The Club PUBlication 09/22/2025

U.S. loses its role as leader on vaccines
Nations turn elsewhere for ways to protect the health of their citizens.
By DAMIEN CAVE The New York Times

​When Vietnam considered making COVID-19 vaccines mandatory for children deep into the pandemic, many parents resisted, fearing side effects and rumors of expired doses.

Their skepticism helped shape policy — the COVID vaccine mandate never happened.  And it led to greater caution.  More parents started scrutinizing packaging to ensure that every vaccine jabbed into an arm came from a reputable company.

What Vietnam's COVID concerns did not do was metastasize into a broader anti-vaccine movement like what the world is now watching in the United States. Instead, COVID revived gratitude for routine vaccination.

Coverage for the first dose of the measles vaccine in Vietnam reached 98% in 2024, and the vaccine for polio reached 99%.

"There was a scare, and that's why there was an almost global commitment to say, 'We will now work toward making a more robust system,' " said Basil Rodrigues, UNICEF's Regional Health Adviser for East Asia and the Pacific. "Countries are trying to ensure that they strengthen their vaccine systems."

Brazil, Nigeria, Hungary and Samoa are just a few of the nations investing more in vaccination to try to catch up after COVID, during a global rise in outbreaks of measles and yellow fever.
​
That makes the United States an obvious outlier, though not because of public opinion, which still favors vaccination. Rather, experts say, it is because of the government. Health Secretary Robert F. Kennedy Jr. and other vaccine critics are now in charge of public health and — under a banner of MAHA or "make America healthy again" — they are stripping away support for vaccine development, promotion and distribution.

Florida recently became the first U.S. state to announce an end to mandates for vaccines.
​
Experts say that weakens a policy devised to ensure that — in a decentralized and unequal health care system — nearly every child could be protected from horrific infections.

Kennedy has defunded vaccine research.
He has replaced vaccine experts with critics on a key advisory panel, limited access to COVID-19 shots and muddied official guidance on many others, worrying experts who see confusion eroding vaccine confidence worldwide.

As Heidi J. Larson, who leads the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, recently put it in an essay for the Lancet:

​"The USA, long a cornerstone of global health leadership, has become an unexpected source of global instability in vaccination confidence."
Scientists see facts being cast aside, with effects that could last for years.

"The threat is this:
that the U.S. style anti-vax movement linked to MAHA wellness-influencer grifting and authoritarianism is now globalizing," said Peter J. Hotez, a vaccine expert at Baylor College of Medicine and the author of a new book, "The Deadly Rise of Anti-Science."

Mandates, usually focused on entry to school, have also been common for decades.

In a recent study of 194 countries by international academics, 106 nations had policies requiring vaccination for at least one disease. Vaccines against diphtheria, measles, and tetanus were the most mandated, while COVID vaccines were among the least.

Governments often harden childhood mandates when threats intensify. For example, Italy and France added measles to their mandatory schedules after outbreaks in 2017 and 2018. Within two years, vaccination rates had risen nearly 6 percentage points in Italy, and around 4 in France.

That is usually how it goes, though less so with Americans.

After a measles outbreak in 2015 led California to stop letting parents opt out of vaccines for nonmedical reasons, such as "personal belief," fewer kindergartners showed up at school without their shots. But studies later found that medical exemptions had quadrupled.

The medical exemption rate at private schools was 10 times higher than the median nationwide.

America did not start out determined to avoid vaccines.
In 1806, President Thomas Jefferson wrote a letter to Edward Jenner, an English scientist, thanking him for developing the world's first vaccine, against smallpox. Jefferson wrote that he "took an early part in recommending it to my countrymen."

In 1855, after a rash of smallpox deaths, Massachusetts became the first state to require that children be vaccinated for school. In 1905, the Supreme Court upheld the right to mandate vaccination for public safety.

None of that history earned a mention when Joseph Ladapo, the Florida surgeon general, announced last week that Florida would end vaccine mandates. "Who am I to tell you what to put in your body?" he said to loud applause, at an event near Tampa. "Your body is a gift from God."

Ladapo and others — including Kennedy — have celebrated a "your research, your choice" approach that, according to various studies, bolsters false claims of vaccine danger.
​
Worldwide, the U.S. is a major exporter of vaccine misinformation.
That global exchange of vaccine-preventable diseases will become more common, experts argue, because worldwide vaccination levels are still below those from before COVID — the pandemic disrupted the supply chain for many vaccines and kept people from scheduled vaccination. It is also, many add, because the U.S. government is backing away from the country's role as a champion of immunization.
"It's a clichea cute; that infectious diseases know no borders, but it is true that our global preparedness and response to infectious diseases relies on a strong U.S. presence and U.S. commitment to vaccination, from research to development to deployment," said Jason L. Schwartz, a public health professor at Yale.

"So the steady weakening of U.S. government support for all aspects of vaccination will invariably weaken our response to vaccine preventable diseases around the world."