“You’re comparing apples to fruit salad,” she said. Mandates during a crisis were one thing, she suggested, but they weren’t necessary when there’s not an emergency.
The reason there’s not a measles crisis, I thought, is because there’s already a measles vaccine. At the time, I never dreamed that the COVID-19 pandemic would turn into a market opportunity for vaccine skeptics, but that’s exactly what happened. What had been a fringe position — that vaccines are dangerous — has now entered the political mainstream. “The average person would say that vaccines are good," says Ohio state Rep. Beth Liston. “Now all of a sudden it seems legitimate to question them.”
Peddling vaccine misinformation has become the work not only of a few groups playing on parental fears, but now gets routinely spread by physicians and elected officials as well. Medical groups have pushed back hard against a recent recommendation from Florida Surgeon General Joseph Ladapo that men avoid COVID-19 vaccines.
“There used to be a small pool of well-funded anti-vaccine sentiment groups,” says L.J. Tan, chief strategy officer with the Immunization Action Coalition, a Minnesota-based nonprofit. “Now they have formed this alliance with the political right: You can’t force me to do something.”
The result is that vaccination rates are down — not just when it comes to COVID-19, but long-established diseases as well. Pediatric vaccination rates have bounced back from lows seen earlier in the pandemic, when fewer kids were seeing doctors or going to school, but not all the way back. Adult rates, meanwhile, continue to lag.
The danger is that diseases that were nearly forgotten are threatening to come back. This summer, an unvaccinated adult in Rockland County, N.Y., was identified as having paralytic polio. With the polio virus found in wastewater in several New York counties, the United States has joined the list of about 30 countries around the world where polio is actively circulating.
“We are actively making a choice to go backward,” says Brian Castrucci, president of the de Beaumont Foundation, which supports public health efforts. “We’ve conquered these childhood diseases and now it’s like we missed them and are inviting them back.”
Last month, California Gov. Gavin Newsom signed legislation to penalize physicians who spread misinformation about COVID-19 vaccines, including possibly revoking their licenses. Other states, however, are moving in the other direction. Iowa, Louisiana and Ohio, among others, have considered legislation that bar vaccine mandates, with language broad enough to block requirements not only for COVID-19 but vaccinations in general.
“I have real concern about the impact of the anti-vaccine movement broadly because of the platform it's been given in the Ohio General Assembly,” Liston says.
Why COVID-19 Vaccines Backfired
COVID-19 vaccines have been lifesavers. Last month, the Journal of the American Medical Association published a large-scale study of 1.6 million people who received care at Veterans Health Administration facilities. Among those who were fully vaccinated and boosted against COVID-19, only 8.9 out of 10,000 persons died or were hospitalized due to the disease. A study in the British Lancet found that COVID-19 vaccinations prevented 14.4 million deaths in 185 countries.
And yet, COVID-19 vaccines — so much in demand when they were first introduced at the end of 2020 — seem to have gone nearly out of style. The number of Americans getting vaccinated has dropped with each successive shot. As of the end of last month, only 4 percent of those eligible had received the latest bivalent booster.
From their earliest days, the development and rollout of COVID-19 vaccines amplified fears some people harbored about vaccines generally, says Jennifer Reich, a sociologist at the University of Colorado, Denver. The investment of billions of dollars by the Trump administration into Operation Warp Speed — and the subsequent billions spent by the Biden administration on buying and distributing vaccines — played into fears about collusion between the government and the pharmaceutical industry.
Before vaccines were developed, of course, there’d already been a backlash against various governmental interventions, with many Americans objecting to stay home orders, school closures and mask mandates. “There was pretty aggressive conservative messaging early on in the pandemic, that public health responses represented government overreach,” Reich says. “Vaccines raised those same sort of concerns.”
Anti-vaccine groups certainly amplified such concerns. And, perversely, the great success of prior vaccines worked against COVID-19 vaccines. So-called breakthrough infections of vaccinated individuals became common, leading many people to the conclusion that they don’t work. You didn’t have to buy into crazy ideas that they contain magnets or tracking devices to have doubts.
Other vaccines, such as flu vaccines, require continual updating, but the high rate of COVID-19 infection among vaccinated and boosted individuals runs counter to expectations raised by the eradication of smallpox and the seeming elimination of other killers such as measles, polio and diphtheria. “The (COVID-19) vaccines do great things because they prevent hospitalizations and deaths, but they don’t always prevent infection,” says Reich, author of Calling the Shots: Why Parents Reject Vaccines.
The Price We Pay
At a “national conservatism” conference last month, Florida Gov. Ron DeSantis bragged about rejecting “the elites” when it comes to school closures and public health. “They were wrong about forced masking,” he said. “They were wrong about the efficacy of the mRNA vaccines.”
Since the start of the pandemic, Florida has suffered 381 COVID-19 deaths per 100,000 population. By comparison, California has had 244. Numerous studies have shown that people in counties that vote Republican are dying at higher rates than those in Democratic counties. Vaccines are a big part of that story.
“Registered Republicans in Florida and Ohio had higher excess death rates than registered Democrats, driven by a large mortality gap in the period after all adults were eligible for vaccines,” according to a paper published last month by the National Bureau of Economic Research. The excess death rate was 76 percent higher among Republicans than Democrats. "The gap in excess death rates between Republicans and Democrats is concentrated in counties with low vaccination rates and only materializes after vaccines became widely available."
The mortality gap actually grew after vaccines became available. That’s in contrast to past outbreaks. People in isolated communities may have decided they no longer needed to take a disease like measles seriously, but once it reared its ugly head, they got themselves or their kids vaccinated, says Jonathan Berman, who teaches at the Biosciences Institute at Arkansas State University.
That didn't happen with COVID-19.
“There’s kind of a direct relationship between communities or groups of people who are undervaccinated and then susceptibility to diseases that would otherwise have been eliminated,” Berman says. “We can really just expect more of that with so much growth in the anti-vaccine movement over the last couple of years.”
Not Trusting Messengers
There are still more than 10,000 Americans dying from COVID-19 per month, with scientists worried about another spike this winter. The Biden administration has relied on vaccinations as its primary means of combating COVID-19, but it appears to be running out of ways of convincing people to head to pharmacies and clinics.
Courts have struck down most of the mandates the administration imposed last year, including the Supreme Court blocking the requirement for large employers in January and a federal district judge ending the vaccine and mask requirements for Head Start employees last month.
Also last month, New York Mayor Eric Adams ended the city’s mandate on private employers and requirements that schoolchildren be vaccinated to participate in sports or after-school programs. Employers, who were among those pushing hardest for vaccines last year, mostly seem to have lost interest at this point.
Schoolchildren remain behind when it comes to traditional vaccines. Vaccine rates dropped by double-digit percentages between 2019 and 2021 in states such as Arkansas and Virginia. More than 20,000 children in the District of Columbia were behind on routine shots when the current school year began. More than one in eight children between the ages of 4 and 6 hadn’t gotten their measles, mumps and rubella shots in California by this summer.
JEFF KOWALSKY/AFP/TNS
Pediatricians have long been at the forefront of efforts to convince parents about the value and safety of vaccines. Public health officials often talk about the need for “trusted messengers” to bring skeptics on board. They may not listen to people in government, but they are more likely to trust their own doctors or community leaders. “It’s not that they’re actively super anti-vaccine themselves, it’s just not what the people around them are doing,” Berman says. “They don’t see good models to follow, and they maybe have more access to misinformation than they do to good information.”
That’s one of the dangers of people in Republican areas becoming less likely to agree to vaccinations. It becomes more of a norm within a community to skip or oppose vaccination. One of the major selling points for vaccination against infectious diseases is that you’re not only protecting yourself but others around you. When fewer people are willing to get shots, that gives diseases more chance to spread.
Vaccines have been one of the greatest public health triumphs of the past century, lengthening life expectancy while sharply reducing childhood mortality. Those gains appear increasingly at risk, due to changing attitudes and political polarization.
“We know that when we can vaccinate children effectively, we can reduce their deaths and we can create herd immunity that protects the whole population,” says Jill Rosenthal, director of public health policy at the Center for American Progress, a progressive think tank. “It’s one of the cheapest and most effective things that we can do to protect against disease.”
