How Covid made it nearly impossible to pass new vaccine rules

SACRAMENTO, Calif. — The HPV vaccine has been around for almost two decades and could spare thousands of people from developing cervical and oral cancer — so mandating it for schoolchildren once seemed an easy call for Democrats in deep-blue California.

But a bill to do just that has been watered down beyond recognition in one of the most liberal states in the U.S., a victim of a homegrown anti-vaccine movement that has become more organized and more successful since the pandemic.

Anti-vaccine activists didn’t do it on their own. The “most powerful thing to get the author to withdraw the mandate was school districts opposing the bill," said Joshua Coleman, who founded the group V for Vaccine to fight such requirements.

While only a handful of mostly small, rural districts formally opposed the bill, statewide education groups also started to privately pressure the lawmaker to drop or soften her proposal.

Toxic, pandemic-era battles over immunizations and school closures have made vaccine politics radioactive, even on diseases wholly unrelated to Covid-19. In California, where lawmakers pushed through some of the nation’s strictest mandates through 2019, schools are wary of wading back into the fight.  

Across the country, blue-state policymakers have nearly given up trying to create new vaccine policy and are now simply trying to hold the line on a decade’s worth of public health gains. Attempts to add required vaccines for school kids this year sputtered in Wisconsin, California and Massachusetts, a stunning reversal after a successful push to tighten exemptions for mandated childhood vaccines.

“It’s fair to say we’re experiencing a new paradigm in the vaccine debates,” said Troy Flint, a spokesperson for the California School Boards Association, which has not taken an official position on the bill. “I think there is weariness about addressing the issue because of the impact that the closure of in-person instruction had on students, as well as just the vitriol that surrounds the issue and has the potential to distract.”

Anti-vaccine activists, who argue immunizations are a personal choice and should not be compelled by the state, have seized on that reluctance — and lately, they’ve been on a winning streak. In just over a year, proposals in Sacramento to let younger teens get the shot without parental consent, require the Covid-19 vaccine for schools and some employers, and tighten up vaccine reporting requirements lost steam, weighed down by pandemic fatigue and growing public resentment toward public health mandates.

“People are so wary of science and data now,” said the HPV bill’s author, Democratic Assemblymember Cecilia Aguiar-Curry. "I have to have a brass backbone on this," she added.

It’s an ominous sign for the ability of states to enact new vaccine laws.

“There’s been an avalanche, a flood, of bills introduced on vaccine policy, but they’re mostly negative,” said Brent Ewig, the chief policy and government relations officer of the Association of Immunization Managers, which has been going state to state to counter the small but loud “medical freedom groups.”

“Right now the politics of vaccines are such that we’re in a holding pattern.”

The anti-vaccine side is not waiting it out. 

Even before Aguiar-Curry’s HPV bill had been formally introduced, groups advocating for “parental choice” and “medical freedom” were roaming the halls of the state Capitol, meeting with elected officials in case anyone in Sacramento was thinking of trying to mandate the Covid-19 vaccine again.

By the time the Democrat finally proposed an HPV mandate, one that she had been urged to shelve years earlier during earlier vaccine wars, the politics had hardened. Almost immediately, her bill — which would have required students to receive the HPV vaccine by eighth grade to attend school — became a problem.

HPV is a virus that is often, but not always, sexually transmitted, and certain strains of it can lead to cervical, oral and other cancers. It’s the cause of around 3 percent of all cancers in women and 2 percent in men, around 36,000 new cases each year. A vaccine for the few cancer-causing strains has been available since 2006; it prevents around 90 percent of HPV-related cancers.

In 2007, Texas became the first state to mandate HPV vaccines for 11- and 12-year-old girls when then-Gov. Rick Perry, a Republican, signed an executive order. His action was quickly overturned by the state legislature after public outcry over the vaccine manufacturer Merck’s lobbying and campaign contributions to the governor. It cast an early shadow of controversy over the vaccine, one that skeptics have latched onto since.

In California this year, vaccine mandate opponents began calling the offices of nearly every member of the Assembly’s health committee to complain about the bill. They put out calls on Twitter and Facebook, urging like-minded people to show up to hearings.

But anti-vaccine groups — which are generally viewed as pariahs in the state Capitol — also leaned on the influence of the pandemic-battered education world, which weathered years of exhausting debates over distance learning, masking and vaccine mandates. They called up schools and churches — two places that sat in the crosshairs of Covid public health fights — and mobilized from there.

Struggling to generate enthusiasm among her colleagues for the bill, Aguiar-Curry continued amending it — first, by removing the mandate for middle schoolers and kicking it up to college students and, later, replacing the mandate with a recommendation.

“I thought I did them a big favor,” Aguiar-Curry said. “I got the schools off the bill because they were upset about it.”

The post-pandemic vaccine backlash has led to a sense among pro-vaccine advocates across the country that the best they can do is protect existing rules.

Republican lawmakers in Wyoming and West Virginia spent the past year trying unsuccessfully to remove all school vaccine requirements and making it easier for children to opt out of vaccines, said Becky Christensen, the state campaigns director for the Safe Communities Coalition, which advocates for pro-vaccine policies state-by-state.

“We’re just trying to hang onto the provisions we do have in place,” Christensen said, noting that “the situation and the climate is so volatile.”

Wisconsin is one of the only other states that tried any kind of vaccine mandate this year, through its health department. What should have been a simple update — to put the state in line with federal recommendations requiring that seventh-graders be vaccinated against meningitis and 12th-graders be boosted for it — became a supercharged political issue as Republican lawmakers blocked it, said Ryan Westergaard, chief medical officer for Wisconsin Department of Health Services.

“The pushback was unexpected, and the tenor was much more intense and personal than we anticipated,” Westergaard said in an interview, noting that Wisconsin’s school vaccine requirements hadn’t been updated in a decade. “There’s a real reluctance to introduce any proactive policy to improve vaccines because once it gets discussed in the public sphere there’s a real danger that we will lose ground.”