Routine childhood vaccination rates have declined in the U.S. and vaccine-preventable childhood diseases are on the rise.

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Rustam Shaimov/Getty Images

President-elect Trump says he wants Robert F. Kennedy Jr. ‘will let go of health’. That makes many pediatricians nervous about RFK Jr.’s anti-vaccine rhetoric. When another vaccine skeptic, Joseph Ladapo, became surgeon general in Florida, some doctors there say vaccine hesitancy worsened.

“It’s because people in power, like our surgeon general, for example, are pushing this anti-vax message,” said Dr. Jeffrey Goldhagen, a professor of pediatrics at the University of Florida College of Medicine and chairman of the International Society for Social Pediatrics and Child Health.

Vaccine hesitancy has increased in Florida. When Ladapo was appointed in September 2021, the routine childhood vaccination rate for preschoolers was 93.3%. It has now fallen to 90.6%. That is the lowest rate in more than a decade – and well below the threshold needed for herd immunity against highly contagious diseases such as measles.

Dr. Lisa Gwynn, a pediatrician in Miami-Dade County, says she spends a lot of time combating misinformation about vaccines. “Probably 50% of our work in pediatrics is explaining to parents the importance of vaccinating their children,” she says.

Earlier this year, Gwynn saw the consequences of not getting routine childhood vaccinations firsthand.

“We just had a measles outbreak around the corner from the elementary school my daughter attended,” she says in nearby Broward County. “There were five children who contracted measles and they were not vaccinated.”

When a measles outbreak occurs, the Centers for Disease Control and Prevention advises parents to keep unvaccinated children home after exposure to prevent the disease from spreading. But Florida Surgeon General Joseph Ladapo’s advice was very different: He told parents of unvaccinated children that it was up to them to decide whether to send their children to school or keep them home.

Those guidelines “violated every premise of how measles should be addressed,” Goldhagen says.

Vaccine hesitancy was on the rise in Florida long before Ladapo became surgeon general. In the two years before he took office, vaccination rates fell by a fraction of a percentage point every year. After his appointment, the decline accelerated: in just two years, the number fell by almost 3%.

Goldhagen says the fight against vaccine hesitancy has become more difficult. “It accelerated during COVID. It accelerated post-COVID and it accelerated mainly because of this surgeon general’s anti-vaccine stance,” he says.

In January 2022, Ladapo recommended vaccinating children against COVID, contradicting federal public health leaders who recommended that all children receive the shots. The Florida chapter of the American Academy of Pediatrics called the move irresponsible.

That same year he appeared on a podcast hosted by Dr. Sherri Tenpenny, a prominent anti-vaccine doctor in Ohio. When she made false claims that vaccines cause autism, Ladapo did not correct her, nor did he correct her claim that no vaccine has been proven safe or effective.

In January this year, Ladapo called for a halt to the use of mRNA COVID-19 vaccines for both adults and children, citing unproven health risks that have been refuted.

Ladapo has become a frequent target of critics who say his positions on vaccines run counter to established science. Last year, the CDC and FDA sent Ladapo a letter reprimanding him for spreading misinformation about COVID vaccines and fueling vaccine hesitancy. Now Ladapo is being mentioned as a possible candidate to lead the Department of Health and Human Services. This also applies to RFK Jr.

Pediatricians say anti-vaccine attitudes that have grown during the pandemic, particularly around the COVID vaccines, are now affecting all childhood vaccinations.

And it’s not just in Florida.

Routine vaccination in children In most US states, rates have fallen while vaccine exemptions have risen.

Gwynn fears these numbers will fall further if those responsible for national health policy doubt the safety and efficacy of vaccines. “I’m very concerned, as are all pediatricians across the country,” she says. “One of our most important roles as pediatricians is to protect children. And the most effective way to protect children from preventable communicable diseases is vaccination.”

Dr. Rana Alissa is president of the Florida Chapter of the American Academy of Pediatrics. She says vaccine hesitancy is complex and can’t be attributed to one person. But she says the politicization of vaccines during the pandemic, when people’s attitudes toward COVID vaccines became something of a litmus test for their political views, hasn’t helped.

Vaccines are one of the most effective tools health care providers have to prevent disease, she says. “The vaccines we have in the US prevent 21 deadly diseases.”

The success of vaccines means that many people no longer remember how serious some diseases can be. Alissa says this could lead some people to make flawed risk calculations about the value of getting a vaccine.

“People think that getting the disease is easier than or safer than getting the vaccine. I have no idea where this comes from,” says Alissa.

The US is already seeing a rise in some vaccine-preventable childhood diseases, says Dr. Adam Ratner, a pediatric infectious disease specialist in New York City and author of a forthcoming book on the measles resurgence and the growing anti-vaccination movement.

Outbreaks of measles and cases of chickenpox and pneumococcal disease are increasing in the U.S., he notes.

“When we see children in the hospital with complications from these things that we can prevent or at least reduce the risk by using vaccines, it’s very frustrating,” he says.

As vaccine hesitancy continues to spread, Alissa and other pediatricians worry that other devastating childhood diseases like polio could reemerge.

Alissa says many people have lost faith in public health science, and the country needs leaders who will help regain that trust.

This story was edited by Jane Greenhalgh