Last month, a child in Montana died of Haemophilus influenzae type b, better known as Hib. According to the state health department, the child had not received the Hib vaccine, and Montana's four other pediatric deaths from H influenzae since 2012 were all caused by strains the vaccine doesn't cover. That makes this the state's first pediatric Hib death in at least 14 years. 

Many parents have never heard of Hib, because the vaccine worked so well that the disease all but disappeared. Public health is often called a victim of its own success, and Florida's proposal could make children the victims instead.

Tomorrow, Florida's Department of Health will hold a public hearing on its plan to remove requirements for four vaccines that protect against Hib, pneumococcal disease, hepatitis B, and chickenpox. The Hib and pneumococcal vaccines are currently required for daycare and preschool, while hepatitis B and chickenpox are required through K-12. 

State officials have framed the change as a matter of parental rights and "medical freedom," and the department hasn't pointed to any new evidence about the safety or effectiveness of these vaccines. The department can remove these four through its rulemaking authority, while measles and polio requirements are written into state law and would need action from the legislature. 

These four vaccines also protect against the diseases parents are least likely to remember, which makes them the easiest to give up. Florida is the first state to propose this, and health departments in some other states have similar authority to try it.

Before Hib vaccines came into wide use in the late 1980s, Hib was the leading cause of bacterial meningitis in American children under 5 years, and about one in 200 kids developed invasive Hib disease by age 5. Each year, roughly 20,000 young children got severe Hib disease, and about 1,000 died. Among children who survived Hib meningitis, 15% to 30% were left with hearing loss or other permanent neurologic damage. 

Pediatricians who trained in that era still talk about it (and the clinicians we work with often name Hib as one of the scariest vaccine-preventable diseases). MaryAnne, who shared her story with Voices for Vaccines, nearly died of Hib at age 4 in the early 1960s, when an infection of her epiglottis left her unable to breathe and doctors performed an emergency tracheotomy.

These four vaccines also protect against the diseases parents are least likely to remember, which makes them the easiest to give up.

Once the vaccine became routine, cases in young children dropped by 99%, and in 2022 the United States recorded just 17 confirmed cases in children under 5. Provisional surveillance data from the Centers for Disease Control and Prevention show 28 cases so far this year. 

Florida pediatricians have been warning about an increase in Hib cases for months. At a state workshop on the proposal last December, a Panama City pediatrician said he had seen two unvaccinated children with Hib in the intensive care unit in the previous six months, a 4-month-old who died and a 2½-year-old left “brain dead.”

All four diseases are easy to underestimate, and for Hib, the name is part of the reason. The bacterium was first identified during an influenza outbreak in 1892, before scientists knew a virus caused the flu. The “influenzae” part of its name makes it sound like something a flu shot would cover. 

Pneumococcal disease is just as unfamiliar to most parents, even though, before the vaccine, about one in 500 US 1-year-olds developed a serious invasive infection like meningitis or a bloodstream infection each year. Many adults remember chickenpox as a harmless rite of passage, even though before the vaccine it caused 10,500 to 13,500 hospitalizations and 100 to 150 deaths in this country each year. Hepatitis B tends to be thought of as an adult disease, even though about 90% of babies who become infected develop chronic infection, and about a quarter of people chronically infected during childhood eventually die early from cirrhosis or liver cancer. 

When a vaccine works, the disease disappears from daily life, along with the stories and firsthand experience that once made the vaccine feel necessary. For most families, the last time anyone saw these diseases up close was a generation or more ago. Measles still has some cultural memory (and plenty of recent headlines), while most parents today have never known a child with Hib meningitis. 

That gap makes it easy to frame these four shots as optional extras, and it helps explain why Florida's proposal has drawn far less public outrage than a move against the measles vaccine would.

When a vaccine works, the disease disappears from daily life, along with the stories and firsthand experience that once made the vaccine feel necessary.

Supporters point out that removing a requirement doesn't take the vaccine away, and parents can still choose it. In practice, decades of research link stronger school requirements with higher vaccination rates, and easier exemptions with higher exemption rates and more disease. 

Florida is starting from a weak position, too, with kindergarten vaccination coverage falling substantially in recent years, from at least 93.5% for major required vaccines in 2019-20 to 88.9% of kindergarteners fully vaccinated in 2025-26. Requirements also prompt the pediatrician visit and records check that catch a missed dose before a child starts daycare or school.

Even with the governor's support, no Florida legislator filed a bill to repeal the state's school vaccine laws in any of its 2026 sessions, and no state has repealed its school vaccination laws outright. 

But the health department route doesn't need legislators at all, and many states give their health departments authority over which vaccines are required for school (how much varies by state), which means appointed officials in those states could do what Florida's surgeon general is attempting. 

Anti-vaccine advocates are already pushing Louisiana, Texas, and Idaho to follow Florida's lead. In each state, the most exposed vaccines will be the ones that aren't written into statute and that parents are least likely to defend. If Florida's rule is approved, other states with similar rules could follow the same process.

Public support for school requirements remains strong, and 81% of US parents back requiring measles and polio vaccines for school, with some exceptions, although those aren't the vaccines on the table in Florida. That support goes only so far if parents don't know what Hib, pneumococcus, hepatitis B, and chickenpox did to children before we had vaccines. 

For those of us in public health and medicine, the job is to make these diseases familiar again with facts and real cases. Clinicians can share what they've seen, health departments can report cases and deaths quickly and clearly, and communicators can talk about these four vaccines with the same urgency we bring to measles.

States also need to know where coverage is slipping. Montana is the only state that doesn't require school districts to report vaccination data to its health department, and legislators voted down a bill to change that last year, just as measles returned to the state for the first time in 35 years. 

Hib became a disease most parents have never heard of because vaccination made it rare. But keeping it rare means maintaining the high vaccination rates that requirements help sustain.

Dr. Steier is a public health scientist and scientific communicator. She is the founder of Unbiased Science, an organization that uses data visualizations, real-world analogies, and human voice to communicate complex scientific concepts for public understanding via multiple media modalities.

The opinions voiced in CIDRAP Op-Ed pieces are the authors' own and do not necessarily represent the official position of CIDRAP.