Who Will Protect the Children?

At a recent news conference, Florida Surgeon General Dr. Joseph A. Lapado announced plans “to end all vaccine mandates in Florida law.” Dr. Lapado claimed that vaccine requirements were an “immoral” infringement on personal liberty and declared, “Who am I, as a government … to tell you what you should put in your body?” In fact, this is precisely his job. As the state's leading public health advocate for wellness and disease prevention, his responsibility is to promote evidence-based health policies and to inform those Florida citizens who cannot gather, research, or interpret the vast epidemiological data about how infectious diseases arise, spread, and are controlled. In this regard, both Dr. Lapado and the Secretary of the US Department of Health and Human Services (HHS), Robert F. Kennedy Jr., have failed to act solely for the public good and have violated the fundamental principle that “public service is a public trust.”

Public health imperatives should not compete with personal liberties. Individual freedoms are valued in American culture, but the prevention of contagious diseases requires civic responsibilities and collective action. All adult citizens in the US have autonomy—the ethical principle that they can make decisions for themselves. The autonomy principle is easily defended if an individual lives alone and has no contact with others. However, any infected individual who shops at the supermarket during a viral epidemic can expose vulnerable fellow citizens to the risk of major illness, hospitalization, or death.

Young children do not have autonomy and must rely on their parents to make health care decisions on their behalf. Children do have an ethical right to a healthy future, independent of their parents. If parents receive misinformation about the risks and benefits of childhood vaccines and decide against the measles, mumps, rubella (MMR) vaccine for their children, those children may die during a future measles epidemic or cause the death of an immunocompromised classmate at school. Before the measles vaccine became available in 1963, 3–4 million cases occurred annually in the United States, with 48,000 hospitalizations, 500 deaths, and 1000 cases of severe encephalitis [1]. Public health officials are responsible for protecting the right of children to a healthy future, even if some parents are vaccine-hesitant.

There is a long and tragic history of misinformation in the public sphere causing great harm to citizens. AIDS denialism in the early 1990s—the pernicious hypothesis that HIV did not cause AIDS—led to significant public health consequences [2]. A broad body of scientific evidence demonstrated that specific anti-retroviral therapy (ART) decreased viral replication, blocked the spread of HIV between individuals, and prevented maternal transmission during pregnancy. Despite the scientific consensus, AIDS denialists influenced public health policy against the use of ART in South Africa in 1999, resulting in the deaths of an estimated 330,000 South Africans and 35,000 preventable infant HIV infections [3].

During the COVID pandemic, two phase 3 randomized controlled trials each enrolled more than 30,000 participants and provided unequivocal evidence of the safety and effectiveness of mRNA vaccines in preventing infection and severe disease [4]. Concurrent vaccine disinformation, exacerbated by social media, led to low vaccination rates in some states and more than 230,000 preventable deaths [5]. As unfortunate as this is, the current leadership of the US public health systems is suppressing scientific findings and rescinding scientific integrity policies.

Healthcare providers adhere to the principle of veracity in medical ethics, which is telling the truth and providing accurate information to patients to build trust and enable their informed decision-making. Medical “truth” integrates the best available scientific evidence on safety and benefit with clinical expertise and patient values. Pediatricians in Florida and across the US will hopefully do their best to inform families about the proven safety and efficacy of childhood vaccines and protect the children who are their patients.

For most of human history, parents grieved the immense impact of neurological injury and death that can occur in infants and children from infectious diseases such as measles, polio, HIV, pneumococcus, and Haemophilus influenzae type b. Unfortunately, the collective memory of these once-feared and now preventable diseases may be fading from public consciousness.

HHS leadership should recognize the history of infectious disease, endorse rigorous science, and act ethically—these are public expectations. Americans deserve better and should call for change.

William D. Graf and Leon G. Epstein contributed equally to this study.

The authors received no specific funding for this work.

The authors declare no conflicts of interest.