of those infected so far are vaccinated. The remaining patients are either unvaccinated or their vaccine status is unknown. 

Robert F. Kennedy Jr., the newly confirmed head of the U.S. Department of Health and Human Services, has a long history of around vaccines, including the one for measles. He recently put vaccine advisory meetings — where a panel of experts establish a vaccine schedule used to inform state policies — on indefinite and wields power over how organizations within HHS, such as the Centers for Disease Control and Prevention, respond to such crises. 

Earlier this month, his anti-vaccine organization, Children’s Health Defense, put out a blaming the Texas outbreak on the vaccines themselves, arguing, “The real issue is not a failure to vaccinate but a failing vaccine.”

“As measles outbreaks continue to surface, the mainstream media is now using them as a political weapon, attempting to blame … Secretary Robert F. Kennedy Jr. for so-called ‘anti-vaccine rhetoric,’” the statement read. “His warnings about vaccine-induced injuries and failures are validated by the very outbreaks being reported today.”

Rekha Lakshmanan, chief strategy officer at The Immunization Partnership, a Texas-based education advocacy organization that promotes childhood and adult immunization, said she is “just absolutely flabbergasted that there is intentionality to put blame on the vaccine when that is not where anybody should be spending their time or their effort. Our effort should be supporting families, making sure they’ve got the right information and supporting helping our public sector partners so we can try to get to the end of this crisis sooner rather than later.”

“CDC is aware of the death of one child in Texas from measles, and our thoughts are with the family,” Andrew Nixon, director of communications at HHS, wrote in a statement to ����Ӱ��. “CDC continues to provide technical assistance, laboratory support, and vaccines as needed to the Texas Department of State Health Services and New Mexico Department of Health, which are leading the response to this outbreak.”

There are now also at least nine reported cases in neighboring  

Kennedy that he’s following updates on the outbreak, which he noted was mainly in the Mennonite community. Despite the confirmed death of a child, Kennedy appeared to downplay the spread, saying, “It’s not unusual. We have measles outbreaks every year.”

Measles were declared eliminated in the United States in but there’s been a resurgence of cases as vaccination rates have dropped.

Mary Koslap-Petraco, a pediatric nurse practitioner who treats underserved children in New York state, said that when she heard about the child’s death Wednesday morning, “Quite frankly, I broke down in tears. This was [99%] preventable.”  

She placed much of the onus on the anti-vaccination movement, saying they planted “seeds of distrust” that ultimately scared parents.

“I know this family only wanted the best for this child,” she said, “and I’m really sorry that they weren’t able to encounter someone who could help them through this misinformation that they’re hearing to feel comfortable enough to vaccinate their child.”

‘Primed for something like this to happen’ 

Measles is a highly contagious which can be serious and sometimes fatal in children. If one person has it, up to 9 out of 10 people nearby will become infected if they , though spread is preventable through the measles, mumps and rubella vaccine, which is safe and about . The infection is often marked by a high fever, sore throat and rash; more severe complications can include pneumonia and swelling of the brain.

In a statement Wednesday, the Texas Department of State Health Services said the best way to prevent measles is through the vaccine. The department  it was “working with local health departments to investigate cases, provide immunizations where needed, and keep the public informed.”

Texas is one of 18 states that allow school-aged children to of vaccine requirements for medical, religious or “personal belief” reasons.

The majority of measles cases so far are in Gaines County, a small, rural county in West Texas, with one of the state’s highest vaccine exemptions rates: up from just over 4% a decade ago. And the actual number of unvaccinated kids in the county is likely significantly higher, because there’s no data for the many children who are homeschooled, according to reporting from the

Some of the initial cases appeared to be connected to . 

To be exempted for “reasons of conscience,” a parent or legal guardian has to submit a form to the school. Under certain circumstances — like an official emergency or epidemic — these students might not be allowed to go to school.

None of the four public school districts serving Gaines County immediately responded to a request for comment. The county’s small Loop Independent School District of K-12 students had a conscientious exemption for immunizations in 2023-24. The statewide vaccine exemption rate is 2%.

“We know based on a ton of research that these kinds of exemptions cluster,” Lakshmanan said. “They cluster geographically, they cluster in schools, they cluster in neighborhoods, they cluster in faith-based communities. Sadly we are seeing the practical reality of this type of loophole … when we start to see high exemption rates, we are bound and we are primed for something like this to happen.”

Kindergarten measles vaccination rates in Texas generally have fallen to below 95% since the pandemic, though they still remain just above national averages, according to a recent data analysis from  

A number of Texas parents who previously had not vaccinated their children are now changing course. “We’ve vaccinated multiple kids that have never been vaccinated before, some from families that didn’t believe in vaccines,” Katherine Wells, director of public health for Lubbock’s health department, told

Yet, as the outbreak spreads, Texas lawmakers are preparing to consider bills that would further loosen exemption requirements.

“Now is not the time to be playing a game of roulette with children’s lives or Texans’ lives and even contemplate making the exemption process easier,” Lakshmanan said.

Kate Gould said the classroom became a dangerous place for her son after took over the Douglas County school board and the district removed masking requirements.

After a prolonged back-and-forth, involving a pulmonologist and a special education attorney, district leaders finally agreed to an accommodation for his classroom, mandating masks. But mere weeks later, the superintendent was fired and, under new leadership, the district again removed the masking accommodation without consulting doctors or Gould, she told ����Ӱ�� in a recent interview. 

Now, almost four years later, Gould and her family live in Southern California — where they moved during the pandemic for its masking and eventual COVID vaccine requirements — and they and other parents, advocates and health experts are gearing up for what could be the next front of the school culture wars: a broader attack on school vaccine mandates by the incoming Trump administration.

Currently, all 50 states have vaccine requirements for children entering child care and schools. But with Robert F. Kennedy Jr. — who has peddled baseless conspiracy theories and “There’s no vaccine that is safe and effective” — potentially at the helm of the Department of Health and Human Services, advocates and parents are right to fear a rollback of requirements, enforcements and funding, according to interviews with about a dozen experts. 

“The anti-vax warriors have made it inside the castle walls,” said Richard Hughes, a George Washington University law professor who teaches a course on vaccine law.

Kennedy’s legitimization and the different levers he could pull, experts told ����Ӱ��, could have an immense impact on vaccination rates and the spread of preventable, contagious diseases in school-aged kids.

If confirmed by the Senate, Kennedy would take control of an agency with a budget and 90,000 employees spread across 13 agencies, including the and the . Dave Weldon, nominated by President-elect Donald Trump to head the CDC, has also endorsed debunked theories, and some chronic diseases.

Kennedy, whose nomination faces from health professionals and scientists and questioning by , did not respond to requests for comment. He has said he would not take away vaccines but look to make more of their safety and efficacy data available. 

“We don’t know what he’s going to do,” John Swartzberg, a professor at the University of California Berkeley’s School of Public Health told ����Ӱ��. “But if he tries to carry out the things that he’s publicly stated — not just recently but over a long, long time — then the implications for our children in school are dire.”

While most school vaccine requirements come from states, the recommendations they’re based on begin with federal agencies, such as the CDC, and enforcement is often left up to local districts. This leaves room for both federal influence and “a hodgepodge of enforcement,” said Northe Saunders, executive director of the pro-vaccine , who sees battles around school vaccination mandates playing out at the federal, state and school board levels.

Experts agreed the federal government is highly unlikely to attempt to take vaccines off the market or categorically ban mandates, and most don’t anticipate individual states will do away with their long-standing requirements.

But James Hodge, a public health law expert at Arizona State University’s Sandra Day O’Connor College of Law, pointed out, “You don’t actually have to pull the vaccine for people to stop using it. You have to raise doubts about it.”

That can happen by planting seeds of misinformation, he said, or by starting to require that vaccines be assessed differently for approval or federal funding. Any slight dropoff in parents vaccinating their kids entering schools or day care can result in disease outbreaks, an outcome Hodge said he expects to see over the next year or so. Such declines are

As secretary, Kennedy could delay FDA vaccine development and influence the selection of CDC advisory committee members who make the vaccine recommendations that states then use to determine their requirements. Programs that provide free vaccines for kids could also see their funding cut.

“There’s short-term threats in terms of funding and what’s going to be available for state immunization programs,” Saunders said, “[and then] there’s long-term threats about immunization policy and what the future of the immunization landscape in the country can hold.”

Even in Democratically controlled California, Gould, the mom whose son has cystic fibrosis, said she’s concerned about shifts in vaccine rhetoric, particularly at the school board level. 

“I think what I have learned from my experience in Douglas County, Colorado, is that when these individuals take over majorities on school boards, it really affects everyone … Despite the fact that we are a highly educated, very liberal, coastal section of Southern California, you definitely have people that are trying to make inroads — and these are people who are anti-science.”

Are vaccines the new critical race theory?

Parents across the country are able to apply for exemptions if their child is unable to get vaccinated for medical reasons. Most states also have religious exemptions, and 20 have some form of personal , leaving a varied landscape. 

School vaccine mandates have been around for , and while some pushback has always existed, it wasn’t until COVID that there was a real spike in vaccine hesitancy, according to Kate King, president of the and a school nurse in Ohio.

The source of the skepticism has shifted, too: “Rarely have we seen the federal government behind those debates in a way that this next administration could be,” said ASU’s Hodge.

Randi Weingarten, president of the American Federation of Teachers, sees the potential “unraveling of decades and generations of protective vaccines.”

“RFK believes he knows more than the totality of any science that has come before him,” she said. 

For a vaccine to get approved, it must first go through an advisory committee at the FDA. Another committee at the CDC then develops recommendations for vaccine schedules, which state legislators rely on to determine their school policies. Kennedy would have an enormous impact on who serves on these committees, and he could stack them with anti-vaccine advocates.

Kennedy could also request a review of all vaccines that have been previously approved by the FDA and subject them to new requirements. 

Many vaccines are paid for by the federal government. If Congress — under HHS’s direction or on their own — were to begin pulling that money, some of the most vulnerable children across the country could lose access to immunization. Trump has threatened to requiring vaccines for students. 

“The moment you start tacking on any price tag to a vaccination — any price tag whatsoever, even fairly minimal — you do see vaccination rates go down,” said Hodge.

Beyond policy actions, experts warned of the power of rhetoric. “We still rely — even under legal mandates that exist at the state level — on public acceptance of vaccines,” Hodge added, so for vaccine rates to remain high, so too must the public trust. The mere presence of a federal official who is skeptical and — at times outright hostile — towards vaccines gives the opposition more credibility.

Since the enforcement of these policies is typically left up to the district level, some advocates are anticipating increased pressure on school board members to take anti-vaccine positions. 

“The real tension is if a school board decides that they don’t want to support these [vaccine mandate] policies,” said Hughes, the GW law professor. “They can’t change the policies, but they might say, ‘We don’t support these policies. Not in our school district. No way, no how.’”

He said he’s already seen some groups use vaccines as a wedge issue, much like the debate over critical race theory — an academic framework used to examine systematic racism — that convulsed school boards a few years ago.

In , public health workers were recently forbidden from promoting COVID, flu and mpox — previously known as monkeypox — shots, according to a recent NPR investigation. And a regional public health department in Idaho is no longer providing COVID vaccines to residents in six counties after a by its board. 

There’s money in anti-vax anxiety

The anti-vaccination movement is not new. It can be traced back as far as the 18th century with Edward Jenner’s discovery of the smallpox vaccine. Because it was made from cowpox, people at the time were afraid that if they got the vaccine, they’d turn into a cow, said Swartzberg, the public health professor who has taught a course on the anti-vax movement for over a decade. 

“There’s always been opposition to vaccination because it’s the idea of the word inoculate, — meaning putting into you something foreign — and that scares people,” Swartzberg said. “I understand that. That’s where emotion has to be countered with data.” 

The group of people so stringently anti-vaccination that they refuse them is small but vocal, he said. Over the past few years, though, “something has dramatically changed in our society,” and the voices behind the movement have shifted from expressing personal fears to looking to monetize the fears of others. 

For example, Joseph Mercola, deemed one of the — the 12 people responsible for sharing the majority of anti-vax messaging on social media — made substantial sums of money by peddling far-fetched health claims and then as alternative treatments. Kennedy also appeared on the “Disinformation Dozen” list.

Others sell merchandise, books and tickets to events, offer exclusive paid content on platforms like Patreon, have sponsored content and display affiliate marketing links to anti-vaccine products.

“It’s turned into an incredibly lucrative field for anti-vaxxers, and what’s really facilitated this has been the internet and the lack of any monitoring of the internet for misinformation and disinformation,” Swartzberg said.

Just last week, Meta, the owner of Facebook, Instagram and WhatsApp, d that it will end its fact-checking program on social media posts. 

Using social media and other mechanisms, the anti-vax movement has targeted fairly insular groups around the United States with misinformation, he added. These include New York’s and the y in Minnesota, both of which have seen recent measles outbreaks. 

While the image of vaccine skeptical parents is often one of young, white “,” Keri Rodrigues, president of the National Parents Union, also pointed to “well-earned” trepidation among Black and Latino parents. 

Historically, she noted, significant harm has been done to Black communities through the weaponization of medical trials, and families of color have had particularly negative experiences with the health care system —

During the pandemic, Children’s Health Defense, Kennedy’s anti-vaccine advocacy organization, seemed to tap into this distrust when it put out targeting Black Americans with disproven vaccine claims. 

Gould, the California mom, said if she were still living in more conservative Douglas County she’d fear that people would “believe the disinformation [and] stop vaccinating their children. For kids with chronic illnesses — or like my son, a life-limiting illness — that has massive consequences. It has life-or-death consequences.”

Advocacy groups formed on all sides of the political spectrum with some designed to address long-standing inequities and others meant to push back against what members considered a liberal agenda.

Right-leaning parents who oppose COVID restrictions in schools and the teaching of systemic racism are seen as key to Republican in the Virginia governor’s race and are already being counted as a in the 2022 midterms. 

Tina Descovich is the co-founder of Moms for Liberty, a high-profile and fast-growing parents’ rights organization founded in January. The group boasts 140 chapters in 32 states with roughly 60,000 active members, with 24,000 members in July. 

While Descovich pushes back at descriptions of Moms for Liberty as being solely conservative, many of its members have publicly railed against mask mandates, vaccine requirements and the teaching of critical race theory.

Descovich, who served four years on the Brevard Public Schools Board of Education in Florida before in 2020, said she was prompted to start the organization after observing how poorly some members of her community — and others throughout the country — were treated by school administrators when they tried to address hot-button issues surrounding COVID.

ATTENTION School Boards, City Officials, State Legislators, Governors, Congressmen, and every single unelected bureaucrat in between, this message is for YOU.

— Moms for Liberty (@Moms4Liberty)

Moms for Liberty members, wearing shirts emblazoned with the group’s logo in white lettering and its increasingly recognizable catchphrase, have been attending school board meetings in force across the country, repudiating not only pandemic-related restrictions but many schools’ efforts around equity and inclusion. 

Descovich believes their viewpoints are valuable and the discourse long overdue.

This interview was edited for length and clarity.

����Ӱ��: Why do you think Moms for Liberty has had such success in such a short timeframe?

Descovich: We filled a need, just like any other organization or business or anyone that has success when they … create a way to help people with the problem that they have. And so again, we saw parents kind of floundering not knowing what to do to stand up for their children. We kind of gave them a model and a little background information from experiences that we had had over the previous four years and people are finding that to be helpful.

What are some of the unifying principles among your members?

Our mission is to empower parents to stand up and reclaim their parental rights at all levels of government. Right now, that seems to be really focused on public education because of the things that families have faced over the last two years. The principle that ties us all together is that we love our children, we care for our children and we believe that we are the best decision-makers for our children.

Of course, some people believe it is their fundamental right to send their child to a school with vaccine and face mask mandates. They also love their children and want to protect them.

Yeah, I agree with what you’re saying. And I think everybody deserves a voice in the conversation. What we were seeing was that as COVID was unfolding and 2020 was happening, those that disagreed with what you just said were being silenced. I was watching it happening in my own school board. I remember one specific mom getting up and talking about concerns she had about her child and literally getting heckled from the back of the room. I watched her walk out of our school boardroom in tears. And so they felt, you know, marginalized and like their voices shouldn’t be heard.

Is there a “happy medium” in terms of vaccines or mask mandates? People look at these issues as absolute.

I do believe we can live in a world where people get to choose what is best for them. Those that want to continue to mask because they’re more vulnerable, that is their right. And there’s different quality of masks. They could be in an N-95 mask … They can be six feet away from those that choose not to mask or have been vaccinated and feel like they don’t need to mask anymore or have had COVID. Every person needs to make the decision that is best for them.

Much of what you said about the founding of your organization — how it sprang up in response to parents not being heard — is actually in line with other parent groups on the opposite side of the political spectrum. Yet your group has a conservative political bent. How did that happen?

I think because of the issues of today … but to assume we’re conservative, I know that’s how we’ve been branded, locally and nationally. I did an unscientific survey of our chapter chairs a couple of weeks ago … and we have quite a few that are independents, one Democrat. So, the idea that … only conservative parents should be part of our organization … it’s just false. We want better educational outcomes for all children. And if there’s a segment of our organization that wants to fight for, you know, our Title I schools to get more services, we will gladly support them. We welcome them. We want to help with that fight.

But if a parent wanted the right to stand up and say, “We need a mask mandate,” or “We need mandatory vaccines,” they could not be part of your organization, correct?

So, I think that we would diverge when it came down to the issues of individual liberty. I mean, our title is Moms for Liberty. So … once a parent wants to make decisions for other children, and force things on them, I think that’s where it would divert and our values would separate. If they want to go in and fight for … a better curriculum that targets a certain demographic, you know, we would support that all day long.

What if you had a mom who wanted their child to learn about Ruby Bridges and Dr. Martin Luther King, Jr.? Is that something Moms for Liberty would appreciate?

One hundred percent. Yes.

Even though you have members within your organization fighting to take those same materials out of children’s hands?

Yeah, I think you’re just looking at headlines. You’re probably talking about They went through every book, every piece of curriculum for English language arts, from K-6, and they made a huge spreadsheet. They put, I think, 1,000 hours into that and they logged all of their concerns. As a parent, they have the right to do that. What I have seen from that chapter is they have legitimate concerns about the grade level that some of the stuff is introduced … Nobody that I know of in our group wants to not teach about Martin Luther King or Ruby Bridges for that matter … I think all parents and community members should have open minds, open hearts, open conversations. If you can’t have that and people just want to label somebody a racist or a bigot or these names because they don’t want to hear anybody else’s input, I think that’s unfortunate — and it will not move us forward.

Does your organization take a stance on critical race theory?

Nationally, we have not officially taken a stance on any issue. We try to support our local chapters and things that they’re fighting for, helping them get exposure and uncover issues that they want to bring to light.

What are you most proud of in terms of your membership? Is there anything you’re seeing from some of your members and their approach to school board officials that you would discourage?

So, we…use the term “joyful warriors” when we talk about Moms for Liberty. We want that word to resonate with all of our members. We want them to feel confident to stand up for their children and what they’re seeing and what they believe. But we want to be … the most kind, most joyful protesters out there by any stretch of the imagination. We get a lot of flak for other organizations and other parents and what they’re doing. But what I see our chapter chairs doing — and what I’ve been trying to share a little bit more of on social media — is doing drives for school supplies … I’ve seen them do things to try to support the schools and the administrators … that are really working hard to educate our children … We have chapters that are engaging with their school boards in a very productive way. They have built relationships with them. They’re doing meetings with them, one on one, showing them their concerns and … things are being handled. That’s not the stuff that makes the news and makes the limelight. And that’s the ultimate goal. A lot of the stuff that’s been catchy and flashy these days, is where the relationship starts breaking down and people have to come to the meetings and things are getting a little bit more heated.

Some school board meetings have become particularly vitriolic. The National School Boards Association recently walked back remarks about domestic terrorism, but I think we would both agree that the threats against school staff are really frightening. I would imagine that is not something you would support.

We absolutely do not support that in any way, shape, or form. If any of our members act in that manner, they will be removed from our organization. But to add to that, this isn’t anything new. Tiffany [Moms for Liberty co-founder Tiffany Justice] and I both served for four years on our school boards, and we could (share) all of the things that we went through: the threats, the constant harassment … I’m shocked at maybe the level of exposure it’s getting right now. Maybe it’s more widespread than it ever has been. But here in Florida and Brevard County and in Indian River County … Tiffany and myself can attest to threats that have been happening for a lot of years.

Have you ever felt truly frightened by someone who you felt was going to go after your life, your job or your family?

I can show you … messages from strangers that say, “I hope to inject your family with COVID. I’m going to make sure your kids get sick.” This was back in 2020. We (the school board) were having open public discussions about opening schools and things of that nature. If you want to go back a couple of years prior to that when I was on the school board right after the Marjory Stoneman Douglas massacre … and we were debating publicly here if we wanted to have guardians armed in our schools and the threats that I received during that time. Yes, it was scary. Just like school board members now, I had to have a police escort in and out of … a town hall that we had here. So, to me, this is nothing new. We’ve experienced it firsthand. It’s unacceptable. It’s inappropriate behavior. It is never good. We do not support it. We speak out against it. And we will remove any member … that acts in that manner.

Regarding the Marjory Stoneman Douglas massacre, what sparked those threats against you?

I was supporting arming employees. I need to say this very carefully because I got branded as someone that wanted to arm teachers. That was not the case. At the time, the state legislature here in Florida had made a provision that allowed, because we did not have enough school security officers … and the sheriff and the local municipalities did not have enough employees to give our schools … and there was a state mandate that we had to have an armed person in each school … they made a provision that you could train someone through your local sheriff’s department that was former law enforcement or former military that worked currently in the school. They could voluntarily go through the six-week training, and then be able to conceal carry in the schools to protect the school in case of an active shooter. I was very interested in that program … and that’s what brought on that vitriol.

And then there was another instance during the pandemic that your family was being threatened?

Yeah, I believe those started when I was pushing to open schools.

And were you the only board member pushing to open at that time?

I don’t remember off the top of my head … This was the summer of 2020. Schools around the country were still closed. This is before the governor said we were going to open schools here. So, we as the school board felt like it was our decision if we were going to open or not…We all moved all over the spectrum during these discussions and debates.

Some people might look at groups like yours and say, “I’m uncomfortable with parents, many of whom have no background in education, making decisions that impact all children in the district, with their wishes supplanting people who have devoted their entire lives to education.” What makes parents qualified to do what they are doing now across the country?

So, there’s no one that knows my child better than I. When it comes to all these decisions, not just curriculum, but in anything, you know, I have been blessed with my children. And it is not only my right, but my responsibility to make sure that the best is provided for them in every fashion. And, you know, I think it’s important to look at all sides. I think it’s important to listen to the experts that have done these studies. But the ultimate and final decision on my child should be made by the parents.

One of your Moms for Liberty organizers recently wished for a mass exodus from the public schools and a turn toward homeschooling. Has that come up throughout your chapters?

That is not our national stance at all. As an organization, we, Tiffany and I, have been very clear from Day One, we want to fix public education. We think it is vital that America has, you know, an excellent, best-in-the-world public education system. And we think that will be attained by parents being awake, involved, engaged. I mean, we know every study shows, when parents are involved in their children’s education, scores, grades, the outcomes are … always better.

What is your goal politically? Do you have political aspirations for your members beyond the school board?

The places where we have good relationships with our school board members, I think, you know, that’s wonderful. That’s the ultimate goal. But when you have school board members that will not listen, that are trying to silence parents, silence the public and go against a parent’s right to have input on what their child is learning and how they’re being raised, then yes, I hope our members will decide and choose to go run and fill that seat.

So much of the Virginia governor’s race is focused on education. What is Moms for Liberty’s role in this critical race? Is your group becoming politically active or trying to get out the vote?

No, we have no involvement in that race whatsoever. We will continue to just advocate for parents and candidates that align with standing up for parental rights.

As an organization, Moms for Liberty has not come out for a particular gubernatorial candidate?

We’ve given counsel and direction to all of our chapters that they are allowed to endorse candidates — but only in school board races.

Is there any way for your group to become a political organization?

We are a registered nonprofit . So, we cannot get all in for political activism in that way. We are allowed to be issue based … parental rights focus at all times. Now, we are considering maybe branching out … with maybe a more political arm forming in that area in the future.

How is your organization funded? And what’s your budget?

We are still funded by mostly just small donors.

You don’t have a big donor, right, like the Koch brothers or some other major conservative group?

We’e seen all the national stuff that says, you know, we’re part of this conservative affiliation with Koch brothers behind us. And that’s completely untrue. I don’t know the Koch brothers. I actually Googled them for the first time the other day. We do sell a lot of T-shirts. [The group sells merchandise on its website from $10 to $75]. That’s our biggest funding source right now. Our annual budget … just broke $150,000.

And what will that money be used for?

A lot of it goes back into buying more products. But we’re using it to fund the national organization, web development, data management, things of that nature … We just opened a little tiny office here in Brevard County … People have just been very generous with everything from their money to supporting our products to just giving us things that we need to be able to move forward.

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In order to return to school in person post-summer break, were to show proof of receiving at least one dose. Today, of the young population are at least partially vaccinated, a rate higher than any other mainland U.S. state or territory.

The percent of Puerto Rico’s school workforce of roughly 60,000 was vaccinated by the end of March, within six weeks of opening eligibility to the group. To prepare for school reopenings, teachers were included in the second eligible wave, accessing shots just after health and residential care workers.

The island of about 3 million has boasted higher-than-average vaccination rates since rollout, having finalized its robust mass vaccination plan in 2020, well before distribution. Their work provides an opportunity for a case study of successful adolescent vaccination, as most U.S. states struggle to get shots into their school-age population.

That mass vaccination efforts in Puerto Rico are outperforming mainland U.S. states may come as a surprise to those accustomed to stateside news outlets which the island as being in constant disaster recovery. While Puerto Rico has faced serious hardship, it appears to have pulled together in the face of COVID-19 in a way that has eluded other Americans.

When folks think about highly vaccinated places in America

They think Vermont or CT or MA

Those places are good

But not the most vaccinated place in America

So who’s #1?

Puerto Rico!

But PR has gotten way too little attention

Its worth reflecting on how they did it

Thread

— Ashish K. Jha, MD, MPH (@ashishkjha)

“In Puerto Rico, the pandemic was never politicized … People were really rowing in the same direction.” Daniel Colón-Ramos back in March. Colón-Ramos is a professor of cellular neuroscience at Yale University and president of Puerto Rico’s Scientific Coalition, a group of experts advising Gov. Pedro Pierluisi on the island’s Covid-19 response.

As of Sept. 29, 56 percent of U.S. youth aged 12-17 had taken at least one dose of the vaccine, according to the American Academy of Pediatrics, while of adults have completed their sequence. Yet the rates drastically vary by region; . About with the virus required intensive care, according to the Centers for Disease Control and Prevention.

Scholars, residents and local leaders chalk Puerto Rico’s comparative success up to far-reaching mandates across industries, in a once-public health care system and a common belief in getting students back in classrooms — by any means necessary.

“They urgently needed to get students back to school in person because they couldn’t take it any more. They were hurting and needed to be there, with their teachers,” said Edgar Bonilla, a single father of three living in Caugus, a mountainous city about 20 miles south of San Juan.

Bonilla, one of several island residents interviewed by ����Ӱ�� in Spanish, said he witnessed at least five of his children’s peers leave school last year out of frustration and feeling lost with online learning. Those that stayed may have progressed to the next school grade, he says, but need support with understanding material.

And while there have been a few dismayed teachers since the mandate, he believes “you have to see the other side” — students without needed resources, those who can’t effectively learn online with audio or speech disabilities or who live with chronic health conditions.

“The student who’s unvaccinated, for religious or health reasons, has to take COVID-19 tests the whole week to enter school. Really all have to be vaccinated. There are students with chronic asthma, diabetes, or who are cancer patients like myself,” Bonilla said. The stress of everyone’s health during the pandemic, “has affected me a lot mentally.”

His 14- and 15-year-olds excitedly got both doses before this school year. Their household continues to wear masks outside their home and washes their hands regularly, to protect their unvaccinated 11-year-old sister.

And at the Bonillas’ public high school, youth stay in the same classroom all day. Only teachers rotate between rooms, to make any student quarantines smaller and easier to roll out. Lunch is outside, in small groups with open air, or in smaller capacity classrooms for younger children.

Puerto Rico Department of Health’s extended the vaccine requirement to all school staff and anyone entering school buildings. Families told ����Ӱ�� enforcement is strict to minimize contacts — if you forget your vaccination card, for instance, school staff or your child must come find you outside or meet at your car. No exceptions.

The only comparable sweeping K-12 mandate in the mainland is for California’s K-12 children. Gov. Gavin Newsom announced the s on Oct. 1, yet it’s unlikely to go into effect until July 2022.

Some California districts are weighing vaccination mandates because of concerningly among youth. And where they have been adopted stateside, many are not complying and at least two — in Los Angeles and San Diego — are being

Three weeks ahead of its deadline, Los Angeles Unified estimated had not yet gotten a dose. The district recently extended its deadline for educators to Nov. 15, fearing the original cutoff would worsen critical shortages, though roughly . And New York City’s mandate for educators faced protests, legal and union challenges, but now about of their teaching force has gotten one dose.

Overall, there are more states that ban vaccine mandates for school staff (14) than have instituted them (11). In further contrast, when Puerto Rico did announce its mandates, no formal opposition followed.

In late March and April, the island saw an uptick in cases. And though no outbreaks were linked to the roughly 100 schools then open part-time for special education and young children, in an abundance of caution. The closures seemed typical of the system’s strict approach to COVID-19 safety.

Following a for all government employees, Gov. Pierluisi also this August that many private businesses, including restaurants, salons, casinos and gyms, require all employees to show proof of vaccination. Those claiming an exemption must show negative test results weekly. Businesses must also require that their customers show proof of vaccination or cut capacity by 50 percent.

The constant guidance from health and government officials has helped families return to in-person learning, though some schools are now facing closures amid a wave of unrelated to the pandemic. In addition to dealing with infrastructure damage from years of destructive hurricanes, Puerto Rico’s circa 1976 power generation units are twice as old as those stateside and due for major replacements.

For many, vaccination is the one factor they can control to keep children in school.

Daniel Pacheco says there’s a “responsibility” felt among families when it comes to the mandates. His family of four lives in Aguadilla, a city of about 55,000 on the island’s northwest tip where about 73 percent of the population has been vaccinated, and has seen the pandemic’s impact firsthand. His wife, Marizabel, is a nurse.

“My wife and I think the same way, that teachers in direct contact with children have to be vaccinated to avoid the spread,” he said. “I think [the vaccine] should be approved and given to all kids because there’s already scientific evidence that it’s really beneficial for them to get vaccinated.”

Their school hosted a virtual open house before classes resumed to explain how exactly quarantine protocols would work. His two children, ages 6 and 10, returned to school for the first time fully in person this August and will be vaccinated once eligibility is extended to their age group. The Federal Drug Administration will review Pfizer’s request to extend vaccine eligibility for youth 5-11 on Oct. 26, and authorization may follow in early to mid- November.

While parents in Puerto Rico say there hasn’t been much widespread hesitation, a recent parent poll across the U.S. revealed roughly 51 percent would vaccinate their children when eligible. Low adolescent vaccination rates raise concern for recently opened mainland schools now facing threats of closure with student and staff quarantines. As of Oct. 10, COVID-19 outbreaks in the 2021-22 school year precipitated about according to Burbio, a website tracking school policies and schedules.

For instance, amid rising Delta variant cases, recent efforts in double the city’s youth vaccination rate to 55 percent, a rate still leagues behind Puerto Rico’s. The key, local leaders say, was making the shot available at schools, churches and essential community organizations; stopping misinformation and deploying health officials throughout the community to address concerns.

One whose organization distributed vaccines told the Miami Herald that he believes using community groups to administer vaccines has made the difference for small populations skeptical of the government or pharmaceutical industry.

The strategy of spreading secure information at the local level could help Puerto Rico reach herd immunity, local journalist and mother Paola Arroyo said.

Similar to the anti-vaccination camps on the mainland, some of those holding out, “are not very aware of how beneficial the vaccine is and are carried away by fake news on social networks or platforms that aren’t necessarily official,” she said. Others aren’t vaccinated for religious or health reasons, or lead a kind of natural lifestyle and prefer to build immunity without vaccination.

A 29 year-old resident of Guaynabo, just outside of San Juan on the northern coast, Arroyo stays cautiously hopeful. She regularly sees youth, even infants, wearing masks outside and taking stock of health guidelines posted outside businesses.

“Youth are very aware of the problem that we’re confronting. They’re more aware than adults themselves,” she said.

Arroyo had her first child during the pandemic, and though vaccines weren’t available during her pregnancy, she was “confident” when getting both doses as soon as she became eligible. With encouragement from her pediatrician, she is passing antibodies onto her 9-month-old daughter Valentina through breastfeeding.

“I’m going to get the booster when it’s available and continue breastfeeding to protect her,” Arroyo said. “I believe in the power that vaccines have and understand that it’s a social responsibility.”

According to the Centers for Disease Control and Prevention, about 96 percent of school districts are now offering full-time, in-person instruction. Stakeholders, including the two national teachers unions, are on board with vaccine mandates for school employees. So after more than a year of battling, everyone should be relieved that those major issues have been resolved.

Not a chance.

It turns out to be relatively easy to issue a vaccine mandate and an entirely different matter to implement and enforce it. In many places, the mandate is accompanied by bargaining, cajoling, exemptions, injunctions and jurisdictional complications — all of which make it virtually certain that your children are spending at least part of their school day indoors with an unvaccinated adult.

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You might find this alarming because the whole point of school closures was to eliminate exposure of children to COVID-19 in classrooms. Or you might not find it so alarming, because that “staff-to-staff transmission is more common than transmission from students to staff, staff to student or student to student.”

Even President Joe Biden might wonder why a vaccine mandate issued from the White House has had so little effect. The president directed that any employer with more than 100 employees would have to require vaccines or weekly testing. This would seem to affect most school districts in the United States. But as Nat Malkus points out in The Hill, the mandate because of the jurisdictional limits of the federal Occupational Safety and Health Administration.

The option of weekly testing is also a poor substitute for vaccination, since an employee could have already spread the virus before receiving a positive test result.

In New York City, a federal judge issued a . An appeals court lifted the injunction, but lawyers representing teachers who brought the suit said they will petition the U.S. Supreme Court. The city’s Department of Education reports that about 29,000 school employees have yet to upload proof of vaccination.

Over at Chalkbeat, Matt Barnum reports, “Even in the strictest districts, the timeline allows teachers to before being fully vaccinated.”

With all the media attention on vaccine mandates, one reality has been largely overlooked.

“In fact, it doesn’t appear that any large school district started this year with a full vaccine mandate in place, though the vaccine was available beginning last spring and teachers often were provided with early access to it,” wrote Barnum.

Research by the University of Washington’s Center on Reinventing Public Education shows that the majority of school districts do not require teachers to be vaccinated. Even so, they are now being given priority access to booster shots.

“That is a major unresolved problem,” said CRPE Director Robin Lake. “Why do we keep giving teachers priority access to the vaccine without requiring they all do their part to protect kids?”

No one thinks these policy choices are easy, but they should adhere to some sort of internal logic. If vaccinated employees are an absolute requirement for schools to operate in person, then there should be no exceptions. The unvaccinated should not be in contact with students or other staffers. What to do with them instead is a matter for each school district (and probably union) to decide.

If, on the other hand, we are going to allow unvaccinated staffers to interact with students and other employees, then why were schools closed for 18 months?

“While millions of people have already safely received COVID-19 vaccines, we recognize that for some, the FDA approval of a vaccine may now instill additional confidence to get vaccinated,” said Acting FDA Commissioner Janet Woodcock .

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“Today’s milestone puts us one step closer to altering the course of this pandemic in the U.S.”

Surrounding the approval were several announcements of new vaccine requirements across the country from school districts, colleges, corporations and government agencies. In New York, school officials announced that New York City will require all 148,000 department of education employees to receive a first dose of the vaccine by Sept. 27. In Washington, D.C., the defense department will be mandating vaccinations for the nation’s 1.4 million service members.

The FDA published a full news release Monday (see below); the agency also livestreamed its morning conference call with the media:

The Pfizer vaccine also continues to be available for younger students between the ages of 12 and 15 through the emergency use authorization approved last May.

A few of our recent reports on student vaccines and school safety going into the fall:

—Bringing Vaccines to Schools: How NYC is aiming to make it easier for teens to access COVID vaccinations (Read more)

—CDC Changes Definition of ‘Close Contacts’ in Classrooms: Health experts now say properly protected students needn’t quarantine (Read more)

—F������-���𳦰�: Are 90 percent of teachers really already vaccinated? The numbers say otherwise (Read more)

—College COVID Safe Zones: Open letter from former government officials — How higher education leaders can accelerate America’s vaccination push (Read more)

Click to read Monday’s full guidance from the FDA: