In a new JAMA Viewpoint, Lainie Friedman Ross, MD, PhD, chair of the Department of Health Humanities and Bioethics at the University of Rochester Medical Center, and Mark Navin, PhD, chair of Philosophy at Oakland University, argue that America's vaccine policy demands a new approach.
Their article, "America's Vaccine Policy Whiplash — Finding the Way Forward," lays out a practical middle-ground framework: acknowledge shared blame, abandon absolutist tactics that have fueled public backlash, and rebuild trust through smarter, community-based education and outreach.
"There's plenty of blame to go around," write the authors. "But the medical community must own its share if we're going to rebuild trust."
Why this matters
Ross and Navin describe recent federal and state actions that have destabilized vaccine policy, including a proposal by Florida's Surgeon General to eliminate all of the state's school vaccine mandates, which have been the backbone of U.S. immunization policy since the 1960s.
Vaccination rates were already declining before these changes, and outbreaks of vaccine-preventable diseases are now on the rise. National non-medical exemption (NME) rates for school vaccine mandates rose to 3.6% in 2024–25, up from 2.5% pre-pandemic. Seventeen states now report exemption rates above 5%, while 39 of 50 states have dropped below the 95% MMR coverage target for herd immunity.
The results are clear: measles cases jumped from 285 in 2024 into the thousands in 2025, including the first three U.S. measles fatalities in a decade.
How did we get here?
While politics has accelerated today's crisis, Ross and Navin argue that the medical community must also confront its role. After the 2015 Disneyland measles outbreak, major organizations like the American Academy of Pediatrics (AAP) and the American Medical Association (AMA) advocated aggressively for eliminating NMEs.
Pediatricians have increasingly adopted policies to dismiss families who refuse vaccines, a stance the AAP endorsed and reaffirmed as recently as last year. During the COVID pandemic, professional organizations supported restricting vaccine refusers from public spaces and the workforce.
These hardline policies, the authors argue, helped provoke today's backlash.
The misunderstood role of mandates
Ross and Navin stress that school vaccine mandates were never primarily about coercing committed refusers. Instead, they worked as a "nudge"—creating a pro-vaccine social norm and encouraging the large group of parents who were neither enthusiastic nor opposed. Removing mandates, they argue, eliminates this nudge just as coverage is faltering and outbreaks are spreading.
"Mandates nudged the ambivalent," the authors explain. "Eliminating them risks signaling that vaccines are unsafe," when there is overwhelming evidence that childhood vaccines are safe and effective.
The way forward
Ross and Navin call for a reset in vaccine policy, grounded in humility and partnership. That means:
- Personalized education and reminders for parents who are willing but forgetful.
- Evidence-based communication training for clinicians, equipping them to engage vaccine-hesitant families with patience and skill.
- Partnerships with trusted local leaders, religious organizations, and parent groups to amplify accurate, credible messages.
"Mandates were intended to be one tool among many, not a substitute for robust communication and public education," they write. "The medical community must pivot to strategies that rebuild trust."
