Florida’s planned rollback of long-standing school and day care vaccine requirements highlights the nation’s increasingly polarized views on immunization, a divide sharpened by changes at the federal level.

Pediatricians and several medical groups, including the American Medical Association and American Academy of Pediatrics, oppose Florida’s changes, saying they roll back decades of public health progress and put children at risk for diseases that can result in serious illness and death.

“It’s a very dangerous move for the citizens and the children of Florida,” said Dr. Jesse Hackell, a retired pediatrician of 41 years who wrote the American Academy of Pediatrics’ most recent report on the importance of childhood vaccines. “It flies in the face of the science and the evidence that vaccines are incredibly safe, incredibly effective and have saved lives.”

Vaccine requirements have not been eliminated yet, but Florida Gov. Ron DeSantis and Surgeon General Joseph Ladapo say they are working to do so. Some rollbacks would require state lawmakers to change the law.

Here is what to know about vaccination requirements in Florida and what’s going on nationally.

Does the federal government mandate vaccines for children?

No. States determine and enforce their own vaccine schedules and requirements. All 50 states and Washington, D.C., require some shots for children entering public school.

The federal government, through the U.S. Centers for Disease Control and Prevention, issues guidance on which vaccines should be provided. The Food and Drug Administration regulates and approves vaccines for use nationwide.

What do Florida’s immunization requirements protect against?

Florida in 1981 adopted the current schedule of requirements for schoolchildren to get vaccinated from various diseases.

It requires different shots at various childhood stages.

Not all vaccines are made the same or fight against infection in the same way. Some, like the polio vaccine, include inactive or weak strains of the disease to prompt the body’s immune response. Others, like the vaccine for hepatitis B, are meant for bacterial infections and include molecules used to help the body fight an infection.

None of the vaccines Florida requires are mRNA vaccines like the COVID shot, which uses a molecule in the body to send a message to cells to create an immune response.

Which vaccinations does Florida require?

Polio: This is a viral disease that can cause muscle pain and paralysis. There is no cure, but it can be prevented by a vaccine that carries an inactive strain of the polio virus and doesn’t transmit the disease.

Measles, mumps, rubella: These are three highly contagious viral diseases that cause high fevers and rashes and, if left untreated, can cause serious brain and heart problems. There are two vaccines parents can choose that protect against these three infections. They are “live attenuated virus” vaccines that include a strain of each virus that have each been treated so that the virus cannot cause disease.

Diphtheria (respiratory infection), tetanus (lockjaw), acellular pertussis (whooping cough), also known as DTaP: These are three bacterial infections that can have serious long-term effects for children. Diphtheria can cause severe throat swelling, breathing problems, and heart damage. Tetanus causes muscle spasms and pertussis is highly contagious and causes severe coughing. There are seven types of pediatric vaccines that are licensed in the U.S. for these diseases.

Florida Department of Health rules require four more vaccines for children:

Chickenpox (Varicella): This is a contagious viral infection that causes an itchy rash. The primary vaccine is a shot that contains a weaker version of the varicella virus.

Haemophilus influenzae type b: This is a bacterial infection that can cause problems like ear infections and bloodstream infections. The shot protects against one infection caused by the virus, Hib.

Pneumococcal conjugate (PCV15/20): This is a bacterial infection that can cause infections such as pneumonia, meningitis and blood infections. Infants and small children are recommended by Florida to have four doses starting at 2 months old.

Hepatitis B: This is a viral disease that can cause liver damage. The hepatitis B vaccine contains a noninfectious part of the hepatitis B virus and causes the body to create its own protection.

Some public higher education institutions require:

Meningitis: This is inflammation of the membranes surrounding the brain often caused by bacteria. Untreated, it can lead to brain damage and death. Many public universities, including some in Florida, require this vaccine before students move into dorms. There are several types of shots using different technology that target different bacteria that cause meningitis.

What’s the argument against vaccine mandates?

Critics of required vaccines say they should have the freedom to choose what is best for their children’s bodies without being barred from schools.

Vaccines have had their skeptics for decades, as some parents feared a link between the shots and autism (which scientists have shown is untrue).

Concerns about vaccines mounted during the COVID-19 pandemic, when many states and municipalities required proof of vaccination for indoor dining and other activities. Some vaccine skeptics express concerns about perceived conflicts of interest between pharmaceutical companies and vaccine regulators.

What vaccine exemptions does Florida have now?

Parents can exempt their children from vaccine mandates on medical or religious grounds.

Medical exemptions must be documented and affirmed by a private health care provider and submitted to the state.

About 3% of children have religious exemptions on file, according to the state health department. The parent must provide a form with the exemption to a child’s school upon entry.

What happens next in Florida?

Removing vaccine requirements entirely would require approval from state lawmakers. The Legislature is not scheduled to begin its session until January.

But the state Department of Health, which is overseen by Ladapo, said Wednesday that it will work to remove vaccine requirements in state administrative rules, a process that takes around 80 days.

The department said it will also seek to expand exemptions to let people cite personal beliefs as a reason not to vaccinate.

Meanwhile, DeSantis said the administration will propose a legislative package to remove the requirements.

He is also planning a Florida “Make America Healthy Again” commission to support and amplify what Robert F. Kennedy Jr. is doing at the federal level examining causes of chronic diseases. Lt. Gov. Jay Collins and first lady Casey DeSantis will lead the state commission.

Are vaccines continuously monitored for safety?

Yes. The federal government tracks side effects from all vaccines, which the public can report through the Vaccine Adverse Event Reporting System. Vaccines that are found to be problematic or need more vetting can be pulled from the market. All data from the system is public.

What is the immunization rate in Florida?

Last school year, 88% of Florida kindergartners were up to date on vaccinations, according to Florida’s Health Department. That’s a decrease from 94% before the pandemic, in 2019.

In Hillsborough County, the immunization rate for last school year was slightly below the state average, at 86%.

Pinellas County had a similar rate of 87%, while 92% of Pasco County kindergartners last year were current.

If my child is vaccinated but others aren’t, is my child protected?

Herd, or community, immunity works when a majority in a group are immune to an infection because of a vaccine or prior infection. This limits the spread of the disease.

A vaccinated child will likely be protected from an infection that they were vaccinated against, but if others in the community are not vaccinated, those unvaccinated people can spread the disease. No vaccine guarantees absolute protection from infection, but the scientific evidence overwhelmingly shows that vaccines significantly diminish the risk of getting sick while limiting the spread of diseases.

For contagious diseases, the CDC and World Health Organization say a 95% vaccination rate is the recommended target for herd immunity.

Hackell, the retired pediatrician, said he expects to see rates of immunizations to decrease if mandates are erased.

“It just tends to be a slippery slope,” Hackell said. “This is not something we can afford to be casual about.”

What is going on in other states?

Florida’s proposed changes come as the national consensus on vaccines and the authority of federal guidelines has eroded. As Florida looks to scrap its immunization schedule, other states are developing their own guidelines amid upheaval at the CDC.

This week, California, Washington and Oregon — all states governed by Democrats — announced they will create an alliance to develop their own vaccine rules and recommendations.

Physicians say they will increasingly look to the various professional groups in their medical specialties, like obstetrics, pediatrics and others, for recommendations on vaccines and other practices.

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(Times/Herald Tallahassee bureau reporter Romy Ellenbogen contributed to this report.)

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