Rebecca Hardy and Michelle Evans helped found Texans for Vaccine Choice with a group of like-minded women in 2015, as measles was spreading in California. They defeated legislation tightening Texas school vaccine requirements, and helped oust the lawmaker who wrote it, earning a catchy nickname: “mad moms in minivans.”
Now, as a measles outbreak that began in West Texas spreads to other parts of the country, the “mad moms” have a slew of new allies. The 2024 elections ushered in a wave of freshman Republicans who back their goal of making all vaccinations voluntary. But no ally may be as influential as the one they gained in Washington: Health Secretary Robert F. Kennedy Jr., the nation’s most prominent vaccine skeptic.
More than five dozen vaccine-related bills have been introduced in the Texas Legislature this year. Last week, the Texas House passed three of them. Those bills would make it easier for parents to exempt their children from school requirements; effectively bar vaccine makers from advertising in Texas; and prevent doctors from denying an organ transplant to people who are unvaccinated.
The Association of Immunization Managers, a national organization of state and local immunization officials, is tracking 545 vaccine-related bills in state legislatures around the country, 180 more than last year — evidence, the group’s leaders say, that Mr. Kennedy is changing the national conversation. After peaking at the height of the coronavirus pandemic, the number of vaccine-related bills had come down in recent years.
But the big fear of public health leaders that began during the pandemic, and accelerated with Mr. Kennedy’s political rise — that states will undo school vaccine mandates — has so far not come to pass.
“For the 10 years that Texans for Vaccine Choice has existed, we have had a federal government that has been wholly irrelevant or working against us,” said Ms. Hardy, the group’s president. “We’re excited about having individuals in the federal government who will actually cooperate with us. But what exactly that means, we don’t know.”
The women of Texans for Vaccine Choice have long been inspired by Mr. Kennedy. When the Texas bill that would have tightened vaccine requirements was introduced in 2015, he spoke out vigorously against it. “I don’t think it’s appropriate to force people to undergo, or to have their children undergo, a medical procedure in this country,” he said then. In 2019, the group hosted Mr. Kennedy for an event at the State Capitol in Austin.
Then came the 2024 election. Ms. Hardy said that after a decade of watching political speeches, she rarely gets emotional. But last year, when she watched Mr. Kennedy announce that he was merging his campaign with Donald J. Trump’s, “I had tears in my eyes.”
As health secretary, Mr. Kennedy has broken with his predecessors by refusing to advocate for vaccination. In response to the measles outbreak, he acknowledged that vaccines “do prevent infection,” but cast the decision to vaccinate as a personal one. Testifying before Congress last week, he refused to say whether, if he were a new parent, he would vaccinate his children against measles, polio or chickenpox.
“I don’t want to seem like I’m being evasive,” Mr. Kennedy said, “ but I don’t think people should be taking medical advice from me.”
With vaccination rates already dropping, public health experts say it may not matter whether bills eroding vaccine mandates become law; all states already offer either religious or philosophical exemptions to school vaccine requirements. But the vocal activism surrounding the bills is encouraging more parents to seek those exemptions, experts say.
Public health leaders say that could be dangerous, and they point to the current measles outbreak as proof. Since the first cases emerged in West Texas earlier this year, measles has killed two unvaccinated children and one adult, and sickened more than 1,000 people in 30 states, making it the worst measles outbreak in the United States in 25 years.
“It used to be that we would see a bill introduced as a message bill — the intent was never to become law,” said Brent Ewig, the chief policy officer of the immunization managers group. “What we’re concerned about now is that some of those message bills are clearly intended to reduce parents’ confidence in vaccination, and that will lead to lower rates. And that just invites more tragedy.”
In Republican-led states around the country, vaccine debates are playing out much as they are in Texas: The anti-vaccine movement is energized but advancing in fits and starts.
“They are making these small, incremental gains at the edges, tweaking language that makes it easier to obtain exemptions or raising the visibility that exemptions exist,” said Northe Saunders, executive director of the SAFE Communities Coalition, a pro-vaccine advocacy group. “The castle stands, but they are chipping away at the mortar around the base.”
Idaho last month became the first state in the nation to outlaw vaccine mandates, after having the highest school vaccine exemption rate in the country, 14 percent, during the 2023-2024 school year. But the “Idaho Medical Freedom Act,” signed into law by Gov. Brad Little, a Republican, includes exemptions for hospitals and existing school mandates.
In West Virginia, Gov. Patrick Morrisey, a Republican who has appeared with Mr. Kennedy to condemn sugary beverages and food dyes, recently issued an executive order providing religious and philosophical exemptions to school requirements for vaccines. But the legislature refused to codify the order to give it the force of law.
As opponents of vaccination have turned their rhetoric away from vaccine injuries and autism and instead emphasized personal freedom, they have picked up Republican support. The coronavirus pandemic accentuated the trend, making vaccination a partisan issue.
Rekha Lakshmanan, the chief strategy officer of The Immunization Partnership, a Texas nonprofit that advocates for vaccination, noticed the shift in 2015. Until then, she said support for immunization was bipartisan. The defeat of the bill that moved Texans for Vaccine Choice to action, she said, was “when you could see the switch flip.”
Ms. Evans and Ms. Hardy said they were on defense, “killing bad bills,” for the next eight years. But in 2023, they helped pass five pieces of legislation.
As a result of their work, state law now requires doctors who accept reimbursement from Medicaid or the federal Children’s Health Insurance Program to treat unvaccinated patients. Businesses cannot be sued for failing to comply with public health recommendations during a pandemic, and Covid-19 vaccine mandates are against the law.
The vaccine exemption bill that passed the Texas House last week is the group’s top legislative priority this year. The measure would enable parents to download and print their own “reasons of conscience” vaccine exemption forms from home and deliver them to their child’s school. The current system is more cumbersome; the Texas Department of State Health Services must send a form, and requires it to be notarized.
“There’s no other medical procedure where you have to get permission from the state to say no,” Ms. Hardy said. “And that’s a barrier to liberty and free exercise of your deeply held beliefs.”
On a sunny day in March, Ms. Evans, the Texans for Vaccine Choice political director, roamed the corridors of the State Capitol in Austin, trying to drum up supporters for the measure.
Her path to advocacy, she said, began with her second child, a daughter who received a diagnosis of autism after her first birthday. Ms. Evans began exploring the proposition, now discredited, that there is a link between autism and vaccines. She also worked on a 2016 documentary, “Vaxxed,” that questions vaccine safety and was produced by Del Bigtree, who later became Mr. Kennedy’s communications director.Today, Ms. Evans is a familiar figure at the State Capitol. State Representative Shelley Luther, a freshman Republican and Texans for Vaccine Choice ally, greeted her with a hug.
Ms. Luther, who was jailed in 2020 for opening her hair salon in violation of Covid restrictions, wrote the bill that would effectively ban vaccine ads in Texas. Mr. Kennedy, too, favors banning pharmaceutical ads from television. “Great minds!” Ms Luther exclaimed.
Other Republicans were equally enthusiastic about the health secretary. State Representative Nate Schatzline, another freshman Republican and a Christian pastor who had recently moved back to Texas from California, said Mr. Kennedy’s “Make America Healthy Again” agenda ”won over a lot of middle class moms,” including his wife.
Still, the Texans for Vaccine Choice legislative agenda faced hurdles. Its high priority bills were not getting hearings in the Texas House Committee on Public Health; the panel’s Republican chairman, State Representative Gary VanDeaver, was standing in the way. He said in March that he did not want to “do anything that’s going to endanger the citizens of our state in a measles outbreak.”
A few weeks later, Texans for Vaccine Choice publicly accused Mr. VanDeaver of “stonewalling.” Before long, both the organ transplant bill and the medical exemptions bill received hearings, clearing their way for last week’s passage in the House. (Ms. Luther’s bill, on vaccine advertising, was handled by a different committee.)
Ms. Hardy is optimistic that all three measures will soon pass the Senate and become law. Her “dream agenda,” she said, “is getting to a place where your vaccination status is irrelevant to your participation in society in Texas.”
Five years ago she did not believe that would happen in her lifetime. Today, she is optimistic that it will. Still, Ms. Evans says that even with Mr. Kennedy in office, it may take years to get there.
“I know we’re going to have to chip away at this very slowly,” Ms. Evans said. “Every session, we get closer, inch by inch. But I don’t think I’ll be putting myself out of a job anytime soon.”
Sheryl Gay Stolberg covers health policy for The Times from Washington. A former congressional and White House correspondent, she focuses on the intersection of health policy and politics.
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