With no more vaccine mandates, who are the most at risk in Florida?

Shelley Mickle just startedfirst grade when the fever came.

It was polio. It was 1949. There was no vaccine.

She was paralyzed from the waist down for several days. Some movement returned, but some muscles were lost forever.

She wore leg braces, like Forrest Gump’s, for several years. The squeak gave her away when she played hide and seek. Another polio survivor in her class was so weak, the teacher had to put him in a sling and hook him to his desk.

Now 82 and living in Gainesville, Mickle walks with a limp. When she heard that Florida plans to become the first state in the nation to repeal all vaccine mandates, her mind flashed back to the infection that changed her life.

“It was a horror show; so many children were afflicted with this horrible virus and partially paralyzed,” she said. “It’s mind-blowing that someone would suggest going back to the dark ages.”

Florida Surgeon General Joseph Ladapo’s pledge last week to scrap every vaccine mandate has been widely criticized by medical societies and health experts who warn it will undo decades of public health policy that marginalized and, in some cases, eradicated once-common childhood scourges.

High among their concerns are declining vaccination rates resulting in outbreaks of contagious diseases like pertussis — also known as whooping cough — and measles, a disease the United States declared eradicated in 2000.

There have been 35 outbreaks of measles across the U.S. so far this year, more than double the number in2024, and three confirmed deaths, according to the Centers for Disease Control and Prevention.

That included Texas, which had its largest measles outbreak in 30 years, with two child deaths and more than 700 infections.

Nine measles infections were linked to an outbreak at a Broward County high school last year when Ladapo was criticized for a memo that said it was up to parents whether unvaccinated children should be allowed to attend school.

Florida health officials have confirmed six more measles infections this year, including two last month.

Reported cases of pertussis were six times higher in 2024 than the previous year, federal data shows. Complications of the disease include pneumonia, middle ear infection, fainting, dehydration, seizures and brain swelling.

“We’re seeing healthy children die of this disease and ahigh proportion of children being hospitalized for intensive care that are essentially preventable,” said Jennifer Walsh, an assistant professor in the School of Nursing at George Washington University and a pediatric nurse practitioner.

Vaccine mandates for children to attend school have been in place in Florida since 1981. In announcing his decision, Ladapo said it was based on his belief that the government has no right to tell a parent what to put in their child’s body.

The state’s top health official, Ladapo, did not say that the vaccines have been proven to be safe or that he would encourage parents to continue to get their children vaccinated. Since his appointment in 2021, he has repeatedly issued guidance counter to recommendations by the Centers for Disease Control and Prevention and other medical organizations.

In an interview with CNN over the weekend, Ladapo acknowledged that he has not asked his Florida Department of Health staffers to analyze how the policy might impact the state’s children or if it would result in an increase in potentially deadly infections.

On Monday, Florida Gov. Ron DeSantis reiterated his support of his surgeon general and pointed to countries, including the United Kingdom, Sweden and Norway, that do not mandate shots but still achieve high vaccination levels.

“I think his position is that if you provide information and persuasion, that’s better than coercion,” DeSantis said at a press conference in Plant City on Monday.

But other European countries, including Germany in 2020 and France in 2018, have either adopted vaccine mandates or made more shots compulsory in response to outbreaks.

In other instances, the loosening of vaccine mandates has been reversed after outbreaks. In June 2019, New York Gov.Andrew Cuomo signed legislation eliminating the non-medical religious exemption to vaccine mandates after more than 260 cases of measles were confirmed in Rockland County.

Vaccine mandates for students were adopted across the United States to counter high transmission of diseases in confined classrooms, corridors and changing rooms, Walsh said.

To prevent outbreaks of highly contagious diseases like measles, vaccination rates need to be as high as 95%. Only 88% of Florida kindergarteners were up to date on their shots last year, state data shows.

Walsh expects that rate would drop significantly if Florida ends the mandates, putting more children at risk. Florida’s prominence as a holiday destination adds to the peril, with the likelihood of infected visitors bringing diseases like polio that couldspread unchecked among the unvaccinated population.

“We will see a real increase in preventable and potentially devastating diseases not just in Florida but everywhere in the world,” Walsh said.

Before a measles vaccine became available in 1963, the Centers for Disease Control and Prevention estimatedthat up to 4 million people in the United States were infected each year, with up to 500 people dying and 48,000 hospitalized. About 1,000 developed encephalitis, a complication marked by swelling of the brain.

Polio paralyzed more than 15,000 people each year in the United States before a vaccine was introduced in the 1950s.

Ladapo’s proposed policy would require legislation to repeal state laws requiring thatpublic school students be immunized for polio, diphtheria, rubeola, rubella, pertussis, mumps and tetanus.

But other vaccines are only mandated by Department of Health rules, which state officials said will be changed in accordance with Ladapo’s proposal.

That includes shots to protect against varicella, or chickenpox; hepatitis B; Haemophilus influenzae type b; and pneumococcal disease. A rule change process could be completed in about 80 days.

Indiana mom Ashlee Dahlberg, 34, said she was horrified to see that Florida is planning to take this step.

Her 8-year-old son, Liam Dahlberg, was infected with Haemophilus influenzae type b in April when he returned to school after Easter.

Although he was vaccinated, he suffered from asthma, which makes people more susceptible to respiratory infections and affects the immune system’s response.

His condition drastically worsenedovernight and he was transferred to the Comer Children’s Hospital at the University of Chicago. He was intubated and put into a medical coma. But Liam’s infection had escalated into meningitis.

The boy died 36 hours after first becoming sick.

Doctors told his mother that the virulence of his infection likely meant he contracted it from an unvaccinated person. Roughly 20% of children in Lake County, Indiana, are unvaccinated, state data shows.

Dahlberg felt she had to do something so other parents won’t suffer the heartbreak she did. She has gathered almost 20,000 signaturescalling for Florida’s vaccine mandates to remain.

“You shouldn’t just be thinking of your child’s life but of others around you who medically cannot be vaccinated or are like my son and have weakened immune systems and don’t get the full effects of the vaccine,” she said.

Dealing with concerns and skepticism about vaccines has become an everyday part of Wesley Chapel pediatrician Nancy Silva’s job as vaccine skepticism has risen.

Polls by Gallup show that the percentage of Americans who consider vaccines “extremely” or “very important” has fallen from 94% in 2001 to 69% last year.

Silva is an ardent supporter of vaccine mandates. The children she treats include some who are home-schooled because their parents did not want to give their children shots.

“My job is to explain to them the risks,” she said. “I know they have not seen a child die of meningitis.”

Silva fears Florida’s policy is an example of politics taking precedence over long-standing scientific evidence that vaccines are safe and effective.

“I would like to do my job that I was trained for and that I sacrificed 25 years of my life to help children without political problems changing things,” Silva said. “I hope to God the law stands and this is just a political gesture.”

Times staff writers Nakylah Carter and Lawrence Mower contributed to this report.