Ladapo can legally end mandates that arise from the health department, including those for hepatitis B, chickenpox, Hib influenza as well as pneumococcal diseases, such as meningitis. Removing mandates for the vaccines for measles, polio, diphtheria, pertussis, mumps, and tetanus will take action from the state legislature. Dr. Ladapo is an immigrant from Nigeria, so he likely does not take the term “slavery” lightly. This doctor should be applauded for putting freedom at the center of the vaccine debates. Earlier this year, Ladapo also led the successful move to stop the fluoridation of drinking water in his state.

First vaccine order in 1827

How did we come to our current vaccine mandate policies? In the 1978 article “School Vaccination: The Precursor to School Medical Inspection,” author John Duffy noted that school vaccine mandates were almost inevitable given two 19th Century developments: the emergence of institutionalized public health systems and the beginning of mass public school education. In 1827 Boston’s school committee ordered teachers to demand proof of smallpox vaccination from students, although this may have been a temporary order versus a law.

Massachusetts passes first school mandate statute

In 1855 Massachusetts became the first state to require vaccinations for school by statute. Enforcement was an issue at the time, as many teachers and school boards opposed vaccination. In the later 19th Century “as opposition mobilized and numerous antivaccination groups swung into action, vaccination became a perennial issue in local school elections,” Duffy writes. In 1894 the legislature amended the law to permit unvaccinated children to attend school, providing they had a physician’s certificate stating they were ‘unfit for vaccination.’ This “loophole” led to complaints from the board of health that, as Duffy puts it, “children in excellent health were obtaining these certificates and were attending ‘school without the precaution against smallpox which the law formerly required.’”

“Poorer Germans” objected

By the end of the 19th Century most New England states had instituted mandatory vaccination for students. From New England, laws mandating vaccines spread. New York passed its first vaccine mandate for schools in 1860, yet the law lacked an enforcement mechanism. New York City created its health department in 1866, thus providing a mechanism to enforce the vaccine law. Many immigrant groups, including “poorer Germans” objected to these new vaccine laws, and many school officials feared that vaccine mandates might interfere with attendance.

Wisconsin gets pushback

Wisconsin first tried to pass school vaccine mandates in the early 1880s, but there was much opposition. During an 1894 smallpox outbreak one local politician “capitalizing on their suspicion of government officials, hospitals, and vaccination, stirred Polish and German immigrants into mob action.” And author Duffy notes that, “Health officers who sought to quarantine the homes of smallpox patients or take the sick to the isolation hospital found themselves under physical attack from club-wielding men and women.” The Anti-Vaccination Society, the German-language press, and some of the local doctors and ministers denounced the city’s health officer, weakening his authority.

School mandates universal by 1980

Vaccine requirements for school then steadily made their way across the USA. The Mayo Clinic reports that by 1963, 20 US states required multiple vaccines for school attendance. And by 1980 all of the states had some laws regarding vaccines required to attend school. In some states, the legislature has listed the required immunizations, while others let county public health boards decide which ones are required. And while many early mandates had medical exemptions, it was during the 1960s and 1970s that most states added religious and philosophical exemptions. These changes came after religious and civil liberties activists lobbied for a better balance between “public health” and individual freedoms.

CDC’s ACIP versus the American Academy of Pediatrics

Ever since the Advisory Committee on Immunization Practices (ACIP) was created in 1964, it has produced recommendations for vaccinations for the CDC, and the American Academy of Pediatrics (AAP) has followed these official guidelines once the CDC accepted them. ACIP was tasked with reviewing the latest science from an objective point of view, while the AAP is a trade association whose programs have received yearly donations of $50,000 and above from the pharmaceutical firms Abbott, Merck, moderna, Pfizer, and others. In 1995, the first nationwide vaccine schedule was created based on ACIP’s work. Earlier this year HHS Secretary RFK Jr removed the 17-member panel and chose new members, some of whom have concerns about vaccine safety. In response, the AAP has said that it will create its own schedule for the first time and will not be constrained by ACIP recommendations approved by the CDC.

AAP now gives alternative COVID-19 vaccine recommendations

On August 19, the Associated Press weighed in on the AAP/CDC divergence regarding what vaccines to recommend. The pediatrician group is “strongly recommending” COVID-19 vaccine for those aged 6 months to 2 years. And older kids should get these shots “if parents want” them to. On the contrary, CDC does not recommend COVID-19 vaccines for healthy children. In May, CDC followed DHHS’s lead and changed its COVID vaccine recommendation for kids from a “should” to a “may.” 

Blue states to go their own way on vaccine schedule?

On September 9, The Hill reported on “blue” states reacting to changes at DHHS and the ACIP. They note that a West Coast coalition of Democratic states have created an alliance to promote “science-driven” vaccine advice. Washington, Oregon, Hawaii, and California say they will make “evidence-based unified recommendations to their residents” based on the advice of national organizations such as the AAP. “Our communities deserve clear and transparent communication about vaccines — communication grounded in science, not ideology,” Oregon Health Authority Director Sejal Hathi opined. “The reason we’ve set up these very transparent processes, that have outside experts to advise the CDC, to advise the FDA on this, is so that each state didn’t have to go at this alone,” offered Mandy Cohen, former CDC director under President Biden. “Now, [states are] needing to get their source of evidence and recommendations from other places,” said Cohen. In New York, legislation has been filed to delink the state vaccine schedule from ACIP’s, allowing the state health commissioner to add vaccines to that state’s schedule.

All of these moves to work around the ACIP are highly problematic. For one thing, they would undermine national uniformity and trust. Also, ACIP meetings are already public, live-streamed, and allow open comment. By contrast, a handful of governors or health commissioners hand-picking “expert” panels at the state level is less transparent and much more vulnerable to political influence. And the claim to be “science-driven” ignores that science is a process and not a decree. Finally, New York’s proposed law removes legislative approval as a requirement, leaving voters and elected officials “out of the loop” on critical decisions.

Developing story…

The ACIP met on Thursday September 18 and Friday September 19. The meetings had discussions and votes on recommendations for COVID-19 vaccines; the measles, mumps, rubella, and varicella (MMRV) vaccine; and more. A recommendation from the ACIP means that insurers will generally cover the full cost of the vaccine and that liability immunity exists. Without an ACIP recommendation, manufacturers should be liable in court for damages from vaccine injuries. We will be updating you about the dramatic results of this meeting in our next email.