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With a brief memo, Florida Surgeon General Joseph Ladapo has subverted a public health standard that\u2019s long kept measles outbreaks under control.<\/p>\n
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.<\/p>\n
The Department of Health \u201cis deferring to parents or guardians to make decisions about school attendance,\u201d wrote Ladapo, who was appointed to head the agency by Florida Gov. Ron DeSantis, whose name is listed above Ladapo\u2019s in the letterhead.<\/p>\n
Ladapo\u2019s move\u00a0contradicts advice<\/a>\u00a0from the Centers for Disease Control and Prevention.<\/p>\n \u201cThis is not a parental rights issue,\u201d said Scott Rivkees, Florida\u2019s former surgeon general who is now a professor at Brown University. \u201cIt\u2019s about protecting fellow classmates, teachers, and members of the community against measles, which is a very serious and very transmissible illness.\u201d<\/p>\n Most people who aren\u2019t protected by a vaccine will get measles if they\u2019re exposed to the virus. This vulnerable group includes children whose parents don\u2019t get them vaccinated, infants too young for the vaccine, those who can\u2019t be vaccinated for medical reasons, and others who don\u2019t mount a strong, lasting\u00a0immune response<\/a>\u00a0to it. Rivkees estimates that about a tenth of people in a community fall into the vulnerable category.<\/p>\n The CDC advises that unvaccinated students stay home from school for three weeks after exposure. Because the highly contagious\u00a0measles virus spreads<\/a>\u00a0on 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\u00a0ear infections<\/a>\u00a0that can lead to permanent hearing loss, and about\u00a01 in 1,000<\/a>\u00a0die from respiratory and neurological complications.<\/p>\n \u201cI don\u2019t know why the health department wouldn\u2019t follow the CDC recommendations,\u201d 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. \u201cMeasles is so contagious. It is very worrisome.\u201d<\/p>\n Considering the dangers of the disease, the vaccine is incredibly safe. A person is about\u00a0four times<\/a>\u00a0as 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.<\/p>\n Nonetheless, last year a\u00a0record number<\/a>\u00a0of 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\u00a010-year low<\/a>.<\/p>\n In addition to Florida,\u00a0measles cases<\/a>\u00a0have been reported in 11 other states this year, including Arizona, Georgia, Minnesota, and Virginia.<\/p>\n Only about a quarter of Florida\u2019s counties had reached the 95% threshold at which communities are considered well protected against measles outbreaks, according to the most recent\u00a0data posted<\/a>\u00a0by 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.<\/p>\n Broward\u2019s 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\u2019re far less likely to get measles and spread it to others.<\/p>\n For this reason, government officials have occasionally mandated vaccines in emergencies in the past. For example,\u00a0Philadelphia\u2019s deputy health commissioner<\/a>\u00a0in 1991 ordered children to get vaccinated against their parents\u2019 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\u00a0that ordinance<\/a>, the commissioner wrote that the presence of anyone lacking the vaccine in those areas, unless it was medically contraindicated, \u201ccreates an unnecessary and avoidable risk of continuing the outbreak.\u201d<\/p>\n Ladapo moved in the opposite direction with his letter, deferring to parents because of the \u201chigh immunity rate in the community,\u201d which data contradicts, and because of the \u201cburden on families and educational cost of healthy children missing school.\u201d<\/p>\n 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\u00a0cost about $2.3 million<\/a>, 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\u00a05,700 cases<\/a>\u00a0and 83 deaths, mainly among children.<\/p>\n Ladapo\u2019s 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 KFF Health News, Broward County\u2019s health department deferred to Florida\u2019s state health department, which Ladapo oversees.<\/p>\n \u201cThe county doesn\u2019t have the power to disagree with the state health department,\u201d 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.<\/p>\n 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\u2019s health department\u00a0removed information<\/a>\u00a0on covid vaccines from its homepage, and\u00a0reprimanded a county health director<\/a>\u00a0for encouraging his staff to get the vaccines, leading to his resignation. In January, the health department website posted Ladapo\u2019s call to halt vaccination with covid mRNA vaccines entirely, based on notions that\u00a0scientists call implausible<\/a>.<\/p>\n Jones was not surprised to see Ladapo pivot to measles. \u201cI think this is the predictable outcome of turning fringe, anti-vaccine rhetoric into a defining trait of the Florida government,\u201d she said. Although his latest decision runs contrary to CDC advice, the federal agency rarely intervenes in measles outbreaks, entrusting the task to states.<\/p>\n In an email to KFF Health 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\u2019s decision, adding, \u201cThe surgeon general\u2019s recommendation may change as epidemiological investigations continue.\u201d<\/p>\n For Gambon, the outbreak is already disconcerting. \u201cI would like to see the surgeon general promote what is safest for children and for school staff,\u201d she said, \u201csince I am sure there are many who might not have as strong immunity as we would hope.\u201d<\/p>\n<\/div>\n