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As South Carolina grapples with a measles outbreak that has infected nearly 1,000 people, groups with ties to the US health secretary, Robert F Kennedy Jr, are pushing to eliminate immunization requirements that protect children.Activists are targeting vaccine mandates in states trying to tamp down measles as communities across the country struggle to stop the worst spread of the illness since the early 1990s. The Guardian found anti-vaccine groups are encouraging their followers to organize opposition to vaccine mandates in more than 20 states, including at least six with current measles outbreaks.Leaders of this campaign include the anti-vaccine organization Kennedy led for years, a group run by his longtime book publisher, and Leslie Manookian, an Idaho film-maker, homeopath and activist whom Kennedy has called his friend.Doctors and advocates for children’s health warn that removing or weakening mandates, particularly those that require vaccination in schools, will lead to lower vaccination rates – and more illness and suffering for families.“We will see more outbreaks. We will see children missing school, parents missing work,” said Dr Jana Shaw, an infectious disease specialist who has conducted research on vaccine hesitancy. “We will see increased costs for those families whose children will get sick and develop complications and disability. Some of them will die.”The groups pushing to end such laws say that vaccine mandates, including those that require children to get immunized to go to school, violate the freedom people should have to take part in activities such as school or work without getting immunized. They often underpin their justifications for that position by providing false or misleading information to their supporters that plays up the risks of vaccines and downplays the dangers of illness.School immunization requirements are a crucial tool that helps keep vaccination rates high and incidents of infections such as measles and pertussis, known as whooping cough, low. Shaw has found that children who live in counties with more people who refuse vaccines have a higher risk of getting pertussis. Even children who are vaccinated are at a higher risk of getting infected in those communities because the illness can spread more easily.What’s more, Shaw said, research has shown that children who are intentionally exempted from vaccination can end up becoming the source of pertussis and measles infections in schools.“It never is just about you,” said Shaw, a professor of pediatrics at Suny Upstate Medical University. “That’s why we have those immunization laws, because we recognize that your choices impact others.”Among the groups pushing the changes is the recently formed Medical Freedom Act Coalition, which has brought together 15 organizations to advocate for legislation modeled on a 2025 Idaho law that prohibits medical mandates in many settings. Organizers said in interviews they oppose every kind of medical mandate.“This is the most basic human right, the right to decide what we put into and on our bodies,” said Manookian, one of the leaders of the new coalition, who is based in Idaho and was a driving force behind the law.The coalition is led by Manookian’s group, the Health Freedom Defense Fund, and Stand for Health Freedom, which has been working since 2019 to influence vaccine-related state legislation. Among the 15 groups that have joined are Kennedy-affiliated anti-vaccine groups including Maha Action, run by his publisher Tony Lyons, and Children’s Health Defense, which Kennedy led before he joined the Trump administration.Manookian said the coalition is not spreading false facts.“Epidemiological data is being used politically and selectively to create a scapegoat for routine infection rates that rise and fall, every year,” Manookian said.She announced the coalition’s formation on a Maha Action organizing video call in January that Kennedy and his deputy chief of staff, Stefanie Spear, also attended. The organizing calls, which usually last an hour and are held weekly, feature speakers promoting work they are doing to advance Kennedy’s “Make America Healthy Again” agenda. Though Kennedy addressed a different topic – whole milk – and spoke before Manookian did, he gave her a shoutout at the end of his comments. “I see a lot of my friends out there. I see Leslie Manookian,” Kennedy said.Manookian said no one at the Department of Health and Human Services (HHS) has been involved in the Medical Freedom Act Coalition, and she doesn’t know if Kennedy is aware of its work.HHS spokesperson Emily Hilliard said vaccination “remains the most effective way to prevent measles”, but did not answer a question about whether Kennedy supported the coalition’s work to end school vaccine mandates in the states.The coalition has backed bills to end mandates in Arizona, Georgia, Hawaii, Idaho, Indiana, Iowa, New York, New Hampshire, Oklahoma and Vermont, Jill Hines, director of advocacy for Stand for Health Freedom, said.Some bills have failed to advance. In New Hampshire, for example, a bill the coalition backed to prohibit school vaccine mandates died after failing to get enough support from both Republicans and Democrats.But after a medical freedom bill in Iowa died, the advocates moved on and backed a different bill that would end school vaccine mandates. Hines said more legislation is on the way.In addition to those bills, Stand for Health Freedom has put out action alerts for its state partners, asking supporters to contact governors and lawmakers to ask them to end vaccine mandates in 19 states, a review by the Guardian found. Those states include at least six experiencing current measles outbreaks: South Carolina, Arizona, Florida, Utah, Washington state and North Dakota.And in South Carolina, the group published an appeal asking supporters to email members of a legislative committee to urge them to vote no on a bill introduced in February by a Democratic lawmaker. The bill would tighten requirements that children receive the measles, mumps and rubella vaccine before being allowed to go to school.Hines said she didn’t see how removing mandates could lead to more illnesses like measles and children dying.“I don’t see how the two are even connected,” Hines said, adding: “If anybody is concerned about it, they can still go get a vaccine. What we want to prevent is the coerced medicalization of individuals, especially children.”While South Carolina mandates school vaccines, it allows families to opt out of those requirements by getting a religious or medical exemption. In recent years, the number of exemptions has risen and the number of children getting vaccinated has fallen. Some schools in the center of the outbreak in Spartanburg county have vaccination rates as low as 80% or even lower, far below the 95% herd immunity level that keeps most people safe.The Guardian found that in making their case against vaccine mandates, the groups insisted that vaccines were more dangerous than the deadly diseases they prevent. One communication published on Stand for Health Freedom’s website, for example, characterizes a measles infection as mild while arguing for weaker vaccine laws in South Carolina. When she was asked to clarify the assertion that a measles infection is mild, Hines pointed to research from 1962, which was published before the introduction of the measles vaccine in 1963 and suggested the common cold was of more significance than measles in terms of short-term morbidity.The research paper also, however, called measles “an important health problem” and expressed hope that it could soon be eradicated thanks to “new and potent tools”.Shaw said measles causes a broad range of symptoms, some mild, but complications are common, and there’s no way to know ahead of time who will become severely ill.In an interview with the Guardian and in at least one public appearance, Manookian said that measles outbreaks were being “hyped”.“They’re trying to make you think that there’s this huge epidemic and it’s just not the case,” she said in a recent video in which she discussed the coalition’s anti-mandate work.In fact, the US Centers for Disease Control and Prevention (CDC) has reported more than 1,100 measles cases in 2026 so far on top of more than 2,200 last year, when three people died and hundreds were hospitalized. The US hasn’t seen such a high number of cases in the past 35 years.In the same video, Manookian acknowledged that lawmakers have challenged her by raising the threat posed by a potential resurgence of polio. But she dismissed that idea and, in response to queries from the Guardian, said she questioned whether the vaccines were the reason that polio rates declined. Medical experts attribute the near eradication of polio to vaccines.Later, Manookian said: “Your child is more likely to suffer injury or death from the meningitis vaccine than they are from meningitis. That’s how dangerous that injection is.” She later added the chances of getting meningitis are “extremely low”.But Patsy Stinchfield, past president of the National Foundation for Infectious Diseases, said the rate of severe side effects of the meningococcal vaccine is rare to nonexistent. She added that if a child gets meningococcal meningitis, the chances of dying from it are about one in 10.Manookian also disputed that measles caused the deaths of two girls in Texas last year, pointing the Guardian to Kennedy’s former anti-vaccine group, Children’s Health Defense, as one of her sources. Local medical officials, health authorities and Kennedy’s own CDC attribute their deaths to measles.In South Carolina, Hafeezah Yates of the pro-vaccine advocacy group South Carolina Families for Vaccines said she has heard false information about vaccines being shared during statehouse testimony, both from people testifying and from some lawmakers. But when medical doctors and scientists share science-based information to counter it, it doesn’t seem to make a difference to people who are dug in because of mistrust that developed during the Covid-19 pandemic.She worries about the large number of bills being introduced around the country that, if passed, would profoundly affect how society functions – overloading the medical system, disrupting school for children and other long-term consequences not yet anticipated.Yates pointed to new modeling from the Yale School of Public Health, which predicts that a sustained 1% annual decline in the vaccination rate for measles, mumps and rubella could cost the US $7.8bn by 2030, on top of many more people being hospitalized and dying.“This is way bigger than one state,” Yates said. “Life will change for us in a way that we are not prepared to handle.”
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