Intended for healthcare professionals


Covid-19: Florida governor tells under 65s to shun boosters against national guidance

BMJ 2023; 382 doi: (Published 18 September 2023) Cite this as: BMJ 2023;382:p2134
  1. Owen Dyer
  1. Montreal

Florida governor Ron DeSantis has recommended that the state’s residents under 65 shun the new coronavirus boosters, against the advice of federal health authorities.

During an online panel on 13 September, Florida surgeon general Joseph Ladapo, a DeSantis ally who has often drawn criticism for misleading statements about covid, said, “What I have directed our department to do is to provide guidance that recommends and advises against the use of these mRNA covid-19 vaccines for anyone under 65.”

Ladapo and DeSantis attended another event on the social media platform X entitled “No way FDA,” after which the governor made an official statement which read, “I will not stand by and let the FDA and CDC use healthy Floridians as guinea pigs for new booster shots that have not been proven to be safe or effective.”1

The Centers for Disease Control (CDC) have recommended boosters for most Americans aged 6 months or older. In response to Florida’s recommendation, CDC director Mandy Cohen said in a statement that a thorough and independent review has proved the boosters’ safety and efficacy.

“Covid-19 vaccines have saved millions of lives and kept countless people out of hospital,” Cohen said. “Public health experts are in broad agreement about these facts, and efforts to undercut vaccine uptake are unfounded and dangerous.”

Warning letter

Ladapo has been a lightning rod for the DeSantis administration since his 2021 appointment. In March he received an unprecedented joint letter of rebuke from the CDC director and Food and Drug Administration commissioner, warning him that his claims about the potential for adverse cardiac effects from covid vaccines were “incorrect, misleading, and could be harmful to the American public.”2

In April, he was criticised by University of Florida experts after a state sponsored study about vaccine risk in young men was published by his department that changed an assessment of “no significant risk” of cardiac events to instead report “increased risk.”3

Ladapo came to public notice as one of a group of white coated physicians who appeared on the US Capitol steps to denounce lockdowns and praise hydroxychloroquine in a July 2020 online video that was viewed 17 million times after being retweeted by Donald Trump. Social media networks soon scrubbed the video as misinformation, but the group earnt a meeting with Vice President Mike Pence.

Recordings leaked to the Associated Press later showed that the physicians had been recruited by Republican consultants to show doctors who supported Trump’s policy of ending lockdowns.4 Most of the doctors in the video went on to found a group, America’s Frontline Doctors, which would sell alternative and unproven covid cures online and become an influential conservative voice against vaccines.

The group’s leader, emergency physician Simone Gold, later served a six month prison sentence for invading the US Capitol on 6 January 2021, where she climbed a statue and regaled the mob with medical conspiracy theories through a bullhorn. Another member, family physician and TV pastor Stella Emmanuel, drew ridicule for comments that attributed sexually transmitted diseases to dream sex with demon partners.

But Ladapo, a graduate of Harvard Medical School with a more measured presentation, caught the eye of De Santis and was named Florida surgeon general. His predecessor Scott Rivkees, who served as surgeon general under DeSantis from 2019-21, told the Washington Post this week that Floridians should turn to the CDC and major medical societies for advice rather than trust information from the office he formerly led.

Political angle

Since recommending against boosters, DeSantis has gone on air claiming that federal health authorities are “corrupted by ideology.” But rather than Florida media, he chose the radio show of Iowa based commentator Steve Deace. Iowa is the first state to vote for a candidate in the Republican presidential nominating contest.

Vaccines are the clearest policy difference between Trump and DeSantis, argued Deace, an influential voice in Iowa conservative politics who has soured on the former president. Trump acknowledged vulnerability on the matter in a recent interview with former FOX News host Megyn Kelly, noted Deace.

Both candidates have performed U turns on their initial position on vaccines. Trump entered the 2016 Republican race alleging that vaccines caused autism, a message that was met with enthusiasm by the party’s base, prompting several of his rivals, including two who were doctors, to echo it.5 But as the pandemic menaced his economic record, he embraced covid vaccines as a potential saviour and an achievement of his administration.

DeSantis initially joined Trump and other leaders from both parties in promoting coronavirus vaccines, but as his relationship with Trump morphed from protégé to rival, his relationship to vaccines changed to one of open hostility.

The two men’s U turns were clarified on 21 December 2021, when Trump was booed by a Republican audience after he announced that he had received the booster. In a video he released that evening, Trump told Republicans they were “playing right into Democrat hands” and should take credit for the covid vaccines instead of dismissing them.5

Later that day DeSantis was asked if he had been boosted. The governor, who had proudly showed off his first vaccination against covid, refused to answer.

While it may not prove enough to rescue DeSantis’ nomination bid, hostility to covid vaccines appears to be the majority position among Republican voters. In his interview with Megyn Kelly, Trump effectively conceded defeat on the matter within the party. He told her that “very smart” Democratic friends asked him, “Why don’t you talk more about the vaccine? It was one of the greatest things you’ve ever done.” To which he replied, “I’m not going to talk about it one way or the other.” Trump added, “I have people on the other side. Not my side. Although probably there are some on my side, too. They said, ‘You saved 100 million people,’ because I got it done in nine months as opposed to five years to 12 years.”

“You’re proud of it?” Kelly asked.

“No, I’m not proud of it,” said Trump. “I’m saying what Democrats think.”6

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