By Zachary Stieber
For Dr. Anish Koka, vaccine mandates made sense. He has a daughter who received an organ transplant, so she cannot receive certain shots. Mandates help ensure high vaccination rates, which can protect people like her. He also trusted officials who implemented mandates and scientists who said the immunizations are safe and effective.
The COVID-19 pandemic hit. COVID-19 vaccines came on the market in less than a year. Koka opposed mandating COVID-19 vaccination, but thought the data was strong enough that many people should get the vaccines. The cardiologist, who works in Philadelphia, administered shots to people in his private practice.
Then some recipients of the COVID-19 vaccines suffered from heart inflammation. Officials delayed warning people about the inflammation, then downplayed the side effect, which canresultin death.
“To watch the response to that was extremely disappointing,” said Koka, who has received compensation for consulting, other services, and food and beverage from vaccine manufacturers. “And so it kind of made me realize that, okay, maybe in some utopic world where you have these non-political decisions being made that were purely science-based, maybe you could have vaccine mandates. But we certainly don’t have that now.”
Coupled with what he sees as insufficient vaccine safety testing and monitoring, and inadequate or nonexistent risk-benefit analyses for various vaccines, Koka now opposes vaccine requirements.
“I’ve turned, certainly, against vaccine mandates,” he told The Epoch Times.
Mandates Imposed Across US
Vaccines were first developed in the 1700s. Officials in the United States first mandated a vaccine in the 1800s. The U.S. Supreme Court upheld mandates in two rulings, Jacobson v. Massachusetts in 1905 and Zucht v. King in 1922.
Justices said in the latter regarding vaccination requirements for school attendance imposed by San Antonio, Texas, that local and state officials have the ability to put mandates in place.
More municipalities and states soon began requiring certain vaccinations to attend school, and by 1980, all 50 states and the District of Columbia had requirements in place.
The mandates are typically based on the immunization schedule promulgated by the Centers for Disease Control and Prevention. Shots against measles, polio, and whooping cough are among those required.
“Hundreds of the country’s top doctors, public health professionals, and scientists design the schedule to ensure it is safe and effective,” the CDC says on its website.
Nearly all states still require vaccines for school, with exemptions for medical and, in all but a handful of states, nonmedical reasons. Florida is moving to eliminate school mandates, and Idaho has banned the prevention of unvaccinated students from attending school.
Other mandates target college students or workers, primarily those employed in the health care industry.
Former CDC Director Favors Education
Dr. Robert Redfield led the CDC from 2018 through early 2021, the end of President Donald Trump’s first term.
Redfield told EpochTV’s “American Thought Leaders” that he no longer supports requiring people to receive vaccines.
He said he favors instead discussing with patients the importance of vaccination, including how it can prevent deaths among children.
“I think it’s a better thing to educate people so they choose to be vaccinated, rather than mandating it,” he said. “And so I’m a big advocate for personal choice when it comes to vaccines.”
Current top government advisers and officials have also recently said that mandates should not be in place.
“The government, the state, has no right to tell its citizens what medical procedures they must take,” Dr. Robert Malone, a vaccine adviser to the CDC, said on a call held by a MAHA Action, a nonprofit run by people with ties to Health Secretary Robert F. Kennedy Jr.
“Vaccine mandates are, to me, an immoral act against children,” Retsef Levi, another CDC vaccine adviser, said during the call. He said that the requirements prevent some children from accessing school and medical care, referring to how doctors have confirmed in surveys that they kick families out of their practice who will not receive all vaccines required for school.
Dr. Tracy Beth Hoeg, one of the Food and Drug Administration’s top officials, told a meeting on Dec. 5 that vaccine mandates means “people are coerced to take vaccines.” She said on X in 2024, before joining the second Trump administration, that not having mandates “is consistent with basic medical ethics.”
Vaccination Rates
Therearesigns that mandates have increased vaccination rates. “School immunization laws have played a key role in reducing vaccine-preventable diseases in the United States,” CDC officials wrote in a 1999 paper.
Under mandates, some parents have their children vaccinated solely so they can attend school. Mandate proponents say that it helps achieve high rates, which are needed for herd immunity, or a level of protection in the community that often prevents outbreaks.
More recently, however, fewer children have been getting vaccinated.
Rates among kindergartners for vaccines against measles, varicella and diphtheria, tetanus, and pertussis declined between the 2019–2020 and 2024–2025 school years, according to CDC data. Rates of measles vaccine coverage, for instance, dropped from 95.2 percent to 92.5 percent, and a decrease was also recorded on a county-level, other researchers found. The CDC defines herd immunity as coverage of at least 95 percent.
At the same time, the number of exemptions from mandates has increased. The 3.6 percent of exemptions among kindergartners in the most recent school year was up from 2.5 percent in 2019–2020.
Exemptions for medical reasons, such as allergies to vaccine components, are granted in every state. Exemptions for nonmedical reasons, such as religious beliefs, are given in 45 states, according to the National Conference of State Legislatures.
Some organizations, such as the American Academy of Pediatrics, whose partners include vaccine companies, have advocated for eliminating nonmedical exemptions. Other groups have advocated for expanding exemptions, and Kennedy’s department has voiced support for allowing exemptions.
Are There Alternatives?
Florida’s efforts to eliminate mandates are driven by several points, including preserving for parents the ability to choose for their children, Dr. Joseph Ladapo, Florida’s surgeon general, has said.
Ladapo also predicted that if the mandates are cut, vaccination rates will largely not be affected.
“I think you can have a moral environment for providing vaccinations, and you can have a high uptake of vaccines that are effective at preventing a transmission to other people,” he told The Epoch Times in the fall.
Ladapo pointed to other countries without mandates, such as Denmark.
Danish officials focus on being transparent about the benefits and risks of vaccines for different populations while carefully crafting vaccine recommendations, Hoeg, the FDA official, said while presenting on the differences between Denmark and the United States earlier in December.
Dr. Daniel Morgan, professor of epidemiology and public health at the University of Maryland, said in a Dec. 5 viewpoint in JAMA Health Forum that public health officials must respect individual autonomy and should reconsider requiring vaccination.
“We should take the successful approach during the pandemic of countries like Denmark, Spain, and Japan and the state of Colorado of avoiding vaccine mandates,” Morgan and Dr. Deborah Korenstein wrote.
Trump recently directed Kennedy and acting CDC director Jim O‘Neill to review recommendations in other countries, such as Denmark, and update the U.S. childhood vaccine schedule if appropriate. O’Neill, Kennedy’s deputy secretary, signed off on moving the first hepatitis B vaccine dose for many infants, accepting advice from CDC advisers, and suggested that children may not need the vaccine, which is required in nearly all states, at all.
Hepatitis B vaccine mandates are not consistent with the updated stance, Malone, one of the advisers, wrote on his blog.
What Do Surveys Show?
Surveys generally indicate majority support for vaccine mandates. That support has gone down, though, primarily among Republicans.
Just 51 percent of respondents—including just 36 percent of Republicans—in a Gallup poll in 2024, for instance, said that all parents should be required to have their children vaccinated against contagious diseases such as measles, a decrease from 81 percent in a similar poll carried out in 1991. Some 94 percent of respondents in 2001 said it was extremely or very important for parents to have their children vaccinated, compared to 69 percent overall, and 26 percent among Republicans, in 2024.
A smaller amount, or 13 percent of respondents, told the Harvard Opinion Research Program in 2019 that parents should be able to send children to school without being vaccinated against preventable diseases. That did rise to 25 percent in 2022. It declined to 21 percent overall and 32 percent of Republicans in March. At the same time, an overwhelming majority of respondents said in the most recent survey that vaccines are very safe or somewhat safe.
The respondents opposed to mandates most frequently cited parental rights and the belief that there may be too many mandated vaccines in the future as reasons. Only four in 10 referenced safety.
“Now opposition may not just be a function of concerns about safety, but about parental rights, for example, which have come more into the policy space,” Gillian SteelFisher, director of the program, told The Epoch Times. “So I think that’s what’s important to think about, and how we connect with people and make sure they feel heard.”
Data are scarcer for how health care professionals broadly view mandates.
In one online survey conducted with funding from vaccine manufacturer Merck in late 2021 and early 2022, most health care professionals agreed governments can legitimately impose vaccine mandates, particularly school mandates. Professionals with less experience were more likely to disagree.
About 50 percent of health care workers across multiple countries opposed COVID-19 vaccine mandates, and about a third did not support them for health care workers, according to another paper. Many health care workers complied with COVID-19 vaccine mandates, but others refused vaccination, a subset of whom lost their jobs. According to the most recent data available from the CDC, just 10 percent of health care workers had recently received a COVID-19 vaccine, and uptake of influenza vaccines was also down.
What Would Happen If Mandates Are Eliminated?
Some who support removing mandates say it’s possible vaccination rates would drop, which could lead to more cases of vaccine-targeted diseases, but say that is acceptable because there will be fewer vaccine side effects.
“There are tradeoffs. You will probably have more cases,” Koka, the Philadelphia cardiologist, said. Koka, who strongly encourages people to receive certain vaccines, such as the measles shot, says his position is driven by worry about the qualifications of those imposing mandates.
“You need highly competent bureaucrats that aren’t making decisions guided by politics, and I’m not sure if that’s consistently possible anymore,” he said.
Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, told The Epoch Times in an email that after the group in 2000 approved a resolution opposing mandates, some members objected to criticism of vaccines. Since the pandemic, she said, none have.
“The heavy-handed methods of government have caused a lot of distrust of officialdom,” said Orient, whose association says it is not funded by corporate donors or government sources. “I think more parents will be declining or delaying vaccines as information seeps out.”
Dr. William Moss, executive director of the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health, in a recent call with reporters, highlighted the decline in vaccination rates, what he described as the “sowing of mistrust around vaccines,” and the loosening of school vaccine mandates.
“All of this is going to make us more vulnerable to … more frequent and larger outbreaks of vaccine-preventable diseases,” said Moss, whose center’s partners include vaccine manufacturers.
A number of medical organizations, including the American Medical Association, have also said that all mandates should remain in place.
Rolling back Florida’s mandates “would undermine decades of public health progress and place children and communities at increased risk for diseases such as measles, mumps, polio, and chickenpox resulting in serious illness, disability, and even death,” Dr. Sandra Fryhofer, the association’s trustee, said in a statement. The association’s philanthropic arm has received millions of dollars from vaccine manufacturers over the years.
Morgan, of the University of Maryland, told The Epoch Times in an email that he believes vaccines are safe and generally effective, but that he believes the public does not broadly support vaccine mandates any longer.
“Instead of mandates, other countries have been successful with vaccination campaigns, guidance, and making it free and easy to receive vaccinations,” he said.
“In response to concern for falling vaccination rates, that is a risk of removing mandates. If we see more vaccine preventable diseases we may see a change in public opinion.”
