The COVID pandemic might be behind us, but the vaccine debate is not. I am not surprised that people did not react kindly to lockdowns so harmful that we still feel their impact in 2025, ineffective face mask mandates, useless travel bans, and deleterious school closures. In aggregate, the COVID pandemic response entailed some of history's worst public policy choice in an era of peace. That being said, there is difference between a proportionate response to such carnage and having the pendulum swing too far to the other extreme.
Last week, the Florida Surgeon General Joseph Ladapo said at a press conference that he plans to eliminate all vaccine mandates for Florida, including for children in public schools. Setting aside him inflammatory remark of equating a vaccine mandate to "slavery", he made a distinctively libertarian appeal: "Who am I to tell you what you should put in your body?"
I have advocated for the right to consume marijuana and psychedelic mushrooms, engaging in sex work, not being forced to take a COVID vaccine, selling one's organs for cash, adults having consensual sex with whichever adults they want, eating and drinking what you want (including raw milk and processed foods), and using birth control. This is my way of saying that I understand that few freedoms are more fundamental than what one puts into their body.
I can understand how the COVID pandemic played a role in this decision. COVID vaccines had newer technology (mRNA) that was politicized from the onset and used executive orders to implement. Furthermore, herd immunity is not possible with COVID, which was evident as early as 2021. The politicization of COVID health measures and COVID vaccines was an overreach by the government. Plus, with the COVID vaccine mandate, it was either get the shot or lose your job. There was no third option. All of these reasons point to why I argued against a COVID vaccine mandate in 2021, both because of the nature of the vaccine and because of how the mandate was imposed.
Ladapo was hired during the pandemic due to his reputation against harmful COVID interventions. He shaped Florida's COVID response to be focused on medical freedom over public mandate. I pointed out last year the heavy-handed approach with COVID vaccines eroded trust in all vaccines among many Americans. This distrust is now bleeding into policy, as reflected in Florida's move to repeal all vaccine mandates.
For such diseases with legacy vaccines as measles, mumps, and polio, it is unfortunate that Ladopo is conflating them with the COVID vaccines. Ladapo's view is consistent with medical freedom and bodily autonomy. So why is it that I take issue with the COVID vaccine mandate but not for legacy vaccines? There are decades of clinical data showing that legacy vaccines reduce mortality and morbidity with minimal risk. There is generally bipartisan support for the legacy vaccines and were supported by the legislative process, not executive orders. Most importantly, herd immunity is also achievable for many of the legacy vaccines.
The reality is that completely removing the vaccine mandates increases the risk of outbreaks. A couple of multinational systematic reviews of school vaccine mandates show that immunization mandates generally increase vaccination uptake (Greyson et al., 2019; Lee and Robinson, 2016). This is good because these vaccines are shown to reduce morbidity and mortality, whether that is measles, chicken pox, or rotavirus. The World Health Organization's Expanded Programme on Immunization (EPI) was shown to have averted 154 million deaths from 1970 to 2024 (Shattock et al., 2024). Since vaccines are shown to avert deaths, not having enough children vaccinated undermines herd immunity.
Much like I expressed with water fluoridation, outcomes are better when there is an opt-out option for such health interventions. Unlike with water fluoridation, there is the ability to have an opt-out option for a vaccine mandate. There are already 28 states that have religious exemptions for a vaccine mandate, as well as 16 states that allow for it on personal or philosophical grounds. An opt-out process should entail something such as a formal written exemption and signing a waiver stating that you acknowledge risks to others.
As long as an opt-out exists for those who do not want to, society can balance the public health concerns with the matters of personal autonomy. Most will comply with the mandate by default, thereby maintaining herd immunity in most instances (with rare, localized outbreaks taking place) and making sure others are not harmed along the way. The minority that is opposed, which is about 21 percent per recent polling from Harvard, can opt out without state coercion. This "least restrictive means" approach to public health establishes public health standards while still allowing for personal refusal.
Dr. Ladapo's approach appears to be a win for freedom at first glance. In practice, it is a lose-lose for public health and for freedom. Libertarianism is supposed to defend liberty up to the point until it causes harm to others. By discarding minimal requirements for proven life-saving measures, the state of Florida abandons decades of research while exposing its citizens, children in particular, to avoidable risks. A mandate with a clear opt-out option upholds liberty while protecting individual autonomy and public safety.
Worse still, this could ironically invite more government intervention, whether in the form of emergency powers in the event of an outbreak, a higher burden on state medical services that increase healthcare costs, or federal preemption from the CDC that could undermine Florida's sovereignty. A pragmatic path respects both freedom and evidence. In trying to protect freedom at all costs, Florida may end up sacrificing both liberty and life. A smarter, liberty-respecting state would choose a middle path that trusts people without abandoning its responsibilities.
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