Ladapo’s approach to vaccines, framing their use as a parental decision rather than a public health matter, has been soundly criticized by the medical establishment, including the American Medical Association and the American Academy of Pediatrics (AAP). In its statement, AAP said ending vaccine mandates would “put children in public schools at higher risk of getting sick and have ripple effects across their community.”

All childhood vaccines remain available in Florida and religious and medical exemptions exist as well.

VoxPopuli reached out to pediatric infectious disease specialist Dr. Paul Offit, for some perspective. Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, is a former member of the Centers for Disease Control Advisory Committee on Immunization Practices (ACIP) and the FDA Vaccines and Related Biological Products Advisory Committee. He is the author of 15 books, including Vaccines and Your Family: Separating Fact From Fiction, published in 2024.

VoxPopuli spoke to Offit on Sept. 3 and again on Sept. 8. The interviews have been edited for length and clarity.

VoxPopuli: It looks like Florida is going to be the first state to eliminate some vaccine mandates. You’re an infectious disease guy, a pediatrician, a developer of the RotaTeq vaccine against rotavirus. What do you think about this?

Dr. Paul Offit: I think [Ladapo] has removed a very important tool for bringing outbreaks under control. More and more parents are choosing not to vaccinate their children … and while we’re seeing more measles deaths, more flu deaths, more pertussis [whooping cough] deaths, he chooses to remove one of the two greatest tools he has to bring outbreaks under control to protect children: quarantine and vaccination.

No one is making you get a vaccine. It’s pretty easy to exempt yourself from vaccines. So I’m not sure practically in that way that it matters. Where it will matter is if there was ever an outbreak of measles or whooping cough. Measles is the best example because it’s the most contagious of the infectious diseases.

[Editor's Note: For the moment, mandates for measles and polio vaccines remain in place.]

If there was an outbreak … and the virus was spreading, what would [Ladapo] do? Would he not quarantine people who were infected and not quarantine people exposed to those infected, and not insist that people who are not vaccinated not be able to come to school? Is his notion that it’s just fine for these viruses to spread unchecked, that somehow that’s a benefit? If a child dies or two children die, would he still continue to stand back and fight for medical freedom when in fact what he’s really fighting for is the virus’s ability to spread?

VoxPopuli: When I was growing up, there wasn’t a chickenpox vaccine; you just got the chickenpox. I distinctly remember having it as a child. It’s possible that people don’t think of it as being that serious. What do you think about ending mandates for this select group of vaccines — chickenpox, Hib influenza, hepatitis B and pneumococcal diseases?

Dr. Paul Offit: I think vaccines are to some extent a victim of their own success. We had millions of cases of chickenpox every year, now we have far fewer than that. Before there was a chickenpox vaccine, which was 1995, every year there'd be about 10,000 hospitalizations from chickenpox, and 75 to 100 deaths from chickenpox.

Chickenpox can cause pneumonia. Chickenpox can cause encephalitis, which is an infection of the brain. Chickenpox can disrupt the integrity of your skin, allowing for the entrance of so-called flesh-eating bacteria, which can cause something called necrotizing fasciitis, which can be fatal. We have largely eliminated that. And I think that's the problem.

VoxPopuli: What about Hib influenza?

Dr. Paul Offit:  That particular bacteria (Haemophilus influenzae type b) dominated my residency, as did pneumococcus, which causes sepsis, meningitis, pneumonia. That bacteria every year would cause 20,000 to 25,000 cases of pneumonia, bloodstream infections and meningitis, and then, less commonly, epiglottitis, where your epiglottis at the back of your throat would swell up to the point that you suffocated and died.

When I was a resident in the emergency department at Children's Hospital in Pittsburgh in the late ‘70s, I would do two to three spinal taps a night. I was very good at doing spinal taps because of Hib meningitis and pneumococcal meningitis and meningococcal meningitis. Residents today don't know how to do spinal taps. When somebody comes in with a question of bacterial meningitis, the interventional radiologist does the tap because the resident doesn't know how to do it.

VoxPopuli: In 2025, no one should die from a vaccine-preventable disease. A 2024 study in The Lancet noted that since 1974 vaccines had saved an estimated 154 million lives worldwide through the World Health Organization’s Expanded Programme on Immunization (146 million were under 5 years old; 101 million were under 1 year). The study also said vaccines accounted for 40 percent of the decline in infant mortality. So, what’s driving this desire to end these mandates for safeguarding public health?

Dr. Paul Offit:  I think we're paying the price from the first two years of the pandemic. When we had a vaccine in December 2020, in 2021, you were pretty much restricted. If in 2022 and 2023, if you didn't have your vaccine card, if you couldn't show proof of vaccination, you may not be able to go to your favorite bar, sporting event, restaurant, place of worship. You may be fired from your job. Schools were closed. Businesses were closed. People saw that as massive government overreach. They didn't like to be told what to do. And vaccine mandate became a dirty phrase. So this is a pushback on that.

And it reinvigorated the medical freedom movement. There is a tension between medical freedom and public health, which is why it's ironic that Joseph Ladapo as surgeon general in Florida represents public health. Because with medical freedom …  you consider it your right to catch and transmit a potentially fatal infection during an epidemic. In the case of public health, you actually have to care about your neighbor. You may be shedding an infectious virus that may not harm you badly, but you're sitting on a bus next to somebody or riding an elevator with someone who has cancer. Millions of people in this country can't be vaccinated, and they depend on those around them to protect them. What you're saying is, I don't care about them.

VoxPopuli: In Florida, over the last 10 years, there’s been a steady decrease in the number of kindergarteners who’ve been fully vaccinated, according to the Centers For Disease Control and Prevention. In 2014-2015, 93.3 percent of Florida kindergarteners were fully vaccinated against chickenpox, hepatitis B, whooping cough and measles. Last year, 2024-2025, only 88.8 percent were vaccinated against those diseases. At the same time, there’s been a steady rise in non-medical exemptions. A decade ago, 1.8 percent of kindergarteners received non-medical exemptions compared to 2024-2025, when non-medical exemptions reached 4.8 percent. Florida has the highest rate of vaccine exemptions in the Southeast, followed by Georgia (4.7 percent) and South Carolina (4.5). The national average is is 3.6 percent, according to the CDC. Is there a way to re-establish trust in vaccines and turn this around?

Dr. Paul Offit: Most people trust vaccines. There was a study done recently … that found most Democrat and Republican parents support vaccines. COVID is different; it’s in its own category. But regarding all the other vaccines, for the most part, people do support them, and they're starting to get nervous that these vaccines may be at risk.

I think that’s why people like [U.S. Sen. John] Barrasso and [U.S. Sen. Bill] Cassidy and [U.S. Sen. Thom] Tillis really took on RFK, Jr. in such a direct manner during the committee meeting. Maybe we’re at a tipping point because this is only going to get worse.

There’s a man named Maurice Hillman who is the inventor of nine of the 14 vaccines we currently give to infants and children. He is, in many ways, the father of modern vaccines, including the current measles vaccine. I interviewed him for a book I was writing about him. In 2004, he was diagnosed with cancer. He was given six months to live, and I interviewed him for those last six months of his life because I wanted to capture all these amazing stories from a man who had made so many vaccines for America’s children.

Although we’d eliminated measles by 2000, it was starting to come back because of the Andrew Wakefield paper falsely claiming that the measles, mumps, rubella vaccine caused autism.

[Editor's Note: Wakefield’s 1998 study, published in The Lancet, was retracted 12 years later, following an investigation that revealed “research malfeasance.” Together with the media coverage around its assertions, the paper is considered the origin of the erroneous theory — believed by 1 in 3 Americans — that vaccines cause autism.]

I remember saying to him, “Do you think we can prevent this from getting worse by educating about the importance of the vaccine, educating about the seriousness of the disease? Or does this have to come back before people realize the mistake they’re making by rejecting vaccines?”

He spent a long time thinking about that question. He’s sort of a gruff man, brilliant. He was looking out [the window. I remember it was a wintry day n Philadelphia. Then he looked back at me after thinking about it for a while, and he just sort of sadly shook his head and said, “No. I think the disease is going to have to come back before people realize what’s at stake.”

Even though there’s 5,000 cases of measles this year, it’s still a population of 330 million people [in the United States]. Most people haven’t seen a case of measles. I think it’s that we’ve eliminated the memory of measles. People don’t remember how sick that can make you.

 In the 1970s, there were school mandates, but they weren't really enforced. Then there were massive outbreaks in schools in Detroit, Los Angeles, Alaska. The only way those outbreaks were brought under control was by strictly enforcing school vaccine mandates. You could not come back to school until you were vaccinated, period. And with that, those outbreaks ended.

 I lived through the 1990-1991 Philadelphia measles epidemic, which centered on two large churches — [Faith Tabernacle and First Century Gospel] — that had big schools that chose not to vaccinate their children.

In a several-month period, in between 1990 and 1991, we had 1,400 cases of measles and nine deaths. Nine deaths in one city.  We got to the point where we actually had compulsory [court-ordered] vaccination of those children, meaning it's not like it was mandated where you may have to pay some sort of societal price. It was compulsory. You had to get a vaccine, and everybody was for that because people were so scared of coming into the city. We were vaccinating down to six months of age. [Editor's Note: Measles vaccines are typically given between 12 to 15 months of age.]

 We had a religious exemption to vaccines in our city. So these two church groups were electing to do something that was perfectly legal, which is not vaccinate their children because of religious exemptions. They asked the American Civil Liberties Union to represent them, figuring they are willing to represent unpopular causes, and people remaining unvaccinated in Philadelphia when we had a massive outbreak, was a very unpopular cause. And the American Civil Liberties Union chose not to do it.

 They said — I'll never forget this quote — “While you are at liberty to martyr yourself to your religion, you are not at liberty to martyr your child.”