The chaotic national dialogue around immunizations could cause widespread and lasting damage to public health, even in places like the Bay Area where vaccine support remains robust, say experts in infectious diseases.
As national leaders, including the United States’ own health secretary, argue about and frequently dismiss the value of vaccines across all ages, public health experts say the fallout could be as immediate as this winter: A decline in immunizations for the flu, COVID and RSV could result in an uptick in respiratory illnesses and deaths. Or the damage may be felt years or even decades from now, when vaccine-preventible diseases manifest in infants born to unvaccinated mothers.
Vaccine policies from Florida, which earlier this month announced plans to ban many childhood immunization mandates, could reverberate across the country to California, with more exposures to chickenpox, meningitis and other illnesses that are still considered rare in the state.
“The hope is that we will have high enough coverage in California to prevent protracted outbreaks,” said Dr. Art Reingold, a professor emeritus in epidemiology with the UC Berkeley School of Public Health.
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But that still means some people will become ill who wouldn’t have otherwise — many in Florida, but across the country too.
“It’s going to be an interesting experiment,” Reingold said, of the move in Florida along with other efforts to de-emphasize vaccinations. “With states like Florida saying they’ll have no rules or laws or mandates for vaccines for school entry, sooner or later we’ll see more illnesses and unfortunately hospitalizations and even occasional deaths. And that is a tragedy. These are illnesses that are completely preventable with the tools we have.”
“It’s going to do long-lasting damage,” Reingold said.
The attacks on vaccines began almost immediately after President Donald Trump began his second term in January, with the appointment of Robert F. Kennedy Jr. to secretary of Health and Human Services. Kennedy is an outspoken critic of many vaccines, including for measles and COVID.
Kennedy quickly removed everyone from the national vaccine advisory board and replaced them with people largely ambivalent or opposed to vaccines. He has since made several comments questioning the efficacy and safety of vaccines, and he has threatened to deny federal vaccine funding to states that do not allow religious or other exemptions to vaccine mandates. California is one such state.
At a Senate hearing Sept. 4 to defend his record so far with Health and Human Services, Kennedy refused to budge from his stance questioning vaccines. One senator accused him of purposely trying to take vaccines away from Americans.
“When you hear the leader of HHS saying these things about vaccines, it really undermines the confidence people might have,” said Dr. Yvonne Maldonado, an infectious disease expert at Stanford who regularly advises on federal vaccine policy. “It makes this a political issue, and it’s not a political issue.”
Chaos has ensued in particular around COVID vaccines, with recommendations changing frequently and varying depending on the federal, state or local agency issuing them. Several public health experts warned that the upcoming respiratory illness season could be especially brutal with doubts already swirling about who should get what shots, and how.
Ordinarily, the Centers for Disease Control and Prevention would issue recommendations that would be almost automatically picked up by states and counties to release to the public. But the CDC has been gutted and largely voiceless since Trump’s second term started.
“The local public health agencies — the counties and the states — are doing the best we can, but we’re adjusting to losing our national voice,” Maldonado said.
Dr. Nicholas Moss, health officer for Alameda County, said his priority at the moment is making sure residents are able to find and afford the vaccines they need, in addition to helping resolve some of the confusion around immunizations that’s been generated by federal discourse.
“First and foremost, I want people to be able to get the currently authorized and approved vaccine products that are recommended by experts. Fortunately, for right now the products are still out there,” he said. “But the other barrier is confusion. I’m very concerned about confusion over what people should be getting and what their families should be getting. And providers are confused about what they should be doing too.”
Florida announced Sept. 3 that it planned to ban all vaccine mandates in the state, including school mandates for children; the surgeon general compared immunization requirements to slavery in a press event announcing the plan. Since then, the state has backed off somewhat from that plan but still intends to ban some vaccine requirements within a few months.
Infectious disease experts across the country quickly derided the announcement, saying it would threaten lives and derail one of the foundations of public health.
“This unprecedented rollback would undermine decades of public health progress and place children and communities at increased risk for diseases such as measles, mumps, polio, and chickenpox, resulting in serious illness, disability and even death,” said the American Medical Association in a statement earlier this month. “While there is still time, we urge Florida to reconsider this change to help prevent a rise of infectious disease outbreaks that put health and lives at risk.”
The same day as Florida announced it was pulling back from vaccine mandates, California announced it was bolstering its vaccine support by forming an alliance with other Western states to make sure the public is still able to access critical immunizations. Such a move is not unprecedented — Western states similarly came together to study COVID vaccines in 2020 — but these analyses can place enormous burdens on state and local agencies that aren’t designed to do such work, said experts in public health.
And even if California and other states release their own vaccine guidance, decisions could still occur on the federal level that could make it more difficult for residents here to access certain immunizations, whether that’s COVID boosters, annual flu shots or even childhood vaccinations down the line. Maldonado said she worries the CDC could “whittle away” at the vaccine schedule for childhood immunizations.
“If you make the process more onerous,” said Reingold, “it’s simply going to result in fewer people having access to or getting these vaccines. We will see lower vaccine coverage, and we will see more illnesses and deaths that could have been prevented. And that’s very sad for public health.”
Maldonado is concerned about the immediate future, in particular the upcoming flu season. Reingold said he’s also worried about the long-term repercussions, including what appears to be a broad attack on public health.
Outbreaks of measles and mumps, once small and isolated, likely will become more frequent and larger as they spread in under-vaccinated populations. Measles cases already are skyrocketing in the U.S., with nearly 1,500 cases so far this year — the most in decades, as vaccination rates have dropped in some communities.
As long as California continues to require vaccination and maintain high immunization rates — over 95% of kindergarteners in the state meet the current vaccine recommendations — then those national outbreaks shouldn’t do too much damage here. But some people will get sick.
Other illnesses also may resurface or worsen without enough community immunity, but the damage may be harder to determine for a while, said experts in infectious diseases. German measles, for example, generally causes mild illness, but when women are infected during pregnancy the infection can cause blindness, hearing loss, heart defects and other devastating disorders in their newborns.
“And it’s not like immunization is a light switch you can just turn on and off,” Maldonado said. “When diseases take off, it’s really hard to stop them and it costs a lot of money. You can’t just say we’ll vaccinate everyone tomorrow.