This article is republished from The Conversation, an independent and nonprofit source of news, analysis and commentary from academic experts.
is an Assistant Professor of History and Interdisciplinary Studies at , and is the Deputy Director of the Center for Law, Health & Society at
On Sept. 3, 2025, Florida to , including those for children to attend school.
Current Florida law and the state鈥檚 require that children who attend day care or public school be immunized for polio, diphtheria, rubeola, rubella, pertussis and other communicable diseases. Dr. Joseph Ladapo, Florida鈥檚 surgeon general and a , has stated that 鈥渆very last one鈥� of these decades-old vaccine requirements 鈥�.鈥�
As experts on , we took immediate note of Ladapo鈥檚 use of the word 鈥渟lavery.鈥�
There is certainly a complicated history of race and vaccines in the United States. But, in our view, invoking slavery as a way to justify the elimination of vaccines and vaccine mandates will and present a major threat to public health, especially given existing . It also erases Black Americans鈥� key work in centuries of American public health initiatives, including vaccination campaigns.
What鈥檚 clear: Vaccines and mandates save human lives
Evidence and data show that vaccines work, as do mandates, in keeping Americans healthy. The World Health Organization reported in a landmark 2024 study that vaccines have in just the past 50 years.
In the United States, vaccines for children are one of the of the 20th century. Rates of eight of the most common vaccine-preventable diseases in school-age children or more from pre-vaccine levels, preventing an estimated 1,129,000 deaths and resulting in direct savings of US$540 billion and societal savings of $2.7 trillion.
History of vaccine mandates in the United States
Vaccine mandates in the United States date to the Colonial period and have a complex history. , the predecessor of vaccination, against smallpox during the American Revolution.
To prevent outbreaks of this debilitating, disfiguring and deadly disease, state and local governments implemented smallpox inoculation and vaccination campaigns into the early 1900s. They , including enslaved people, immigrants, people living in tenement and other crowded housing conditions, manual laborers and others, those who could not provide proof of prior vaccination.
Although religious exemptions were , some resisted these vaccination campaigns from the beginning, and 19th-century urged the rollback of state laws requiring vaccination.
By the turn of the 20th century, however, the U.S. Supreme Court also began to intervene in matters of public health and vaccination. The court ultimately upheld vaccine mandates in in 1905, in an effort to strike a balance between individual rights with the need to protect the public鈥檚 health. In in 1922, the court also ruled in favor of vaccine mandates, this time for school attendance.
Vaccine mandates expanded by the middle of the 20th century to include vaccines for many dangerous childhood diseases, such as , , and . When Jonas Salk鈥檚 polio vaccine became available, families waited in long lines for hours to receive it, hoping to prevent their children from having to experience .
Scientific studies in the 1970s demonstrated that state declines in measles cases were . The federal launched in the late 1970s helped educate the public on the importance of vaccines and encouraged enforcement. All states had mandatory vaccine requirements for public school entry by 1980, and data over the past several decades continues to demonstrate the .
Most parents also continue to support school mandates. A by The Washington Post and the Kaiser Family Foundation finds that .
Black Americans鈥� long fight for public health equity
Despite the proven success of vaccines and the importance of vaccine mandates in maintaining high vaccination rates, there is a that has .
Misinformation . Some of the misinformation originates in the historical realities of vaccines and social policy in the United States.
When Ladapo, the Florida surgeon general, invoked the term 鈥渟lavery鈥� to refer to vaccine mandates, he may have been referring to the history of racism in the medical field, such as the . The study, which started in 1932 and spanned four decades, involved hundreds of Black men who were recruited without their knowledge or consent so that researchers could study the effects of untreated syphilis. Investigators misled the participants about the nature of the study and actively withheld treatment 鈥� including 鈥� in order to study the effects of untreated syphilis on the men鈥檚 bodies.
Today, the study is remembered as one of the of racism and unethical experimentation in American medicine. Its participants had enrolled in the study because it was advertised as a chance to receive expert medical care but, instead, were subjected to lies and painful 鈥渢reatments.鈥�
The 40-year untreated syphilis study at Tuskegee ended in 1972. Despite these experiences in the medical system, for better health care, connecting it to the larger struggle for racial equality.
Vaccination is no exception. Despite the fact that they were often the , enslaved people helped to lead the first American public health initiatives around epidemic disease. Historians鈥� research on smallpox and slavery, for example, has found that by the early 1700s, and that enslaved people brought the practice to the Colonies.
Although his role is often downplayed, an African man known as Onesimus .
Throughout the next century, enslaved people often continued to inoculate each other to prevent smallpox outbreaks, and enslaved and free people of African descent in keeping their own communities in the face of violence, racism and brutality. The modern Civil Rights Movement explicitly drew on this history and for Black Americans as one of its key tenets, including working to to vaccines for preventable diseases.
In our view, Ladapo鈥檚 reference to vaccines as 鈥渟lavery鈥� ignores this important and nuanced history, especially Black Americans鈥� role in the history of preventing communicable disease with vaccines.
Puritan slave owner Cotton Mather learned about smallpox inoculation from one of his slaves, an African man named Onesimus.
Lessons to learn from Tuskegee
Ladapo鈥檚 word choice also runs the risk of that continues to exist in communities of color about vaccines and the American health system more broadly. Studies show that and other instances of medical racism have had for the health and vaccination rates of Black Americans.
A large body of evidence shows the existence of for Black people in the United States compared with their white counterparts, leading to , and higher rates of communicable and chronic diseases, with .
Eliminating vaccine mandates in Florida and expanding exemptions in other states will continue to widen these already existing disparities that stem from past public health wrongs.
There is an opportunity here, however, for health officials, not just in Florida but across the nation, to work together to learn from the past in making American public health better for everyone.
Rather than weakening vaccine mandates, national, state and local public health guidance can focus on expanding access and communicating trustworthy information about vaccines for all Americans. Policymakers can acknowledge the complicated history of vaccines, public health and race, while also recognizing how advancements in science and medicine have given us the opportunity to eradicate many of these diseases in the United States today.
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