President-elect Trump says he’s going to let Robert F. Kennedy Jr. ‘run amok on health care.’ That’s making many pediatricians nervous, because of RFK Jr.’s anti-vaccine rhetoric. When another vaccine skeptic, Joseph Ladapo, became surgeon general in Florida, some doctors say vaccine hesitancy grew. is aggravated.

“It’s because people in power, like our surgeon general, for example, are pushing this anti-vax message,” says Dr. Jeffrey Goldhagenprofessor of pediatrics at the University of Florida College of Medicine and president of the International Society for Social Pediatrics and Child Health.

Vaccine hesitancy has increased in Florida. The routine vaccination rate for kindergarten children now stands at 90.6%. This is the lowest rate in more than a decade – and well below the threshold needed for herd immunity against highly contagious diseases like measles.

Dr Lisa Gwynn, a Miami-Dade County pediatrician, says she spends a lot of time fighting misinformation about vaccines. “Probably 50% of our work in pediatrics now is explaining to parents the importance of vaccinating their children,” she says.

Earlier this year, Gwynn saw the consequences of not receiving routine childhood vaccinations.

“We just had a measles outbreak right around the corner from the elementary school where my daughter went to,” in neighboring Broward County, she said. “Five children contracted measles and they were not vaccinated.”

When a measles outbreak occurs, the Centers for Disease Control and Prevention advises parents to keep unvaccinated children home after exposure to prevent the spread of the disease. But the advice from Florida Surgeon General Joseph Ladapo was quite different: He told parents of unvaccinated children that it was up to them to decide whether to send their children to school or keep them at home.

These guidelines “violated every principle of how measles should be treated,” Goldhagen said.

Vaccine hesitancy was growing in Florida long before Ladapo became surgeon general. But Goldhagen says combating the problem has become more difficult. “It accelerated during COVID. It accelerated after COVID and it was particularly accelerated because of this surgeon general’s anti-vaccine stance,” he says.

Ladapo has become a frequent target of critics who say his positions on vaccines go against established science. Last year, the CDC and FDA sent a letter to Ladapo chastising him for spreading misinformation about COVID vaccines and fueling vaccine hesitancy. Now, Ladapo has been mentioned as a possible candidate to lead the Department of Health and Human Services. RFK Jr. too.

Pediatricians say anti-vaccine attitudes that grew during the pandemic, particularly around COVID vaccines, are now impacting all childhood vaccinations.

And it’s not just in Florida.

Routine vaccination of children rates have declined in the majority of U.S. states, while vaccine exemptions have increased.

Gwynn fears these rates could fall further if national health policy makers doubt the safety and effectiveness of vaccines. “I am very worried, like all pediatricians in the country,” she said. “One of our primary roles as pediatricians is to keep children safe. And the most effective way to protect children from preventable communicable diseases is through vaccination.”

Dr. Rana Alissa is the Florida Chapter President of the American Academy of Pediatrics. She says vaccine hesitancy is complex and can’t be blamed on one person. But she says the politicization of vaccines that happened during the pandemic, when people’s attitudes toward COVID vaccines became a sort of litmus test for their political leanings, hasn’t helped.

Vaccines are one of the most effective tools health care workers have to prevent disease, she says. “The vaccines we have in the United States prevent 21 deadly diseases “.

The success of vaccines means that many people no longer remember the seriousness of certain diseases. Alissa says this can lead some people to make incorrect risk calculations about the benefit of getting vaccinated.

“People think it’s easier or safer to get the disease than to get vaccinated. I have no idea where that comes from,” Alissa says.

The United States is already seeing an increase in some vaccine-preventable childhood diseases, according to Dr. Adam Ratner, pediatric infectious disease specialist in New York and author of a forthcoming book on the resurgence of measles and the growing anti-vaccine movement.

Measles outbreaks and cases of chickenpox and pneumococcal disease are increasing in the United States, he notes.

“When we see children hospitalized with complications that we can prevent or at least reduce the risk of using vaccines, it’s very frustrating,” he says.

As vaccine hesitancy continues to spread, Alissa and other pediatricians fear that other devastating childhood diseases like polio will resurface.

Alissa says many people have lost faith in public health science and the country needs leaders who will help rebuild that trust.

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