Tag: public health

The Beginning of the End for Vaccine Mandates?: What Happens When Ideological Opposition to Vaccination Invades Public Health Policy

“We did it everybody!” exclaimed Leslie Manookian, “We passed the first true medical freedom bill in the nation!” Ms. Manookian and other members of the anti-vaccine group Health Freedom Idaho were celebrating the Idaho Medical Freedom Act being signed into Idaho state law on April 4, 2025, which protects those who refuse to take medical interventions like vaccines from being excluded from activities of daily life such as obtaining a service from a business or attending school.

Idaho is the first state in the country to enact a law protecting personal medical freedom which includes these types of protections for people who are against getting vaccinated, but other states may attempt to implement similar laws and public health policy changes due to vaccine skepticism present throughout the nation. For example, Florida’s current Surgeon General Joseph Ladapo has expressed a desire to eliminate vaccine mandates throughout the state of Florida despite broad medical and religious exemptions. Mr. Ladapo’s rhetoric regarding eliminating vaccine mandates seems less based on science and more based on morals and principle. When describing vaccine mandates Mr. Ladapo stated, “every last one of them is wrong and drips with disdain and slavery,” he added that forcing vaccine mandates “immoral” and “wrong”, and he proclaimed “Your body is a gift from God.” Similarly, when asked about her motivations to help codify the Idaho Medical Freedom Act, Ms. Manookian stated that she and others pushing for freedom from vaccine mandates believe that “our immune systems, given to us by God, are perfect as long as they’re well nourished.” Ms. Manookian also insisted that it was “not accurate” that the implementation of the measles vaccine was what led to the eradication of measles, instead citing improvements in clean drinking water and waste management which helped quell spread of the disease. These types of moral statements regarding vaccine use reflect a growing population of people who see public health interventions such as vaccines more as an issue of personal freedom rather than an issue of safety. These statements made by Mr. Ladapo and Ms. Manookian highlight a crucial ideological issue that public health officials must learn to address more effectively to reduce vaccine skepticism. Global health organizations are beginning to provide targeted guidance to assist healthcare professionals in combating vaccine skepticism not just by providing accurate information but by building trust and a deeper understanding of community perceptions, social norms, and potential logistical barriers to vaccination.

So far in 2025 the United States had had over 1,600 measles infections, which is the most measles infections in the country since 1992, and in 92% of cases the patients are either unvaccinated people or their vaccine status is unknown. Prior case law on the issue of vaccine mandates in the United States, such as the landmark Supreme Court case Jacobson v. Massachusetts, have allowed state public health departments to compel their citizens to be vaccinated despite ideological opposition to the vaccine, but if the legislatures and health departments themselves buy into ideological opposition to vaccines then a key safeguard against disease transmission will be dismantled. It may not be enough to simply combat vaccine misinformation with accurate science, as surveys have shown that false or unproven claims about vaccines are more widely accepted today than two to three years ago despite concerted efforts to combat misinformation with accurate science. The American College of Allergy, Asthma, and Immunology has urged policymakers to weigh the unintended public health implications if vaccine mandates were to be eliminated, but public health officials and medical professionals should be prepared going forward to find new ways to address skepticism to vaccines once a major legal enforcement tool is eroded.

Maine Ebola Quarantine Underscores Importance of Due Process during Public Health Emergencies

Although the fervor of domestic news coverage regarding the West Africa Ebola outbreaks has subsided, cases that were treated in the U.S. shed light on a public health infrastructure to which Americans rarely give much thought. Among the discussions of travel bans and increased surveillance, an issue arose of particular legal importance: the quarantine of Kaci Hickox.

Kaci Hickox entered the United States on October 24 after a month of work with Doctors Without Borders treating Ebola patients in Sierra Leone. Per protocols developed by the New Jersey Department of Health (NJDOH), Homeland Security officials detained Hickox upon her arrival at Newark Liberty International Airport. During her detention, her temperature appeared elevated, and, following the protocol, Homeland Security transferred her to a New Jersey hospital for quarantine under the watch of NJDOH. An Ebola test administered at the hospital came up negative. Despite the test results, the NJDOH detained Hickox until October 27, when she threatened legal action against the state. At that point, NJDOH released Hickox, who returned to her home in Maine. After Hickox’s arrival in Maine, the Maine Department of Health (MDOH) sought a court order to enforce a 21-day in-home quarantine against Hickox.

Although the MDOH action was rare, it is hardly unprecedented. Societies reaching back to the middle ages have long sought to isolate citizens in the interest of public health. In the United States, courts have upheld state government efforts to do so, even in certain extreme cases where, in the course of quarantine, citizens have been jailed or had treatment forced upon them.

MDOH moved to exercise its quarantine power over Hickox pursuant to the state’s public health emergency statute. Under that law, MDOH may exercise certain powers—such as supervision or monitoring of a citizens health—if a “public health threat” exists. Such a threat can include “behavior that can reasonably be expected to place others at significant risk of . . . infection with” a communicable disease that is reportable to MDOH.

MDOH grounded its argument for Hickox’s quarantine in the fact that she had been exposed to Ebola while treating patients while in Sierra Leone, that Ebola is a particularly virulent disease, and that, to minimize risk to the public, she needed to be isolated from the public for the balance of the 21-day incubation period during which she might develop symptoms. A day after issuing a temporary order on October 30 granting the MDOH petition, the Court altered its position.

In its October 31 order pending hearing, the Court struck down the quarantine. Citing information presented by MDOH in its petition, the Court noted that, despite her exposure to Ebola, Hickox was not symptomatic and, therefore, did not present a risk of infection to the public; only if she were contagious would the quarantine be justified. With that in mind, the Court permitted Hickox to move freely, but also upheld MDOH’s requests that she submit to direct monitoring for symptoms, coordinate her travel with MDOH, and immediately contact MDOH if symptoms develop. The MDOH monitoring of Hickox ended without fanfare on November 10, the end of the 21-day incubation period. Hickox did not develop symptoms at any point during her monitoring.

As fear about a domestic outbreak of Ebola fades, Hickox’s case serves as a useful reminder of the importance of providing due process to those whose freedom is restricted during public health crises. Aggressive state action may, at times, be informed by public sentiment and fear a threat to safety; judicial recourse must ensure that such action is properly checked and grounded in sound assessments of any risk to public health.