Every state, as well as D.C., requires children to obtain certain vaccinations before they can attend school or childcare. These mandates date back decades, and are considered a foundational bulwark of public health defense against infectious disease.
Since last summer, Florida's leaders have aimed to be the first state to drop some of those vaccine mandates. The anti-vaccine rhetoric, and the efforts to revise laws and regulations, rumbled along at the state health department, and in the legislature. But by March, the fight seemed to have stalled out.
But the story may not be over. On April 15, Governor Ron DeSantis called for a legislative special session, which starts today and runs through Friday.
There are only 3 items on the agenda: Congressional redistricting, potential protections from AI, and "medical freedom" around vaccines.
The outcome could help predict the chances of success for similar movements in other states. An Associated Press analysis found at least 350 anti-vaccine bills were introduced in state legislatures last year. Many focused on relaxing requirements for vaccines in schools.
Ladapo: Mandates are bodily 'slavery'
On Sept. 3, Gov. DeSantis and Florida's surgeon general, Joseph Ladapo, held a press conference at a private Christian school east of Tampa. Ladapo declared the state would work to end all vaccine mandates in Florida law.
"Every last one of them is wrong and drips with disdain and slavery," Ladapo said.
"Who am I, as a government, or anyone else — or who am I, as a man standing here, to tell you what you should put in your body?"
Gov. DeSantis is term-limited, so there are only 8 months left in his governorship, and the Congressional midterms are even sooner, in November.
Political analysts say that the effort to cut back on mandated shots for children is closely tied to the political fortunes of the Republican majority.
"For Republicans, they're a little bit leery," said Aubrey Jewett, a professor of political science at the University of Central Florida. "They know we're in an election cycle. They know political history, and it's pretty clear that the President's party tends to lose seats in the midterm election."
Although hundreds of anti-vaccine bills have been introduced in state legislatures, the noisy rhetoric and splashy headlines don't guarantee passage, said Kelly Whitener, associate research professor of health policy at Georgetown University.
"Lots of bills get introduced," said Whitener, "And don't end up passing or being enacted. And that's the same trend that we're seeing this year."
That's because in many states, including Florida, "there's a disconnect between what we hear a lot from a potentially vocal minority about how they feel about vaccines — compared to where the majority of people really are," said Whitener.
"For most people, they still support the idea of near universal vaccination, still understand the importance of vaccinating children to protect people who can't be vaccinated."
Ladapo did not respond to a request for an interview. His recent posts on social media have increasingly focused on healthy eating, testing candy and baby formula for toxins, and pesticide use in agriculture.
Unwinding mandates by law, and through regulation
To undo some of the mandates, Florida's legislature would have to pass new laws.
But 4 of the childhood vaccines — against meningitis, chickenpox and hepatitis B — are regulated by the state department of health.
At a Dec. 12 forum hosted by the health department in Panama City, public comment went on for hours.
"This is about freedom," said Larry Downs, Jr. "The default setting should be freedom, not these corporate chemical vaccine injections."
Florida schoolteacher Marion Fesmire has worked overseas, and defended vaccine requirements in part because of some of the suffering she has seen.
"I've seen kids with polio. I've seen blind kids. I've seen kids die before they're even 10 years old. It's heartbreaking," Fesmire said.
Among the several speakers, those who wanted to keep the mandates slightly outnumbered those who opposed them.
Since that time, the health department hasn't held any more public forums.
The department hasn't filed the paperwork needed to change the vaccination rules, including a statement of regulatory costs. In that, the department must estimate whether changing the rules could affect personal income, the number of visitors to the state, or the size of the Florida workforce.
When NPR asked for an update, the Florida Department of Health said in an email it is "currently in the rulemaking process" and any updates would be posted in the Florida Administrative Registrar.
Keeping mandates, but with a new exemption
On the legislative front, there was little progress on undoing mandates during the regular winter session.
The vaccine-related bill, SB 1756, didn't remove any mandates, Instead it allowed a new kind of exemption — in addition to a religious or medical exemption, a parent could exempt their child for reasons of personal conscience. This type of exemption is already available in 17 states.
Democrats are in the minority in the Florida legislature, and came out against it.
"It's currently very easy to opt out for religious reasons," said state Senator Carlos Guillermo Smith (D). "Why is this bill necessary? Given that context, is your bill just about giving people more options to ignore school immunizations, or is it intended to solve a public health problem?"
A few Republicans also opposed the bill. State senator Gayle Harrell (R) brought up the measles outbreak. So far this year, Florida is the state with the fourth-highest number of measles cases, with over 140.
"I truly believe that this is a dangerous bill, and I cannot vote for it," Harrell said.
The bill also included a permanent ban on mandates for any mRNA-based vaccines, and would have allowed non-prescription sales of ivermectin, an anti-parasite medication that rose to popularity as an alternative treatment for COVID.
Florida's prior Surgeon General, Scott Rivkees, condemned the idea, calling it "the equivalent of walking into a pharmacy and requesting amoxicillin for a self-diagnosed infection."
In the end, the House version of the bill, also known as the "medical freedom" bill, never made it to committee, and died. It had included a new provision, which would allow the Florida Department of Health to discipline health care providers if they refused treat unvaccinated people.
Parental support vs. political rhetoric
A national poll by KFF and the Washington Post showed 81% of parents supported school vaccine requirements.
"They support these vaccines. They support protecting their kids through these mandates. And that includes Florida parents," said Jen Kates, a senior vice president at KFF, a nonpartisan health policy think tank.
Special legislative sessions are unpredictable, and people on both sides say the Florida fight is far from over, with mistrust of the medical establishment still running high after the COVID-19 pandemic.
"There are many more people now who have skepticism about the wisdom of public health policy and law," said Barbara Loe Fisher, an anti-vaccine activist who has been working to end mandates since 1982.
"I don't think that that's going to disappear. I think it's going to grow."
This story comes from NPR's health reporting partnership with WUSF and KFF Health News.
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