There’s a reason certain life-threatening diseases like polio, measles and whooping cough were essentially eradicated, public health experts say: vaccine mandates for schoolchildren.
But a once-routine requirement is under attack due to rising public skepticism that accelerated during the pandemic and has been fueled by online misinformation and promoted by high-profile figures, including U.S. Health Secretary Robert F. Kennedy Jr.
In recent months, Kennedy has canceled millions of dollars in federal funding for mRNA vaccine research and fired the members of the Centers for Disease Control and Preventions committee that makes vaccine recommendations, replacing some members with people who have been critical of vaccines. Last week, Florida’s surgeon general said the state would do away with vaccine mandates, including for schools.
Louisiana still requires students to get a handful of vaccinations, including ones that protect against polio, measles and diphtheria. But the state has one of the broadest exemption policies in the country, allowing parents to opt-out their children for medical, religious or philosophical reasons. In recent years, Louisiana legislators have passed laws targeting vaccines, including one that requires schools to publicize vaccine exemptions to parents.
Lately, the number of Louisiana families declining to vaccinate their children has skyrocketed, alarming public health experts. The rate of families requesting vaccine exemptions for kindergartens reached its highest point in a decade during the 2022-23 school year, and it has continued to rise, with 3% of families requesting nonmedical exemptions last school year, according to the CDC.
To make sense of the changes, the Times-Picayune spoke with Charles Stoecker, a health care economist at Tulane University who studies vaccine policy. Stoecker discussed the recent rise in vaccine skepticism and argued that the decline in childhood vaccinations could seriously threaten public health.
This interview has been edited for length and clarity.
Talk about vaccines that protect against pneumonia, which you’ve studied.
Around 2000, we developed a version of pneumococcal vaccine that took a Diphtheria-causing toxin — something that your body really reacts hard to — scooped out all the bad parts of it and put in something that looked like the stuff that causes pneumonia and that takes really well.
For adults, effectiveness might wane over time, but for kids, it’s almost magical. It’s nearly 100% effective against certain strains of pneumonia and seems to last for the duration of childhood. This was a huge step forward.
How did the development of that vaccine impact public health?
It’s cool to see how disease patterns in adults change when we vaccinate the kids. When kids started getting this magic (pneumococcal) vaccine around 2000, adult levels became nearly undetectable for those strains.
We’re vaccinating the kids so kids can’t get the diseases from each other. (But) even if you don’t have pneumonia, you may carry some of those bacteria around in your nose and you’re coming home to grandma. Since you have this vaccine, it’s not in your nose and you’re not breathing on grandma, and she can’t wind up in the hospital from pneumonia. And of course, it protects the kids themselves.
How has vaccine buy-in changed since the pandemic?
During COVID, a bunch of doctors’ offices closed and kids couldn’t get appointments, so we saw vaccination rates go down. We’ve bounced back up, but not quite to pre-pandemic levels. There’s something that fundamentally changed about people’s perceptions of the necessity of vaccines during COVID. I’m not sure exactly what that is, but it’s bad for public health.
Herd immunity is a patchwork quilt. State-level vaccination rates can hide a lot of heterogeneity. Pre-COVID, wealthy schools wouldn’t vaccinate their kids and would have lower vaccination rates and they’d have outbreaks of measles or pertussis and that’s where they were concentrated. Post-pandemic, state-level vaccination rates fell, but they don’t fall equally. Some schools have lower vaccination rates than others.
Why are school vaccine mandates effective?
The societal bargain we’ve struck is that we will educate your kids for free — through tax revenue but you don’t spend any money — so your kids get an education and are able to make a better wage later. Plus, you get free babysitting while they’re there and you can go to work.
In return, we require you to vaccinate your kids. You may not want to vaccinate your kids because it’s a pain to take them to the doctor or they get fussy or you have other concerns. But we know the vaccines are safe and effective.
This bargain started about 150 years ago and that’s about when we started to see these dramatic declines in infectious disease. It used to be that one-fifth of kids died before they hit 5, and now it’s very rare to have a kid die before age 5.
How could policy changes, including doing away with vaccine mandates for schoolchildren, impact public health?
I think it’s rewinding our disease environment to a place we have not seen in 100 years.
These diseases are not present of mind because we’ve done such a good job preventing their transmission largely through school-based vaccination programs. Not all vaccines are as great as pneumococcal — some are less effective — and some kids can’t get the vaccines because they have cancer or something that makes it not recommended. (But) those kids that are vaccinated protect themselves, protect other kids and their parents and their grandparents.
(Florida’s policy) is going to kick out that critical leg of protection. We don’t know exactly what’s going to happen, but we’ve seen what has happened when we haven’t had that leg. It’s hard to imagine that people won’t get seriously sick and possibly die because of these policies.
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