importance of ending mass vaccination campaigns, saying that “everybody should have a primary care physician if they want one, and nobody is really denied access to a vaccine.”
However, Kimberly Hood, former assistant secretary of the Louisiana Office of Public Health, pointed out that the state is predominantly rural, and many residents lack easy access to a health care provider.
“Failing to promote vaccination may not sound like a huge deal, but it actually invalidates what we in public health have seen and learned for many, many years, which is that you have to make it easy, affordable, accessible,” Hood told the news organization Stateline.
“It’s not just stepping away from vaccination; we’re stepping away from our kind of obligation together, what it means to live together in a society.”
Staying the course in Mississippi
However, in neighboring Mississippi, which is also Republican-dominated, GOP leaders are staying the course — at least for now. More than two dozen anti-vaccine bills have failed in the Mississippi legislature in the last two years, including this year’s proposed ban on mRNA vaccines.
During the pandemic, the state struggled with COVID-19 vaccine hesitancy, and in 2022, Republican Gov. Tate Reeves signed legislation prohibiting COVID-19 vaccine mandates.
For years, Mississippi had one of the highest childhood vaccination rates in the country. Between 2023 and 2024, the state dropped from first to third place after a federal judge ruled that religious exemptions must be allowed. Its current childhood vaccination rate is 97.5%, which is significantly higher than the 91% national average but lower than the 99.3% rate achieved in 2019.
“Our law remains in effect, and if you do not have a medical or religious exemption, you must be fully vaccinated to attend school or day care in Mississippi,” said Dr. Daniel Edney, Mississippi’s state health officer. “The science is clear and in Mississippi we stand on the science.”
Edney stated that he has received no political pressure to change his mind. Unlike in Louisiana, where Republican Gov. Jeff Landry appointed Abraham, a former three-term Republican congressman who co-chaired his transition committee, as surgeon general, Edney was chosen by Mississippi’s 11-member State Board of Health. The governor selects the members of that panel, but they serve staggered four-year terms.
“I have zero pressure from the governor or legislative leadership regarding our approach to vaccines,” he told Stateline. “We’re not into politics. We don’t change our minds because of the administration in power.”
Stateline is part of States Newsroom, a nonprofit news network funded by grants and a donor coalition that operates as a 501c(3) public charity. Stateline maintains editorial independence. For any questions, please contact Editor Scott S. Greenberger at info@stateline.org.
