Robert F. Kennedy Jr., US Secretary of Health and Human Services is under fire for his audacious attempts to discredit vaccines using misinformation and dubious “science”.
State governments, however, have their own arsenals to undermine vaccine uptake as part of the MAHA agenda (make America healthier again). In the United States, children are required to be vaccinated for a variety of infectious diseases including measles in order to attend kindergarten and school. Florida Governor Ron DeSantis announced that the state would scrap all vaccination mandates for school-age children, calling them “slavery”.
The measure will likely pass, as the Florida Surgeon General has expressed strong support for the repeal of vaccine mandates. Also, both the Florida State Senate, and the Florida House of Representatives are controlled by Republicans.
Why mandate vaccines?
High vaccination rates directly protect individuals. They can protect the entire community from diseases like measles. ” herd immunity shields those who cannot be protected directly by vaccinations.
Everyone should be concerned about high vaccination rates.
To promote vaccine acceptance, governments use a variety of levers. To achieve high uptake , they need to be accessible, free and well promoted.
When governments fail to do so, they may depend on mandates in order to encourage people to be vaccinated. States in the US are heavily dependent upon vaccine mandates due to the under-resourced, privatised and underfunded health system. This can make it hard for some families access vaccines.
It is dangerous to remove mandates
Experts have mixed opinions about vaccine mandates. Most experts agree that governments should allow voluntary vaccination as a first step.
Many would agree that removing mandates is a risky proposition, no matter what you think about them.
In the majority of US states, tensions surrounding mandatory vaccines are managed by religious or personal belief exemptions. These non medical exemptions enable parents to opt-out after a bureaucratic procedure, such as filling out a form or attending an educational session.
The layout of these policies has a significant impact – easy access to exemptions results in less coverage and more outbreaks.
What has been happening in the US recently?
The Florida proposal is part of a history in which state legislators have sought to make vaccine mandates for schools more restrictive or permissive. Republicans have led efforts in order to loosen vaccine mandates. However, both Democrats and Republicans have led efforts in order to tighten them.
In recent years, these efforts have become more extreme. The party differentiation has solidified and the courts have gotten involved.
California was the first state in 2015 to eliminate non-medical exclusions. The Democrat-led initiative was a response to community concerns regarding vaccine refusal and outbreaks.
A Mississippi judge will introduce a religious exemption in 2023. Prior to 2023, Mississippi was among the few states which permitted exemptions on medical grounds.
The application of more coercive policies to vaccine refusalers appears to have backedfired and has in part been responsible for shifting the pre-existing polarisation regarding vaccine mandates towards vaccines themselves.
Florida’s proposed policy is a more extreme version of this. Republicans no longer tweak vaccine mandates, but remove them entirely.
What will happen if Florida moves ahead?
Some parents in Florida may stop vaccinating children if there is no way to encourage vaccination.
Many of them will not be anti-vaccine. There will be many poor, disadvantaged and busy parents that need to have their children enrolled in school.
Others will take their cues from the federal and state governments, who may say that vaccination is not important or valuable. They may also internalise RFK Jr.’s message that it is dangerous.
Since the pandemic, the US has seen a decrease in childhood vaccination rates of 2.5 percentage points.
In Florida, where parents are able to access exemptions for religious and medical reasons, coverage rates for kindergarteners have fallen even further. They went from 93.8% prior to the pandemic, down to 88.7% by 2025, leaving thousands of unprotected children.
Without mandates, this rate will continue to decline.
The damage will not be limited to Florida. The disease will be spread to other states, and even other countries by mobile Americans. A trip to Disney World is not without risk.
In the long term, other Republican states will follow suit. We can expect more deaths, more suffering, and more outbreaks in each state.
Could this happen here in Australia?
In Australia, vaccination and vaccine policy are not politised in the same manner.
Both Labor governments and Coalition governments have introduced “No Jab, No Play” and “No Jab, No Pay” policies to prevent children from attending early education and to deny families government benefits.
The major parties also show strong support in favor of childhood vaccinations and mandates for vaccines.
The United States is the greatest threat to us. is sponsoring RFK Jr’s questionable science and he distorts vaccine information.
We don’t yet know the extent to which this attempt at mainstreaming anti-vaccination messages will impact vaccine confidence and vaccination rates in Australia.
Most Australian parents are in favor of vaccination. We can’t afford any more vaccinations because we have already decreased in coverage since the pandemic.
We need to prepare ourselves for these threats by ensuring that our house is in order. The new National Immunisation Strategy of the federal government aims to increase access, improve workforce quality, and use data more effectively for guidance.
The strategy promises to also look into a compensation scheme that is free of fault for rare vaccine-related injuries.
This bold agenda must be implemented with adequate budget and a significant role for the new Centre for Disease Control which will begin in 2026.
We must also continue to strengthen our capacity and provide support to our neighbours in the region, where low coverage and large outbreaks have been caused by a lack of resources.
Read on: In rare cases of vaccine injuries, Australians deserve compensation
Katie Attwell has received funding from the Medical Research Future Fund, a fund of the Australian Government. She received funding for research from the Australian Research Council of the Australian Government, and the Health Department of the Government of Western Australia. She is also a member of the board at Eviva Partners. This non-profit organization focuses on threats to public safety.
Julie Leask is funded by the NHMRC, WHO and NSW Ministry of Health for research. Sanofi funded her travel to a meeting overseas in 2024. She received consulting fees for RTI International, Task Force for Global Health and Task Force for Global Health.
Nancy Baxter has received funding from NHMRC and CIHR.
