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The Trump school vaccine plan will be a public health catastrophe

Former President, and current candidate for the office, Donald Trump decided to weigh in on school vaccine mandates — he vowed not to “give one penny to any school that has a vaccine mandate.” I don’t want to sound alarmist, but if he wins the presidency and implements this plan, it would be a public health disaster that would far outweigh his inconsistent handling of the COVID-19 pandemic.

Although Trump may want to end school vaccine mandates, I sincerely doubt that vaccination rates for most childhood vaccines would drop to zero. Most parents in the USA care about the health of their children, so vaccination rates have remained remarkably high, over 90% for most childhood vaccines despite the disinformation pushed by anti-vaccine activists.

But I want to do a science-based analysis that examines the consequences of the removal of the vaccine mandates across the country. I think the reader should want to know, and I want to provide the data about, what would happen if suddenly vaccination rates dropped.

What are school “mandates” for vaccines?

Every state requires students to have the following vaccinations, with boosters appropriate for the students’ ages, before entering school, including kindergarten and pre-school. These vaccines are:

Some states also mandate the following vaccines:

School vaccine mandates go back 200 years in the USA — in 1827, Boston required every student entering school to have had the smallpox vaccine. Because of the successful smallpox vaccination programs over the past couple of centuries, smallpox itself was eradicated. This deadly disease, which killed over 30% of people who contracted it, was made extinct by vaccinations.

Because of the school vaccine mandates, most of the diseases that are targeted by the vaccines are rare, if not eliminated.

Measles has been effectively eliminated in the USA. There are rare cases of measles, usually brought to the USA by unvaccinated individuals who have traveled to countries where the disease is still endemic.

Because of polio vaccinations, polio cases have dropped by almost 99% across the world. In the USA, polio is extremely rare usually found in unvaccinated individuals who have traveled to countries where the disease is still endemic (yes, I’m repeating myself).

I could go on and on, but cases of tetanus, diphtheria, mumps, and chickenpox are so rare that most people don’t know about them. Sometimes physicians see patients who have these diseases and it takes some time to diagnose them because they don’t train to diagnose and treat them.

In other words, the success of vaccine mandates has been so great, that we have lost the cultural memory of outbreaks of these diseases. People do not know about polio outbreaks closing public swimming pools or measles outbreaks spreading quickly through schools.

When I was in high school, there were a handful of students who had contracted paralytic polio when they were young. Today, I doubt anyone in high school has ever met anyone who had the disease.

I think the scientific data is clear — vaccine mandates have given our children protection against these diseases.

Trump and vaccine mandates

As I stated in the introduction, Donald Trump will try to force schools across the country to drop vaccine mandates. Whether he will actually do that or will courts agree with it is a whole different discussion, which is way outside of my science background. I try not to pretend that I am a political analyst or constitutional lawyer when I write.

But I know what the experts are saying about Trump’s promise. Baylor University professor Peter Hotez, MD, Ph.D., wrote on X (formerly known as Twitter), “Hoping he doesn’t really mean it, since it would create a public health catastrophe for the nation…” Dr. Hotez is one of the leading scientists who studies infectious disease, public health, and vaccines. Dr. Hotez knows more about vaccines in a couple of neurons than I’ll ever hope to know.

Former United States Secretary of Education, Arne Duncan, asked a question to “Parents across America” — “Is this really what you want for your children? Do you want them going to poorly funded schools with children much more likely to be sick? Only an authoritarian leader would want citizens to be poorly educated and not healthy. Truly dystopian…” 

This is truly dystopian. Trump, probably without thinking it through, wants a country where kids are always sick from deadly diseases.

Vaccine-preventable diseases are dangerous

As I mentioned above, the cultural memory of these diseases has been lost except for those of us who are ancient. Some people may think that measles is nothing more than a few red dots on the skin. Or chickenpox is nothing more than a small rash. Or polio would never hurt your child.

But let’s look at the facts about some of these diseases. Let’s take a look at measles. According to the CDC, some of the many measles complications are:

  • About 30% of measles cases develop one or more complications.
  • Pneumonia is the complication that is most often the cause of death in young children.
  • Ear infections occur in about 1 in 10 measles cases and permanent loss of hearing can result.
  • Diarrhea is reported in about 8% of cases.
  • As many as 1 out of every 20 children with measles gets pneumonia.
  • About 1 child in every 1,000 who get measles will develop encephalitis, an inflammation of the brain that can lead to convulsions, deafness, and other long-term neurological deficits.
  • A measles infection can result in short- and long-term immune system dysfunction which can leave the child susceptible to other diseases early in life (which is in direct opposition to claims by anti-vaccine activists that it helps “boost” the immune system).
  • About 1-2 children, out of 1000 who contract measles, may develop subacute sclerosing panencephalitis (SSPE), a rare chronic, progressive encephalitis that affects primarily children and young adults– it is caused by a persistent infection of the measles virusThe disease starts with measles infection, usually before the age of 2 years, followed by approximately 6-15 asymptomatic years. Some researchers think the asymptomatic period is around 5-8 years after the initial disease. The disease gradually progresses with psychological and neurological deterioration, including personality changes, seizures, and coma. It is always ultimately fatal.
  • And sadly, for every 1,000 children who get measles, 1 or 2 will die from it.

People greatly underestimate the consequences of diseases like measles, but it’s dangerous. It can kill.

But let’s look at this if we eliminate the measles vaccine mandate. What if only 60-70% of people choose to vaccinate their children against the disease? That vaccination level will be far below the herd immunity level (that is, the vaccination rate that prevents a disease from spreading) for the measles vaccine of about 92-94%.

Without a mandate, people who are against vaccines will stop immediately. People who don’t have good health insurance will stop vaccinations. People who are lazy or just can’t be bothered with their children’s health will stop vaccinations.

Measles is a highly contagious disease. And it is difficult to treat once a child has contracted it. According to the CDC, one hospitalization for a serious measles complication costs more than US$142,000. In addition, because infectious disease is not as prevalent as it was 60 years ago, hospitals are not designed to treat hundreds of patients at one time — just look at what happened during the COVID pandemic.

If the Trump vaccine mandate plan became a reality, there would be measles outbreaks everywhere, because the disease is so infectious. About 3.7 million children are born every year, and if only 30% were vaccinated, we could expect over 1 million measles cases every year. Of that million, 30% would get serious complications that would require a hospital visit.

Worse yet, out of those million cases per year, 50,000 children would get pneumonia, 1,000 would get encephalitis, and 1,000-2,000 would die. Every single year would be repeated. This would be tragic by any measure.

This level of disease would bankrupt people without good insurance. It would overwhelm hospitals. It would destroy families.

And this is just measles. Without vaccine mandates, we will have outbreaks of polio, mumps, whooping cough, chickenpox, and many other diseases that can be easily prevented by vaccines.

Yet people think that they have superior genetics, so it won’t happen to their kids. Or they have the best organic, gluten-free diet, so it won’t happen to their kids. Or something else that is unsupported by scientific data, so it won’t happen to their kids.

Sadly, the science says one thing — Trump ending vaccine mandates will lead to a public health catastrophe. And that terrifies me.


Michael Simpson

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