As a pediatrician, I’ve seen vaccine mandates at their best. Few public health measures are as effective at ensuring widespread immunization — and thereby reducing preventable illnesses — than requiring children to be vaccinated before starting school. Yet vaccine mandates, once broadly accepted, have recently become a political flashpoint, with leaders questioning the need for them and even threatening to withhold funding from schools with mandates in place, as president-elect Donald Trump did on the campaign trail.
At the heart of this issue lies the tension between personal freedoms and collective safety, but to frame a rollback on vaccine mandates as simply a nod to personal freedoms would understate the tremendous good that has come from them.
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Vaccine Mandates: A Historical Success Story
Vaccine mandates date back to the 19th century, when smallpox vaccinations were required to curb devastating outbreaks. Over time, these requirements expanded to include other life-saving immunizations, ensuring high coverage rates and protecting entire communities.
Schools are a natural setting for mandates. By linking vaccination to enrollment, mandates ensure children are protected before entering environments where close contact is unavoidable.
School Vaccine Mandates Today
Across the U.S., all 50 states have vaccine mandates that require children attending public schools to be immunized against 16 diseases, including polio, measles, mumps, rubella, and tetanus. These mandates are guided by historical precedent as well as science. In New York, where I practice, for example, children under five attending daycares, preschools, and kindergartens must receive the flu vaccine by December 31st every year, or they cannot return to school after the winter break. The reasoning behind this is that young children, with their small airways and developing immune systems, are at higher risk of complications from the flu.
Schools — and kids’ quality of education — also benefit from mandates, with fewer absences due to preventable illnesses and less disruption from outbreaks.
The Additional Benefits of Vaccine Mandates
As a practicing pediatrician, I can tell you the back-to-school season is usually busy with parents rushing to schedule their child’s physicals and vaccinations so their kids can attend school. These visits, nudged by the vaccine mandates, also provide opportunities to address other health concerns, from the simple, like hearing and vision tests, to the more nuanced, like nutrition, sleep, development, and school performance.
The Risks of Weakening Mandates
Weakening or eliminating mandates would have serious consequences. To state the obvious: vaccine-preventable diseases could resurge, endangering not only unvaccinated children but anyone unable to get vaccinated who relies on herd immunity. In communities where vaccination rates have dropped, outbreaks of measles and other diseases have already shown us how quickly these threats can re-emerge.
The removal of mandates would also disproportionately affect vulnerable populations. If not required by the school system, families with limited access to healthcare might delay or forgo vaccinations altogether, putting them at increased risk compared to everyone else and further widening health disparities. Additionally, overwhelmed healthcare systems could face increased strain from outbreaks of preventable illnesses, diverting resources from other critical areas of care.
The Threat of Shifting Rhetoric
Even without significant changes to school mandates, politicizing vaccine policies risks undermining public confidence in immunizations altogether. To many parents whose children I care for in practice, vaccines not being required sounds very similar to vaccines not being needed. This shift in public attitude leaves us, the pediatricians on the ground with limited time with families, in the position of having to communicate as efficiently as possible how very much needed vaccines still are.
The Path Forward
As a pediatrician and mom dedicated to ensuring the health of all children, I see vaccine mandates not as a way to restrict personal freedoms, but rather as a means to ensure everyone’s safety.
As far as it seems we’ve gone down the path of polarizing what should be a non-political issue, we must resist the urge to turn our backs on established science and decades of public health progress, and continue to advocate for evidence-based policies that will keep us all safe.
We must continue to advocate for strong vaccine mandates in schools and resist efforts to weaken them. Our children’s health and our communities’ future depend on our ability to maintain and support these critical protections.
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