Florida is taking steps to make vaccines optional for children. That has some people concerned about safety in schools, as doctors anticipate more infectious disease outbreaks, putting children, teachers and the broader community at risk.
By December, chickenpox, hepatitis B, haemophilus influenzae and pneumococcal vaccines will no longer be required for children to enter day cares and schools. Other vaccines could follow if legislators take up the issue in the coming months.
While the Florida Department of Health has not released any projections about which diseases will return or how many cases could occur, when or where, other scientists have shown how a highly contagious infection like measles can quickly spread in a school-like setting.
“You can expect the worst-case scenario," said Ira Longini, a biostatistician at the University of Florida.
His graphs and analysis, released shortly after Florida Surgeon General Dr. Joseph Ladapo announced a plan to lift vaccine mandates in the state last month, show what would happen at various levels of immunization.
In a county like Sarasota, where 79.9% of kindergartners are up to date on shots, a single case of measles in a school of 200 would likely infect more than 40 people.
The state's current vaccination rate among kindergartners is a little higher than Sarasota’s, at 89%. That's below the 95% needed for herd immunity with measles. Removing mandates is certain to lower the vaccination rate even further, said Longini.
"Coverage is already lower than it should be in the state of Florida, so any further erosion could be quite dangerous," he said.
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“In an average Florida kindergarten, one measles case would cause an outbreak 85.5% of the time,” Longini said.
Lower vaccine coverage means outbreaks would also be larger. Outbreaks in schools can present “more chance of spilling into older individuals who might have waning antibodies and more severe outcomes,” he said.
Another way to visualize the future is with an online measles epidemic simulator from the University of Pittsburgh. It's called FRED, short for “Framework for Reconstructing Epidemiological Dynamics.”
Users can pick their city and state from a drop-down menu, then select the local vaccination rate, whether 80, 85, 90 or 95 percent, and see how far and fast measles spreads when introduced.
At 80%, the screen fills up with red dots showing how cases explode. When 95% of people are vaccinated, only one or two red dots appear.
Those most at risk include people who are not vaccinated, people with compromised immunity and seniors. Florida is also a top state for tourism and also has about 5 million people over age 65, the second most in the country after California.
“The older you are, the more likely that you could not be as able to respond as you used to," said Jennifer Takagishi, vice president of the Florida Chapter of the American Academy of Pediatrics.
Diseases like measles, whooping cough and pneumococcal pneumonias “are already here in the states, and they're just going to increase," Takagishi said.
A recent Washington Post-KFF poll showed broad support across party lines for vaccine mandates in schools, with eight in 10 people nationally, and in Florida, in favor of keeping them and allowing some exceptions.
But among Republicans, support is lower, at 75%, compared with Democrats at 91%.
"See, this isn't a vaccine thing. For me, this is free will, a free choice, a bodily choice," said Rod Thomson, a Republican consultant in Sarasota, who said there is growing mistrust of doctors and the medical establishment.
Parents in Florida already have the option of not vaccinating their children. The number seeking religious exemptions has risen steadily since the COVID pandemic.
"They can opt out, but then what you'll find is they can't find a pediatrician. They can't put their kids in the schools they want to put them in," Thomson said.
Having more unvaccinated children in public schools worries Mary Holmes, 64, who teaches students with special needs in Sarasota.
"We have an entire group of students that are medically fragile. And I personally am working with adults that are undergoing cancer treatment," Holmes said.
In her view, vaccination is an individual choice, one that’s needed to protect the whole community, especially in schools.
"I do think that if a parent chooses to do that (not vaccinate), that's their right. And I think that I have a right as a public school teacher, and a first line of defense for my students to say, ‘But you're not going to expose us,' " Holmes said.
