In February, Florida Surgeon General Joseph Ladapo sent a letter to the families of students attending a school that had reported cases of measles. He told them it’s normally recommended that children stay home until the end of the infectious period, but due to “the burden on families and educational cost of healthy children missing school,” the Department of Health is “deferring to parents or guardians to make decisions about school attendance.”
This statement, which contradicts long-standing policies to isolate children who’ve been exposed — particularly those who are not immunized — illustrates new challenges in childhood vaccine politics following the COVID-19 pandemic. Childhood immunization rates that dropped during COVID-19 have not returned to pre-pandemic levels. Parents who were skeptical about COVID-19 vaccines are less likely to consent to other childhood vaccines. And the political and regulatory environments in which families and public health workers find themselves are now more challenging and may make problems more difficult to solve.
Even prior to COVID-19, vaccine rates were declining. Although most parents fully immunize their children, an estimated 20 to 30 percent of American parents were delaying, spacing or skipping select vaccines. They were not necessarily opposed to vaccines but didn’t accept claims that all vaccines are equally safe, necessary or beneficial.
What I found in my research on these parents is that they were not ignorant or anti-science, but trusted their own judgment more than that of experts and embraced cultural expectations that parents assume personal responsibility for their children’s health and well-being.
Meanwhile, we have witnessed widespread efforts to undermine public health. Underinvestment has led to staffing shortages and high turnover. Between 2017 and 2021, almost half of all employees in state and local public health agencies left, with three-quarters of newer workers and those under 35 leaving. During the pandemic, public health leaders faced threats and harassment that further undermined the workforce. The 2021 termination of Tennessee immunization leader Michelle Fiscus for promoting vaccine information illustrates how the politicization of the COVID-19 vaccine affects all vaccines.
Between 2021 and 2023, some 65 laws were passed in 24 states to restrict state and local officials’ ability to use disease mitigation strategies. These include prohibitions on requiring proof of vaccination; limits on closing schools, businesses or churches; and expanded exemptions from vaccine requirements. How these will affect childhood vaccine requirements is not clear, but powerfully signals weakening support for ideals of shared community responsibility.
There is now greater deference to individual preference. Mandates acknowledged that children seeking an education, as required by law, should not face increased risk of infectious disease while doing so. These laws aimed to protect children who are most vulnerable to the worst outcomes of infection, as we saw in 2015 when Rhett Krawitt, a 6-year-old in California with leukemia, and his family pleaded with their school district to exclude unvaccinated children during a measles outbreak. Despite the goals undergirding the laws, there is now greater support for parents who reject vaccines, as the statement from Florida illustrates.
Each parent should do what they think is best for their child. This was true before COVID-19 and remains equally true now. Yet this commitment to individualist parenting ignores how infectious disease links us together in ways that supersede personal choice.
The new and seemingly increasing support for allowing unimmunized children to fully participate in educational and child-care spaces without contributing to community strategies of protection — even when they may present risk to others — will exacerbate ongoing public health challenges.
Jennifer A. Reich is a sociologist at the University of Colorado Denver.
Governing’s opinion columns reflect the views of their authors and not necessarily those of Governing’s editors or management.
