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WASHINGTON — Right-wing politicians’ resistance to vaccine mandates is extending far beyond Covid-19 immunizations, a startling new development that carries vast implications for the future of public health. 

In Idaho, a lawmaker introduced a bill that would define vaccine mandates — of any kind — as a form of assault. In Florida, a prominent state senator has called for a review of all vaccine requirements, including those for immunizations that have enjoyed wide public acceptance for decades, like polio and the measles, mumps, and rubella shot. And in Montana, the Republican governor recently signed into law a new bill that forbids businesses, including hospitals, from enforcing any vaccination requirements as a condition of employment. 

The bills represent the latest wave of resistance to the Biden administration’s push to impose Covid-19 vaccine mandates for nearly all Americans. But the new, across-the-board revolt against vaccine requirements of any kind, experts told STAT, could begin to reverse a century of progress against diseases that, thanks to vaccines, are afterthoughts to most Americans. 

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“If you [challenge] all of the childhood vaccinations that are required, we could be in a really serious situation with outbreaks of diseases that long ago should have been eliminated in our society. We just can’t have that,” said Anthony Fauci, the government researcher and chief medical adviser to the Biden administration’s pandemic response, in a Tuesday interview at the 2021 STAT Summit. 

In many cases, right-wing legislators’ resistance to vaccine mandates has been cloaked in rhetoric specific to Covid-19 immunizations. Upon closer reading, however, many of the proposals they have floated — some of which have already been signed into law — apply to all vaccines, not just the three currently authorized in the U.S. to prevent Covid. 

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A Tennessee proposal banning employer vaccine mandates, for one, doesn’t specify which immunizations it would apply to, meaning it effectively would apply to any requirement. Alabama’s GOP governor recently signed a new law banning any new vaccine mandates in schools, beyond those that already exist — a measure clearly aimed at Covid but with a potential impact on future immunization efforts.

Public health departments have a tough enough time vaccinating the public even with the benefit of existing laws that support mandates, said Lily Kan, the senior director for infectious diseases and informatics at the National Association of County and City Health Officials. When lawmakers step in to nullify those mandates, she added, that task becomes even more difficult.

“When there’s a direct lack of trust based on misinformation, disinformation, and active efforts to undermine vaccination rates, that’s really concerning,” she said. “We don’t want people to think that not getting vaccinated can be the norm.”

The assorted lawmakers’ push to effectively ban vaccine mandates altogether comes amid a dual crisis. Most pressing is the ongoing pandemic: The U.S. is still recording well over 1,000 Covid-19 deaths each day, and roughly 18% of the country’s adults remain unvaccinated. 

Now, public health experts are beginning to express open alarm about plummeting childhood vaccination rates. In part, they stem from the pandemic itself: Many parents who have worked from home and whose children have attended school remotely have simply made fewer trips into doctors’ offices for fear of Covid-19 exposure. 

In 2020, the World Health Organizations reported that across the globe, childhood immunization rates dropped from 86% to 83%. Roughly 23 million babies didn’t receive basic vaccines normally given, the highest number since 2009. 

“Even before the pandemic, there were worrying signs that we were beginning to lose ground in the fight to immunize children against preventable child illness, including with the widespread measles outbreaks two years ago,” Henrietta Fore, UNICEF’s executive director, said in a recent statement. “The pandemic has made a bad situation worse.”

Increasingly, though, those low vaccination rates may also be driven by turbocharged vaccine skepticism and outright misinformation that has clouded parents’ judgment.  

Even before Covid-19, some U.S. communities had begun to experience outbreaks of diseases that most of the country has largely eradicated. In two recent high-profile instances, a Somali-American community in Minnesota and a largely Orthodox Jewish town outside New York City experienced major measles clusters in 2017 and 2019, respectively. In both cases, the outbreaks were driven by lower-than-ideal vaccination rates, which in turn stemmed from active misinformation campaigns. 

The new wave of resistance to vaccine mandates of any type, however, marks the start of a completely new era of vaccine politics.

“There are real conversations to be had about individual liberty versus public health, government overreach, all of that stuff,” said Nahid Bhadelia, a physician-researcher who leads the Center for Emerging Infectious Diseases Policy and Research at Boston University. “But the level to which this has been politicized — it’s on purpose, and it’s toward the goal of continuing to create strife around the pandemic.”

Still, other experts have warned that governments should factor in inevitable backlash when imposing requirements for Covid-19 vaccines and other immunizations. In situations where most of the population is already vaccinated, sweeping mandates could do more harm than good in the long run, argued Scott Gottlieb, the former Food and Drug Administration commissioner and Pfizer board member. 

“The risk is [that] organized opposition to this OSHA mandate starts to bleed into broader opposition to vaccination and vaccine mandates more generally, and mandates society long embraced become part of this new political fashion,” he wrote this month on Twitter, referring to the Biden administration’s recent requirement that large companies must mandate their employees to be either vaccinated against Covid or tested weekly. “And a whole generation starts to turn against vaccines.” 

But an anti-vaccine generation might already be the reality. According to one recent poll, the partisan divide over Covid-19 vaccination has crept into the country’s annual flu vaccination campaign. 

In 2020, one AP-NORC poll showed just a 4% gap between Democrats’ and Republicans’ desire to be immunized against the flu. Two surveys conducted in 2021, however, paint a grimmer picture: Now, Democrats are more enthusiastic than Republicans about flu vaccines by a 24% or 25% margin, according to Axios/Ipsos and Kaiser Family Foundation, respectively. 

“It’s the perfect storm, because there’s growing vaccine hesitancy, an anti-vax lobby growing more powerful, and this growing milieu of disinformation,” Bhadelia said. “There is a general societal movement here in the U.S. to undermine public health recommendations.” 

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