Measles Outbreak Update, Florida Surgeon General Announces Plan to Remove Vaccine Mandates in Schools

The Florida Surgeon General, Joseph Ladapo, MD, announced plans to remove vaccine mandates in schools, sparking debate amongst health experts amid continued efforts to discredit the efficacy, impact, and importance of vaccines and an ongoing measles outbreak. According to infectious disease forecasters at Stanford University, a 15% decline in vaccination against measles over 25 years would result in 1 million measles cases.^1,2

Vaccine syringes with school materials | Image Credit: © lesslemon - stock.adobe.com

As of September 9, 2025, the CDC reports a total of 1454 measles cases across 40 states, with the majority reported in Texas.³

“As of September 2, 2025, there have been a little over 1000—about 1400—confirmed measles cases across the US, spread over about 35 different outbreaks,” Crystal Hodge, PharmD, BCIDP, BCPS, explained in an interview with Pharmacy Times. “The vast majority, 86%, have been related to outbreaks. An outbreak is defined as t or more cases in one particular location, and the plurality of those cases have occurred in age groups between 5 and 19 years.”⁴

On August 18, 2025, Texas announced the end of the outbreak, along with other states such as Kansas—which also represented a large outbreak area. Although the outbreak is on the decline, persistent attacks on vaccines—through the spreading of disinformation, increasing investigations questioning vaccine safety, and removal of vaccine mandates or recommendations—threaten efforts to control and prevent continued spread.⁴

Despite the observed efficacy of the measles, mumps, and rubella (MMR) vaccine—marked by the disease’s eradication in the US in 2000—vaccination rates are declining, threatening herd immunity. Herd immunity is essential to preventing the spread of disease among both low- and high-risk individuals and is most successful when everyone gets vaccinated.³

*2023 data are preliminary and subject to change. †Elimination is defined as the absence of endemic measles transmission in a region for ≥ 12 months in the presence of a well-performing surveillance system.
Source: CDC

“For herd immunity—or community immunity—we generally look for about a 95% vaccination rate,” Hodge explained. “We understand that not everyone can be vaccinated, since the MMR vaccine is a live vaccine and not appropriate for certain individuals. But to protect the greatest number of people, the community vaccination rate needs to be around 95%.”⁴

Florida’s removal of school vaccine mandates marks another action against vaccination, and the experts from Stanford University project significant future consequences of the decision. According to Florida’s health department, the removal of vaccine mandates likely will not take effect for 90 days and is inclusive of hepatitis B, chickenpox, Hib influenza, and pneumococcal disease vaccines until lawmakers make final decisions on others such as polio and measles. However, this is not expected to take place until January 2026.^1,5

Most concerning to health officials, the Florida Surgeon General stated he did not calculate the potential impact of the mandate on infections, hospitalizations, or deaths. Per the findings from Stanford University, the experts say otherwise.¹

“At current state-level vaccination rates, measles may become endemic again; increasing vaccine coverage would prevent this,” the experts wrote in the study. “Under a 50% decline in childhood vaccination in the US, the simulation model predicted 51.2 million measles cases over a 25-year period, 9.9 million rubella cases, 4.3 million poliomyelitis cases, 197 diphtheria cases, 10.3 million hospitalizations, and 159,200 deaths.”²

With school mandates under review and vaccination rates showing signs of decline, pharmacists are uniquely placed to help mitigate risk through education and proactive vaccination efforts. Pharmacists are often among the most accessible health professionals, positioned to answer vaccine questions, dispel misinformation, and identify patients who may have fallen behind on immunizations. Their presence in both community and clinical settings makes them a frontline defense in maintaining herd immunity.

“So, what can pharmacists do? They can strongly encourage vaccination, including making sure children stay up to date with well-child visits,” said Hodge. “During the pandemic, those visits declined, and although rates are starting to come back up, we want to see that continue with routine vaccinations. Pharmacists should also focus on patient education—encouraging isolation if measles is suspected, vaccination before exposure, and ongoing education about prevention.”⁴

REFERENCES

1. Goodman B. Florida’s surgeon general said he didn’t calculate the costs of ending vaccine mandates in the state. But scientists have. CNN Health. September 9, 2025. Accessed September 10, 2025. https://www.cnn.com/2025/09/09/health/floridas-surgeon-general-calculate-costs-vaccine-mandates

2. Kiang M, Bubar K, Maldonado Y, et al. Modeling reemergence of vaccine-eliminated infectious diseases under declining vaccination in the US. JAMA. April 24, 2025. doi:10.1001/jama.2025.6495

3. Measles cases and outbreaks. CDC. September 10, 2025. Accessed September 10, 2025. https://www.cdc.gov/measles/data-research/index.html

4. Valletti D, Hidge C. Falling vaccination rates threaten herd immunity: The role of pharmacists in preventing measles outbreaks. Pharmacy Times. September 9, 2025. Accessed September 10, 2025. https://www.pharmacytimes.com/view/falling-vaccination-rates-threaten-herd-immunity-the-role-of-pharmacists-in-preventing-measles-outbreaks

5. White E. Florida's plan to drop school vaccine rule won't start for 90 days, won't cover all diseases. ABC News. September 7, 2025. Accessed September 10, 2025. https://abcnews.go.com/US/wireStory/floridas-plan-drop-school-vaccine-rule-start-90-125342308