Threats to the Public’s Health: RFK, Jr. and State Preemption
As an attorney working in public health I have been battered by the news coming out of the U.S. Department of Health and Human Services (HHS) since Robert F. Kennedy, Jr. took the helm. From firing every member of a CDC panel on vaccines to firing the recently-confirmed CDC Director for failure to rubber stamp vaccine recommendations, Kennedy’s actions will harm the public’s health.
Along with the impact of federal actions, another threat to public health authority looms at the state level. State preemption of local public health authority puts the health and safety of residents at risk, and prevents local health departments from pursuing effective and evidence-based interventions to protect their residents.
Just last week, the Florida Surgeon General announced that he would seek to eliminate all vaccine mandates in the state – including immunization requirements for children entering elementary school. The Surgeon General’s plan would require action from the legislature for at least some vaccines. If adopted, local governments would be prohibited from requiring vaccines for schoolchildren. According to the American Medical Association, such a decision will “place children and communities at increased risk for diseases such as measles, mumps, polio, and chickenpox resulting in serious illness, disability, and even death.”
It’s worth noting that this is just one of the ways Florida lawmakers are using preemption to explicitly harm people - in recent years, the state has banned local water break rules for outdoor laborers working in excruciating heat, and has scrapped local policies meant to protect tenants.
The impact of this move against vaccines will be felt far and wide: As we have seen from the recent measles outbreak, infectious diseases by their very nature are widely transmitted and do not stay in one geographical region. Think back to how cigarette smoke did not stay in the “smoking” section of airplanes. Or to put it more crassly, we have a “pee in the pool” problem – it’s not possible to contain the disease to one part of the pool.
States are adopting other laws to implement the MAHA agenda. For example, in 2025, Florida and Utah both banned local governments from adding fluoride to water. Prohibiting fluoride in water runs counter to well-established evidence showing a reduction in cavities from fluoridated water. According to the American Dental Association, "Blindly calling for a ban on fluoridated water hurts people, costs money, and will ultimately harm our economy."
Other states have taken action to limit access to vaccines. Montana passed a law prohibiting vaccines that would otherwise be required under an emergency use authorization; the law also bans public places from regulating admittance based on vaccination status.
In response to the federal uncertainty, some states have begun collaborating to ensure access to vaccines. California, Oregon, and Washington have formed the West Coast Health Alliance to coordinate their vaccine recommendations. Because the federal Advisory Committee on Immunization Practices (ACIP) has not yet provided vaccine recommendations – and the FDA has put limits on who is eligible for the fall COVID vaccines – pharmacists in some states may not be able to administer COVID vaccines.
I’m anticipating that more states will advance dangerous public health preemption bills next year - it’s one of the trends we’ve identified in LSSC’s annual legislative session overview. Consider the 2025 Kansas law that limits the authority of public health officials to impose isolation and quarantine orders for communicable diseases such as measles.
Public health is supposed to be evidence-based, not motivated by politics. Vaccination and fluoridation of drinking water are two of the 10 greatest public health achievements in the U.S. in the 20th century. Removing the ability of local governments to allow these policies will harm the public’s health.
Leslie Zellers, JD, is an attorney with more than 20 years of experience in public health law and policy for nonprofit and government organizations. Leslie serves as co-Legal Team Lead with LSSC, where she supports partners' efforts to fight abusive preemption through collaboration and legal technical assistance including legislative tracking and legal research and writing.