With a brief memo, Florida Surgeon General Joseph Ladapo has subverted a public health standard that鈥檚 long kept measles outbreaks under control.
On Feb. 20, as measles spread through Manatee Bay Elementary in South Florida, Ladapo sent parents a letter granting them permission to send unvaccinated children to school amid the outbreak.
The Department of Health 鈥渋s deferring to parents or guardians to make decisions about school attendance,鈥 wrote Ladapo, who was appointed to head the agency by Florida Gov. Ron DeSantis, whose name is listed above Ladapo鈥檚 in the letterhead.
Ladapo鈥檚 move from the Centers for Disease Control and Prevention.
鈥淭his is not a parental rights issue,鈥 said Scott Rivkees, Florida鈥檚 former surgeon general who is now a professor at Brown University. 鈥淚t鈥檚 about protecting fellow classmates, teachers, and members of the community against measles, which is a very serious and very transmissible illness.鈥
Most people who aren鈥檛 protected by a vaccine will get measles if they鈥檙e exposed to the virus. This vulnerable group includes children whose parents don鈥檛 get them vaccinated, infants too young for the vaccine, those who can鈥檛 be vaccinated for medical reasons, and others who don鈥檛 mount a strong, lasting to it. Rivkees estimates that about a tenth of people in a community fall into the vulnerable category.
The CDC advises that unvaccinated students stay home from school for three weeks after exposure. Because the highly contagious on tiny droplets through the air and on surfaces, students are considered exposed simply by sitting in the same cafeteria or classroom as someone infected. And a person with measles can pass along an infection before they develop a fever, cough, rash, or other signs of the illness. About 1 in 5 people with measles end up hospitalized, 1 in 10 develop that can lead to permanent hearing loss, and about die from respiratory and neurological complications.
鈥淚 don鈥檛 know why the health department wouldn鈥檛 follow the CDC recommendations,鈥 said Thresia Gambon, president of the Florida chapter of the American Academy of Pediatrics and a pediatrician who practices in Miami and Broward, the county affected by the current measles outbreak. 鈥淢easles is so contagious. It is very worrisome.鈥
Considering the dangers of the disease, the vaccine is incredibly safe. A person is about as likely to die from being struck by lightning during their lifetime in the United States as to have a potentially life-threatening allergic reaction to the measles, mumps, and rubella vaccine.
Nonetheless, last year a of parents filed for exemptions from school vaccine requirements on religious or philosophical grounds across the United States. The CDC reported that childhood immunization rates hit a 10-year low.
In addition to Florida, have been reported in 11 other states this year, including Arizona, Georgia, Minnesota, and Virginia.
Only about a quarter of Florida鈥檚 counties had reached the 95% threshold at which communities are considered well protected against measles outbreaks, according to the most recent by the Florida Department of Health in 2022. In Broward County, where six cases of measles have been reported over the past week, about 92% of children in kindergarten had received routine immunizations against measles, chickenpox, polio, and other diseases. The remaining 8% included more than 1,500 kids who had vaccine exemptions, as of 2022.
Broward鈥檚 local health department has been offering measles vaccines at Manatee Bay Elementary since the outbreak began, according to the county school superintendent. If an unvaccinated person gets a dose within three days of exposure to the virus, they鈥檙e far less likely to get measles and spread it to others.
For this reason, government officials have occasionally mandated vaccines in emergencies in the past. For example, in 1991 ordered children to get vaccinated against their parents鈥 wishes during outbreaks traced to their faith-healing churches. And during a large measles outbreak among Orthodox Jewish communities in Brooklyn in 2019, the New York City health commissioner mandated that anyone who lived, worked, or went to school in hard-hit neighborhoods get vaccinated or face a fine of $1,000. In , the commissioner wrote that the presence of anyone lacking the vaccine in those areas, unless it was medically contraindicated, 鈥渃reates an unnecessary and avoidable risk of continuing the outbreak.鈥
Ladapo moved in the opposite direction with his letter, deferring to parents because of the 鈥渉igh immunity rate in the community,鈥 which data contradicts, and because of the 鈥渂urden on families and educational cost of healthy children missing school.鈥
Yet the burden of an outbreak only grows larger as cases of measles spread, requiring more emergency care, more testing, and broader quarantines as illness and hospitalizations mount. Curbing a 2018 outbreak in southern Washington with 72 cases , in addition to $76,000 in medical costs, and an estimated $1 million in economic losses due to illness, quarantine, and caregiving. If numbers soar, death becomes a burden, too. An outbreak among a largely unvaccinated population in Samoa caused more than and 83 deaths, mainly among children.
Ladapo鈥檚 letter to parents also marks a departure from the norm because local health departments tend to take the lead on containing measles outbreaks, rather than state or federal authorities. In response to queries from 黑料吃瓜网 News, Broward County鈥檚 health department deferred to Florida鈥檚 state health department, which Ladapo oversees.
鈥淭he county doesn鈥檛 have the power to disagree with the state health department,鈥 said Rebekah Jones, a data scientist who was removed from her post at the Florida health department in 2020, over a rift regarding coronavirus data.
DeSantis, a Republican, appointed Ladapo as head of the state health department in late 2021, as DeSantis integrated skepticism about covid vaccines into his political platform. In the months that followed, Florida鈥檚 health department removed information on covid vaccines from its homepage, and for encouraging his staff to get the vaccines, leading to his resignation. In January, the health department website posted Ladapo鈥檚 call to halt vaccination with covid mRNA vaccines entirely, based on notions that .
Jones was not surprised to see Ladapo pivot to measles. 鈥淚 think this is the predictable outcome of turning fringe, anti-vaccine rhetoric into a defining trait of the Florida government,鈥 she said. Although his latest decision runs contrary to CDC advice, the federal agency rarely intervenes in measles outbreaks, entrusting the task to states.
In an email to 黑料吃瓜网 News, the Florida health department said it was working with others to identify the contacts of people with measles, but that details on cases and places of exposure were confidential. It repeated Ladapo鈥檚 decision, adding, 鈥淭he surgeon general鈥檚 recommendation may change as epidemiological investigations continue.鈥
For Gambon, the outbreak is already disconcerting. 鈥淚 would like to see the surgeon general promote what is safest for children and for school staff,鈥 she said, 鈥渟ince I am sure there are many who might not have as strong immunity as we would hope.鈥
