Arguably one of the most successful public health policies of all time has been school vaccine mandates, a policy that has been common in states dating back a very long time; indeed, it was in 1827 when Boston first required smallpox vaccination prior to school enrollment, with Massachusetts following suit in 1853, with most of New England requiring smallpox vaccination by the end of the 19th century and such mandates being commonplace during the 20th century. In the wake of the development of the polio vaccine, school vaccine mandates expanded to include the polio vaccine and new vaccines that followed.
The idea behind school vaccine mandates is amazingly simple simple. States don’t actually force children to be vaccinated. Instead, in order to protect children in a place where they congregate together every day, states do require a slate of vaccines before a child can be enrolled in school. Exemptions to such mandates have traditionally been allowed for medical and religious reasons and, more recently, for reasons of “personal belief.” By and large school vaccine mandates have been very successful, as well, and have ensured a high degree of vaccination in most localities without resorting to government-ordered “forced vaccination.” As a result, most states now require vaccines before school enrollment based on the CDC’s recommended birth through 18 years of age immunization schedule.
Antivaxxers have long opposed vaccine mandates of any kind, but in particularly they’ve always despised school vaccine mandates. During the pandemic, this opposition predictably spread to opposition to vaccine mandates for health care workers or by any private company, whether mandated by government or decided upon by a private entity. What a lot of people who only started paying attention to the antivaccine movement don’t know is that this opposition to vaccine mandates is nothing new. Indeed, it’s been a feature of the antivaccine movement since long before I ever started paying attention. The endgame of the antivaccine movement has always been the elimination of all vaccine mandates, including school vaccine mandates. Unfortunately, I fear that that endgame might be closer than ever before, given this news report:
But bills with language expanding religious exemptions for childhood vaccine requirements were passed by the state Senate in March and now face the House when the legislature reconvenes April 25.
They are among the more than 520 vaccine-related bills introduced in statehouses nationwide since Jan. 1, according to data from the National Conference of State Legislatures. Of those bills, 66 specifically relate to childhood vaccine requirements in 25 states.
Prior to around a decade ago, school vaccine mandates had long enjoyed a status that was as close to apolitical as any policy has ever enjoyed in the United States. At the very least, they enjoyed broad and strong bipartisan support and were relatively uncontroversial for decades, representing a reasonable compromise between public health and freedom. There was no compulsory vaccination, but if parents refused vaccines for their children there were consequences in terms of not being able to access public schools and daycare facilities. Because of the privileged position religion has always had in the US as a belief system, there were always religious exemptions. Then, more and more states started allowing more and more nonreligious “personal belief” exemptions, which then led to problems with low vaccine uptake in a number of states, which led states to start trying to make such exemptions harder to obtain or banning them altogether. Indeed, a decade ago I was writing about how pertussis returned in my state due to lax standards for personal belief exemptions, although as early as 2006 I wrote about how pertussis was making a comeback in states with lax laws regarding such exemption and how by 2012 that problem was getting worse.
Enter the Disneyland measles outbreak during the 2014 Christmas holiday season, which was due to low MMR vaccine uptake and galvanized California state lawmakers. In 2015, they passed SB 277, a law that, for all intents and purposes, eliminated nonmedical religious and “personal belief” exemptions to school vaccine mandates. Unsurprisingly, the antivaccine movement strongly opposed passage of the law and during the battle over SB 277 figured out that framing resistance to school vaccine mandates as a matter of “freedom” and “parental rights” could attract the support of right wing groups opposed to government regulation. Within a couple of years, the issue of school vaccine mandates had become hopelessly politicized, with right wingers and Republicans coming down on the side of making exemptions easier to obtain and weakening school vaccine mandates.
In the process, Republicans started backing all sorts of bills to make measles great again and becoming more and more opposed to public health interventions of any kind intended to control infectious diseases, justifying their opposition with bromides like “freedom” and “personal responsibility.” This led to attempts to pass laws like the one in Michigan that would have make personal belief exemptions easy to obtain and even restricted public health officials from being able to bar unvaccinated children from school in the middle of an outbreak of vaccine-preventable disease. Although fortunately this bill never became law, it’s hard not to see it as a precursor to the many bills proposed by Republicans during the pandemic that would strip authority to issue emergency public health orders from governors and state and local public health authorities.
In the process, during the last decade or so, Republicans have gone from just pandering to antivaxxers without really having their hearts in it because right wing activist groups were opposed to vaccine mandates to many of them openly expressing antivaccine conspiracy theories themselves. For example, in 2018 one of the Republican candidates held an antivaccine roundtable in my congressional district. It featured the usual conspiracy theories, pseudoscience, and other nonsense promoted by a local antivaccine group. I documented it all by attending as a mole. Elsewhere, a number of statehouses accumulated a distressingly large contingent of antivaccine-pandering (or outright antivax) legislators; i.e., Ohio and Oregon.
What’s described in the news story that I cited above, though, is a renewed assault on school vaccine mandates beyond what I have ever seen before during the two decades that I’ve been writing about the antivaccine movement. I first warned about this last fall, when a Florida legislator—because of course it had to be Florida!—proposed reviewing all vaccine mandates, including school vaccine mandates. Although that “review” didn’t go anywhere, it was nonetheless symptomatic of how the anti-COVID-19 vaccine activism has spilled over to facilitate an assault on school vaccine mandates. It’s an effort enabled by the COVID-19 pandemic, during which antivaxxers joined forces with—and thereby become subsumed in—the broader anti-government forces arrayed against public health interventions to mitigate the spread of COVID-19, such as masks and “lockdowns,” including the far right.
One way of looking at it is that the antivaccine movement, having enticed the right into opposing school vaccine mandates on the basis of “personal freedom” and “parental rights,” has now found itself just a part of a larger right wing ecosystem of QAnon-based conspiracy theories and resistance to the administrative state and public health. On the other hand, I like to quip, “Come for the freedumb, stay for the antivaccine conspiracy theories.” The idea is that the antivaccine movement has seen its conspiracy theories rise to become a key component of the whole right wing attack on the administrative state. Antivaxxers might now be just a part of a larger right wing enterprise opposing public health, but their movement is clearly a very important part. It’s probably a deal they don’t regret, as they have more cachet than ever, and their endgame, long thought to be impossible, looks more and more possible.
Unsurprisingly, the antivaccine movement sees this maelstrom of resistance to government as a golden opportunity, and they’re trying to take full advantage of it. I’m not the only one who knows what the endgame is:
In Missouri, for example, legislators are considering a measure exempting private school students from vaccine requirements. In Louisiana, a bill in the House would prohibit vaccinations on school property and at school-sponsored events.
Fewer than 10% of the bills will likely gain any traction, but the volume of attempts to roll back vaccine requirements is alarming, said Rekha Lakshmanan, director of advocacy and public policy at the Immunization Partnership, a vaccine education organization.
“Those are all chipping away at one of the end goals for anti-vaccine activists, which is completely doing away with school requirements,” said Lakshmanan. “That’s what people need to be paying very close attention to.”
Lakshmanan is absolutely correct, and this is what I’ve been warning about long before the pandemic. Of course, before the pandemic, even I didn’t think that antivaxxers had a chance of success, except maybe occasionally here or there in individual states. Now I’m not so sure, and neither are a lot of vaccine advocates:
To be sure, anti-vaccine activists have existed as long as vaccines. And legislation to limit requirements to vaccinate against diseases such as polio, measles, and meningitis are not new. But, according to public health experts, the movement has gained momentum amid the coronavirus pandemic, boosting the reach of high-profile anti-vaccine activists.
“If you had told me that a pandemic — and what I would consider a miraculous vaccine for that disease — would trigger an anti-vax surge, I would never have believed it,” said Tracy Russell, executive director of Nurture KC, which works to improve children’s and family health in the Kansas City area of Missouri and Kansas. “But that’s exactly what happened.”
There was a time when I thought the way that Russell thought. I used to think that a deadly pandemic would destroy the antivaccine movement. However, even before the pandemic hit, I was coming to see that I was being hopelessly naive. What led me to this realization was a confluence of events beginning with the Disneyland measles outbreak, which didn’t budge the needle of belief among antivaxxers at all, to the reaction of antivaxxers to the deadly measles outbreak in Samoa right around the time that the very first cases of a novel coronavirus disease were popping up in Wuhan, China, but before the new disease had infected enough people to become major international news. Despite the death toll, antivaxxers doubled down, denied that measles was deadly, and even tried to blame the measles vaccine for the deaths. As a result, I started to realize that even a deadly pandemic countered with a safe and effective vaccine would not change antivaccine beliefs, although I will confess that even I didn’t foresee just how much antivaxxers would double down and become more influential than ever.
And they haven’t.
Also, even though the antivaccine movement has been subsumed in a larger right wing movement, to paraphrase and co-opt Pete Townsend, likely they’d call that “a bargain, the best I’ve ever had,” given this:
One pending Kansas bill would mandate that vaccine exemption requests be accepted without scrutiny if based on religion or personal beliefs. Currently, the state leaves it to day care centers and school districts to accept requests for religious exemptions.
State Sen. Mark Steffen stands behind amendments he pushed nullifying Kansas’ childhood vaccine requirements. The Republican, who said he is “not an anti-vaxxer in any shape or form,” lamented mandates he said were a vestige of a “kinder, gentler time” and suggested that individual rights supersede mandates designed to protect public health.
Steffen, an anesthesiologist who said he is under investigation by the Kansas Board of Healing Arts for prescribing ivermectin to covid patients, said suggestions that a resurgence of vaccine-preventable diseases could occur if vaccination rates fall amount to fearmongering by people paid off by the pharmaceutical industry.
As an aside, here’s an observation. If you feel a need to strenuously deny that you are an antivaxxer, chances are very good that you are, in fact, an antivaxxer. Also, if you invoke the pharma shill gambit to characterize vaccine advocates who oppose your attempts to dismantle school vaccine mandates, you are almost certainly an antivaxxer. It’s also utterly unsurprising that Steffen is quack claiming that ivermectin can treat COVID-19 even though the evidence from a number of clinical trials is now very clear that it is ineffective. For example, just a couple of weeks ago, he wrote a letter to Kansas hospitals:
Ivermectin-supporting anesthesiologist and politician Sen. Mark Steffen told health care providers last week that he considers early treatment with off-label drugs to be the “standard of care” for COVID-19.
“The standard of care is early treatment with FDA-approved medications regardless of their labelled uses,” Steffen wrote in a March 31 letter addressed to health care providers on his official Senate office letterhead. “Delays in institution of these treatments are no longer acceptable.
“The Healthcare Provider has a legal duty to ensure facilitation of treatment as expeditiously as possible. Delayed treatment worsens outcomes.”
None of this is new, either. Dr. Steffen was denying the severity of COVID-19 back in 2020:
He’s also worked with another hard-core antivaxxer who’s made a name for himself since the pandemic started:
He’s also touting a naturopath (and antivaxxer) who has supported his efforts:
And, of course, he is making the same nonsensical attacks to move the goalposts regarding the studies that failed to find efficacy for ivermectin in treating COVID-19:
Here’s another advantage for antivaxxers in having let themselves be absorbed by the larger right wing conspiracy ecosystem:
The similarity of bills from state to state raises red flags to vaccine advocates because it suggests that a coordinated effort to dismantle vaccine requirements and public health infrastructure is underway.
“Because the anti-vax movement is becoming aligned with the far right, I think those information-sharing channels are becoming more sophisticated,” said Northe Saunders, executive director of the SAFE Communities Coalition, a pro-vaccine organization. “Their ability to attract far-right politicians who see vaccines as a cause has grown. That gets them attention, if not votes.”
Efforts are definitely being coordinated, along with efforts to fight mask and vaccine mandates in schools and to “reopen” America (which, oddly enough, hasn’t really been anything resembling closed or “under lockdown” in a long time). Antivaxxers were coordinating efforts before the pandemic, just as right-to-try advocates were coordinating efforts going back ten years to try to pass legislation to weaken the FDA. They just have far more resources and sophistication than they used to. Admittedly, not all Republicans are antivaccine or willing to pander to antivaxxers, but these days even “not antivaccine” Republicans seem to have put aside whatever qualms they once had in order to support—or at least to avoid opposing outright—bills like this in the name of “freedom.”
Eliminating school vaccine mandates, indeed vaccine mandates of any kind, was always the endgame of the antivaccine movement. Unfortunately, the pandemic has not only made what once seemed impossible appear to be potentially within reach, at least in some states, but it has accelerated the timeline beyond even the most wildly optimistic timeline for eliminating school vaccine mandates that antivaxxers could ever have imagined. While it is unlikely that even in this environment antivaxxers will succeed everywhere, nonetheless, their endgame has begun.