As Florida works to scrap its vaccine requirements, public health experts worry that rising risks of infectious diseases and intensifying hurricanes could collide to present graver dangers to the public.
The state’s surgeon general, Joseph Ladapo, announced earlier this month that the state Department of Health would begin the process of allowing people to opt out of vaccine mandates for “personal health benefits.” The move, which has been criticized by many medical professionals, echoes the Make America Healthy Again initiative led by U.S. Health Secretary Robert Kennedy Jr., a longtime vaccine skeptic.
It comes as rising temperatures are fueling stronger hurricanes in the Atlantic Ocean, potentially forcing people to evacuate their homes. That could increase the risk of disease outbreaks during future storm seasons, health experts said.
“Something like measles is so infectious, it would go through a hurricane shelter like wildfire,” said Katie Huffling, executive director for the Alliance of Nurses for Healthy Environments.
The move by Florida comes as the U.S. is experiencing its largest outbreaks of measles in decades, with 1,454 cases this year across 42 states, including Florida, according to the Centers for Disease Control and Prevention. Three people have died.
The state currently requires a number of vaccines for children entering school at different grade levels, including inoculations against tetanus, pertussis, polio, measles, mumps, rubella, hepatitis B and varicella.
Exceptions are allowed for religious reasons, with roughly 5.1 percent of Florida kindergartners skipping the shots last school year.
But Ladapo indicated that the state’s vaccine requirement is overly rigid, saying that it is “wrong and drips with disdain and slavery.”
“Who am I to tell you what your child should put in their body?” he said at an event with Gov. Ron DeSantis (R) earlier this month. “I don’t have that right. Your body is a gift from God.”
Florida’s announcement has been roundly criticized by public health experts, including at the American Academy of Pediatrics.
“When everyone in a school is vaccinated, it’s harder for diseases to spread and easier for everyone to keep the fun and learning going,” said AAP President Susan Kressly, adding that the announcement “will put children in Florida public schools at higher risk for getting sick and have ripple effects across their community.”
Super-spreader hurricane shelters could be one outcome.
“For an area of the country that has a lot of disasters, where people are always sheltering, having a group of unvaccinated people when there isn’t a capacity to vet their health status before you bring them into a crowded area with lots of elderly folks, it isn’t a good thing,” said Georges Benjamin, the president of the American Public Health Association.
Outbreaks of gastrointestinal illnesses, like norovirus, salmonella and E. coli, are commonly seen following storms due to poor hygiene and less frequent hand washing, Benjamin said.
Hurricanes have also contributed to outbreaks of respiratory diseases. One study following Hurricane Ida in 2021 looked at cases of Covid-19. States with lower vaccination rates saw higher rates of infections and death. The authors said the results “indicate that natural disasters can compound pandemic preparedness efforts [and] exacerbate the risk of virus.”
The Florida Department of Emergency Management did not respond to a request for comment.
The state Department of Health has begun an 80-day process to enact the first part of its vaccine exception, which would immediately apply to shots for diseases like chickenpox. Removing requirements for measles and polio vaccines require a change in state law.
Public health experts expressed concern that it could come next. About 89 percent of Florida kindergartners are vaccinated in accordance with its current mandates, far lower than the CDC’s recommendation that at least 95 percent of the population should be vaccinated to prevent measles outbreaks.
A 15 percent decline in measles vaccinations in Florida could lead to 1 million additional cases of the disease in the state, according to a recent study from researchers at Stanford University.
American Red Cross spokesperson Stephanie Fox said her group is “committed to maintaining safe and healthy environments in all of our shelter operations” during hurricanes.
The Red Cross follows “established best practices for preventing and managing communicable diseases,” including by conducting health screenings and “implementing isolation protocols for individuals who may be ill,” she said in a statement.
Benjamin, the public health expert, expressed concern about the combination of lower vaccination rates and the presence of large crowds in hurricane shelters. Measles, a highly infectious disease, is more contagious before patients experience the telltale rash that accompanies infection. But it’s not the only disease Benjamin is worried about.
“Even chickenpox, when someone with that comes into the waiting room at the hospital, we freak out because it is so contagious,” he said.
The changes to Florida’s policies won’t be in place before the end of this hurricane season, but health risks could rise in the coming years, Benjamin said, adding that “after a couple of cohorts of kids, you’d have to assume there are more unvaccinated people.”
Huffling, of the Alliance of Nurses for Healthy Environments, noted that hurricane shelters generally serve lower-income people who have no where else to go when evacuation orders are issued. That often includes older people.
“The folks who go to shelters may already be at more risk or have underlying chronic diseases that could make them super sick if they get one of these infectious diseases,” Huffling said. “If I was an elderly person living in Florida, I would be super scared about large swaths of kids not being vaccinated.”
“Vaccines don’t just protect the kids, it protects all the people around them,” she added.
