The Florida Department of Health held a hearing in October 2026 on a proposal to remove four vaccine requirements for school and child care entry: Haemophilus influenzae type b, or Hib, chickenpox, pneumococcus and hepatitis B.
These vaccines were used in the United States at various times, from the early 1980s until 2000. Before that, there were millions of cases of chickenpox and thousands of serious bacterial infections and preventable deaths among American children each year. Vaccination has significantly reduced the number of victims of these diseases.
Many parents today grew up during the transition to widespread vaccination against these diseases and may never have witnessed the serious complications that these vaccines help prevent. I’m an epidemiologist who studies vaccine-preventable diseases and health communication, and I worry that the luxury of forgetting about these diseases will end up giving birth to a generation of children who are not vaccinated against them.
What Florida Would Choose
School vaccination requirements help communities establish herd immunity, which is when enough people are vaccinated to prevent a disease from spreading easily. When vaccination rates decline, infections can spread among susceptible children throughout the community, exposing those who are too young to be fully vaccinated, as well as those who cannot develop adequate protection due to medical problems.
Florida’s proposal would not eliminate these four vaccines, nor would ending one mandate mean that every family would stop using them. However, this would weaken one of the policies aimed at maintaining high vaccination coverage. If, as a result, fewer children are vaccinated, the risks will extend beyond the families who make this choice.
The consequences could be devastating.
Hib: the bacteria that can cause meningitis
Before Hib vaccines became widely used in the late 1980s, pediatricians were sometimes faced with a terrifying emergency: an infant suffering from fever, lethargy and a stiff neck. Analysis of spinal fluid would reveal bacterial meningitis caused by Haemophilus influenzae type b, or Hib, an infection that could kill a child or cause lasting neurological damage.
Today, many doctors have never seen a single case. The bacteria has not disappeared, but widespread vaccination has made serious Hib disease much less common in young children.
Before the vaccine, Hib was the leading cause of bacterial meningitis. In the early 1980s, there were 20,000 invasive Hib infections among American children under 5 years of age, 12,000 of which were meningitis. Between 3 and 6% of these children died and between 15 and 30% of survivors became deaf or suffered brain damage.
Hib infection has not manifested itself in dramatic epidemics. Young healthy children wore it silently and some, unpredictably, became seriously ill.
After the introduction of Hib conjugate vaccines in the late 1980s, cases in young children declined by 99%. In 2023, the United States reported only 13 cases in children under 5 years old. In 2026, this number rises to 28.
Chickenpox: the “harmless” rite of passage
In the early 1990s, there were more than 4 million cases of chickenpox in the United States each year. Of those infected, 10,500 to 13,500 were hospitalized and 100 to 150 died. More than 90% of cases and about 70% of hospitalizations were among children, as were about half of the deaths.
But even those who have had manageable cases of childhood chickenpox are at risk for shingles later in life, which can lead to painful and sometimes lifelong health complications.
Children are contagious before the rash appears and each case has an incubation period of up to three weeks. A single infection can spread through a school or daycare in waves for a month or more. Since vaccination began in 1995, deaths from chickenpox in people under the age of 20 have been virtually eliminated.
José Luis Pelaez Inc/DigitalVision via Getty Images
Pneumococcus: serious infections
Pneumococcal bacteria can live safely in a child’s upper respiratory tract, that is, in the nose, but if they enter the blood or organs, they can cause serious harm.
Before the introduction of the childhood vaccine in 2000, pneumococcal disease caused approximately 17,000 invasive infections in American children under 5 years of age each year, including approximately 700 cases of meningitis and 200 deaths. Additionally, pneumococcal disease has caused approximately 5 million ear infections.
Hepatitis B: the silent threat
Hepatitis B can be passed from an infected mother to her baby during childbirth and through contact with infected blood. People with chronic hepatitis B may have no symptoms and may not know they are infected, allowing the virus to spread unknowingly within families and communities. Infected infants and young children are also often asymptomatic.
However, the consequences can be serious. Infants infected with hepatitis B have about a 90% chance of developing chronic hepatitis B, which over time can cause cirrhosis and liver cancer. The risk of chronic infection declines sharply with age, making prevention of infection early in life particularly important.
Before the hepatitis B vaccine became available in the United States in 1982, approximately 20,000 American children were infected each year.
In 1991, the U.S. Centers for Disease Control and Prevention recommended universal vaccination of infants against hepatitis B as part of a comprehensive strategy to prevent transmission. The CDC estimates that perinatal hepatitis B infections in the United States decreased by 75% between 1987 and 2000.
Florida’s Future
Florida’s historical records of these diseases are incomplete. For example, chickenpox was not a disease tracked by the Florida Department of Health until late 2006. It is therefore difficult to reconstruct the pre-vaccination impact of these diseases in the state from surveillance records alone.
But Florida doesn’t need to imagine what happens when vaccination is neglected: Measles has resurfaced in the state this year. It had already been eliminated nationally by 2000, meaning that sustained endemic transmission had been interrupted. The disease has never been eradicated globally and imported infections can trigger outbreaks when they reach undervaccinated communities.
An outbreak at Ave Maria University outside Naples has infected at least 62 people, and the state has reported 162 cases as of Oct. 17, 2026. This is the most recent data available at the time of this article’s publication.
The proposal to stop requiring hepatitis B, chickenpox, Hib and pneumococcus vaccines comes as only 88.9% of Florida kindergartners received the measles, mumps, rubella — or MMR — vaccine in the 2025-2026 school year. This figure is lower than both the US national average of 92.4% and the recommended threshold of 95% to create herd immunity.
Unfortunately, it is difficult to know current measles rates in Florida. In May 2026, the Florida Department of Health removed county-level disease data from its website. The data has since been replaced, but there is currently no measles dashboard to track cases in the state. The department’s counts for 2026 have often been delayed and public tracking systems disagree on the statewide total.
An entire generation of parents has been spared the experience of seeing a child with Hib meningitis or young adults suffering from liver problems due to chronic hepatitis B. They also didn’t have to find another daycare for a month because a chickenpox outbreak closed their child’s preschool. These are achievements of vaccination – and a reminder of what can be forgotten when prevention works.
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