Can Florida really end vaccine mandates? What would this mean for the US and countries like Australia?

When it comes to the future of childhood immunisations, all eyes are on Robert F. Kennedy Jr, US Secretary of Health and Human Services, and his audacious attempt to discredit vaccinations with misinformation and dodgy “science”.

But state governments have their own weapons to destroy vaccine uptake in line with the MAHA (make America healthy again) agenda. Children in the United States are currently required to be vaccinated against a range of infectious diseases, including measles, to attend school and kindergarten. This week, Florida’s Governor Ron DeSantis announced the state will scrap all vaccine mandates for children attending school, describing them as “slavery”.

With strong support from the Surgeon General of Florida to abolish vaccine mandates, and with the Florida State Senate and House of Representatives both controlled by Republicans, the measure is likely to proceed.

Why mandate vaccines?

High vaccination coverage rates protect individuals directly. They can also protect the community against diseases such as measles. “Herd immunity” shields people who can’t be protected directly by vaccines.

This is why high vaccination rates are everybody’s business.

Read more: What is herd immunity and how many people need to be vaccinated to protect a community?

Governments use various levers to promote vaccine acceptance. They need to be free, accessible, and promoted well to achieve high uptake.

But when governments do this poorly, they may rely on mandates to prompt people to get vaccinated. US states are heavily reliant on vaccine mandates because of the country’s under-resourced and privatised health system, which can make it difficult for some families to access vaccines.

Removing mandates is risky

Experts have mixed views on vaccine mandates. But almost all agree governments should enable voluntary vaccination in the first instance.

Most would also agree that whatever you think of mandates, removing them is risky business.

In most US states, tensions around mandating vaccines are managed through religious and/or personal belief exemptions. These non-medical exemptions allow parents to opt out after following a bureaucratic process, such as completing a form with a clinician or participating in education.

The design of these policies is influential – easily accessible exemptions result in lower coverage and more outbreaks.

What’s been happening in the US?

The Florida proposal joins a long history of state legislators seeking to make school vaccine mandates more restrictive or more permissive. Republicans led efforts to loosen mandates, but both Democrats and Republicans led efforts to make them stricter.

These efforts in both directions have grown more extreme in recent years. The party distinction has solidified, and the courts got involved.

In 2015, California became the first state to remove non-medical exemptions entirely. This Democrat-led measure was a response to community concerns about vaccine refusal and disease outbreaks.

In 2023, a Mississippi judge introduced a religious exemption to that state’s mandate. Previously, Mississippi was one of the few states that allowed exemptions only on medical grounds.

Applying more coercive policy to vaccine refusers seems to have backfired, and is in part responsible for shifting pre-existing political polarisation about vaccine mandates to vaccines themselves.

The proposed Florida policy is just a more extreme form of this: Republicans are no longer tinkering with vaccine mandates but removing them altogether.

What happens if Florida goes ahead?

Without a lever to prompt vaccination, some parents in Florida will stop vaccinating their children.

They won’t all be vaccine refusers. Many will be poor, disadvantaged or busy parents who need the prompt of the school enrolment routine.

Some will also take the cue from federal and state governments that vaccination isn’t important or valuable. Worse, they may internalise RFK Jr’s messaging that it’s dangerous.

Childhood vaccination rates have already fallen by 2.5 percentage points in the US since the pandemic.

In Florida, where parents can currently access religious and medical exemptions, the coverage rate for kindergarteners fell even more – from 93.8% before the pandemic to 88.7% in 2025 – leaving thousands of children unprotected.

This rate will decline even further without mandates.

And the damage won’t be limited to Florida. Mobile Americans will spread disease to other states and other countries. Even a visit to Disney World will come with increased risks.

In the longer term, other Republican-led states are likely follow suit. In each of them, we can expect to see more outbreaks, suffering and death, and likely more cases elsewhere in the US, Canada and around the world.

Could this happen in Australia?

Vaccination and vaccine policy is not politicised in Australia in the same way.

There is strong, bipartisan support for vaccine mandates; both Labor and Coalition governments introduced “No Jab, No Play” and “No Jab, No Pay” policies for children to attend early education, and for families to receive government benefits.

There is also strong support for childhood vaccination and vaccine mandates among those who vote for the major parties.

The greatest risk we face is from adjacent developments in the United States. RFK Jr is distorting vaccine information and sponsoring questionable science.

This attempt to make anti-vaccination messaging mainstream will affect vaccine confidence in Australia, and potentially vaccination rates – but we don’t know how much.

Most Australian parents support vaccination. But we can’t afford to lose any more people who vaccinate because our coverage has already fallen since the pandemic.

To prepare for these threats, we need to ensure our own house is in order. The federal government’s new National Immunisation Strategy aims to improve access, strengthen the workforce, use data more effectively to guide us and increase community confidence.

The strategy also promises to look into a no-fault compensation scheme for rare vaccine injuries.

We need to see this bold agenda implemented well, with sufficient budget, and with a strong role for our new Centre for Disease Control, which will start in 2026.

We also need to continue to strengthen capacity and support for our regional neighbours, where low and declining coverage has led to large outbreaks.

Read more: In the rare event of a vaccine injury, Australians should be compensated

Katie Attwell receives funding from the Medical Research Future Fund of the Australian Government. She has previously received research funding from the Australian Research Council of the Australian Government and the Health Department, Government of Western Australia. She is a board member of Eviva Partners, a not-for-profit organisation focused on addressing threats to public health.

Julie Leask receives research funding from NHMRC, WHO, and the NSW Ministry of Health. She received funding from Sanofi for travel to an overseas meeting in 2024. She has received consulting fees from RTI International and the Task Force for Global Health.

Nancy Baxter receives funding from the NHMRC and CIHR.