Florida Surgeon General Dr. Joseph Ladapo has drawn controversy over his opinions on public health issues like COVID-19, measles and fluoridated water in the past.
A single-dose vial of measles, mumps and rubella vaccine is shown next to a container with nine other vials at a vaccination clinic held in Erie, Pennsylvania.
A nurse readies a syringe during a free vaccination event for students and faculty at Iroquois High School in Louisville, Kentucky. The event was voluntary for those wishing to receive vaccinations for measles and Covid-19.

In an unprecedented move since all 50 states adopted mandates in 1980, Florida officials have announced plans to repeal vaccine requirements for children attending public schools.

In a news conference Sept. 3, Gov. Ron DeSantis, Surgeon General Dr. Joseph Ladapo and other state leaders said Florida was working to end all vaccine mandates. At the news conference, Ladapo − an already controversial figure for his handling of other public health issues, including COVID-19 and measles − compared compulsory vaccinations against diseases like polio to "slavery," saying: "Who am I to tell you what your child should put in their body? I don’t have that right. Your body is a gift from God."

The announcement was cheered by anti-vaccine and personal freedom advocates while being criticized by professional medical societies and health experts. Amid the back-and-forth is more confusion for the general public. Can Florida do this? Is it legal? Are vaccines safe?

Here's what you should know.

Did Florida end vaccine mandates?

No, Florida has not yet ended vaccine mandates. In the news conference Sept. 3, state officials, including the state's governor and surgeon general, announced plans to roll back vaccine requirements, including for school-age children. But the plan is not immediate and could face legal challenges.

Which vaccines are required for schoolchildren in Florida?

According to Florida law, children planning to attend public school are required to receive immunizations for polio, diphtheria (a bacterial infection), rubeola (measles), rubella (a viral infection also called German measles), pertussis (whooping cough), mumps, tetanus and other "communicable diseases" as determined under rules created by the state Department of Health.

Private schools not funded by state money can set their own vaccine requirements. Families in Florida can also seek temporary or permanent exemptions for medical or religious reasons.

Can Florida get rid of vaccine mandates? Explaining the process.

Technically, states can and sometimes do dictate their own vaccination requirements, but the process isn't simple, nor does it allow unilateral decisions by single parties, said Dr. Brigid Groves, a vaccine policy expert and a vice president of the American Pharmacists Association.

"Because of the way their laws are written, it would require both regulatory change, rule change, and also a policy change on the Department of Health side," she said. It would take time to undo some Florida mandates because "the state Legislature needs to get involved."

The Florida Department of Health did not immediately respond to a request for comment but told Politico it would roll out new exemptions over the next 80 days that would allow people to opt out of vaccine requirements for “personal health benefits."

The department also said it plans to end requirements for four vaccines, including chicken pox, that were mandated under its authority and will seek changes to the law to do away with other requirements, such as those for measles and polio.

Immunizations required by law, including the MMR (measles, mumps, rubella) and polio vaccines, cannot be revoked without approval from the Legislature. Though Ladapo said Sept. 3 that the the governor and legislators will work to repeal those requirements, the Florida Senate and House Majority Offices have yet to publicly indicate their support or opposition. House Speaker Daniel Perez and State Senate President Ben Albritton, both Republicans, did not immediately respond to a request for comment.

The Senate Minority Office, however, issued a statement Sept. 3 saying the proposition was met with "unanimous opposition" from the chamber's Democrats. Senate Democratic Leader Lori Berman called the announcement "ridiculous" and said she would "be doing everything in my power to protect our kids from these reckless attempts to harm them.”

How long would it take for vaccine mandates to change?

It is unclear how long changing vaccine mandates would take in Florida. Though the health department has mentioned an 80-day timeline, some proposed modifications would still need to make their way through the Legislature. That means those rules would not be repealed for this school year, which has already begun.

Why are vaccines required in schools? When did mandates start?

Mandatory vaccine schedules for children attending public school date back to the 1850s, when Massachusetts enacted a smallpox immunization requirement, according to the CDC. By 1900, nearly half of the states had a smallpox vaccine requirement.

The federal Childhood Immunization Initiative was created in the 1960s after a major measles outbreak in the United States, and it created the vaccine schedule we are familiar with today. By 1980, the CDC said, all 50 states had a vaccine mandate for public school students.

Dr. Scott Weaver, director of the Institute for Human Infections and Immunity, said consistency across states with vaccine mandates has enabled the United States to control or eliminate highly infectious diseases like polio and measles. This is most effectively done by achieving what is known as herd immunity through vaccinations. That threshold is reached when enough people in an area are vaccinated that the disease cannot spread effectively to others even if someone does become infected.

"We've relied on these childhood vaccines to protect the entire population of the U.S., including these vulnerable groups who really don't have any other option to protect themselves," he said. "And now we're backtracking."

The Supreme Court has reaffirmed the constitutional right of states to make vaccination compulsory on multiple occasions. In the first case, Jacobson v. Massachusetts, the justices ruled in 1905 that the city of Cambridge, Massachusetts, could fine residents who refused to receive smallpox immunizations, according to a summary from the National Constitution Center.

In 1922, the U.S. Supreme Court ruled specifically on vaccine requirements for children attending public school in Zucht v. King, unanimously upholding the Jacobson v. Massachusetts finding that "it is within the police power of a state to provide for compulsory vaccination."

What should parents know about vaccinating their kids?

Parents who are confused, concerned or have questions about vaccinating their children should speak directly to their medical providers or seek information from reputable sources such as professional medical societies like the American Medical Association and American Academy of Pediatrics, said Weaver and Groves.

Widely mandated vaccines, such as the MMR, have been proven safe and effective through decades, or even centuries, of widespread use, Weaver said. Not only are the vaccinations safe, he said, but they have been required up to this point for a reason.

"They did it because they were seeing life-threatening infectious diseases all the time. They were seeing polio up until the 1950s, so it was a little easier to convince people that you have to use vaccines not only to protect your family, but to protect the community," he said. "But, it's human nature that when we don't see a problem for a long time, we assume there's not a need to invest in controlling the problem."

A measles outbreak in Texas this year shows just how quickly low vaccination rates and a single infection in a small community can balloon to a nationwide problem that not only makes children sick but also stresses the public health system as a whole.

The outbreak, which has been declared over after spreading across 40 states, resulted in 1,356 confirmed measles cases, 171 hospitalizations and three deaths, according to the CDC as of Aug. 5. The majority of those cases, 92%, were in people who were unvaccinated or had unknown vaccine status.

When fewer children are protected from preventable disease, the entire system suffers, Groves said. Without widespread vaccination, children's educational outcomes suffer from increased absenteeism and more time away from school and friends. The likelihood of children having long-term complications that require expensive or time-consuming medical care and resources increases; stress on parents, caregivers and local hospitals builds and, in the worst case, children die or become permanently disabled.

Contributing: Ana Goñi-Lessan, USA TODAY Network – Florida

This article originally appeared on USA TODAY: A state hasn't removed vaccine mandates for 45 years. Can Florida do it?

Reporting by Mary Walrath-Holdridge, USA TODAY / USA TODAY

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