Vaccine skepticism poses growing public health risk

Editor's note: This article was published here Governing'Spring 2024 magazine. You can subscribe here.

In February, Florida Surgeon General Joseph Ladapo sent a letter to families of students who attended a school where measles cases had been reported. He told them that it is generally recommended that children stay home until the end of the infectious period, but because of the “burden on families and the cost to their education of healthy children not attending school,” the health department is “leaving the decision about school attendance up to parents or guardians.”

This statement, which contradicts longstanding policies of excluding children who have been exposed to the disease – especially those who are not vaccinated – reflects new challenges in the politics of childhood vaccination after the COVID-19 pandemic. Childhood vaccination rates that fell 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 before COVID-19, vaccination rates were declining. Although most parents fully vaccinate their children, it is estimated that 20 to 30 percent of American parents were delaying, spacing, or skipping select vaccines. They were not necessarily anti-vaccine, but they did not accept the claim that all vaccines are equally safe, necessary, or beneficial.

In my research with these parents, I found that they were not ignorant or anti-science, but rather they trusted their own judgment more than experts and embraced the cultural expectation that parents take personal responsibility for their children’s health and well-being.

Meanwhile, we have seen widespread efforts to undermine public health. Underinvestment has led to staff shortages and high turnover. Between 2017 and 2021, nearly half of the employees of state and local public health agencies left, including three-quarters of new hires and employees under the age of 35. During the pandemic, public health leaders faced threats and harassment that further weakened the workforce. The 2021 dismissal of Tennessee vaccination leader Michelle Fiscus for promoting vaccine information demonstrates how the politicization of the COVID-19 vaccine affects all vaccines.

Between 2021 and 2023, approximately 65 laws were passed in 24 states that restrict the ability of state and local officials to use disease mitigation strategies. These include bans on requiring proof of vaccination; limits on the closure of schools, businesses, or churches; and expanded exemptions from vaccination requirements. How these will affect childhood vaccination requirements is unclear, but indicate weak support for ideals of shared community responsibility.

There is now more respect for personal choice. Mandates acknowledge that children seeking education, as required by law, should not face increased risk of infectious disease while doing so. These laws are intended to protect children who are most vulnerable to the worst consequences of infection, as we saw in 2015 when 6-year-old Rhett Kravitt, a California student with leukemia, and his family requested their school district exclude unvaccinated children during a measles outbreak. Regardless of the goals behind the laws, there is now more support for parents who refuse vaccines, as the Florida statement shows.

Every parent should do what they feel is best for their child. This was true before COVID-19 and remains equally true today. Yet this commitment to individualistic parenting ignores how infectious diseases connect us to each other in a way that transcends personal choice.

New and growing support for allowing unvaccinated children to fully participate in educational and child-care spaces without contributing to community strategies for protection — even though they may pose a 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 writers, and do not necessarily coincide with their views. GoverningBy the editors or management of.

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