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During his first year in practice as a pediatrician, Dr. W. Jason Cornett examined an infant brought in for treatment of a cold and an ear infection.

Cornett learned that the infant, who was in foster care, had not received the recommended early-childhood vaccinations.

Within a day, the child was dead, felled by pneumococcus meningitis, often called strep pneumo. That is one of the potentially fatal illnesses for which babies are normally vaccinated, receiving a first dose as early as age six weeks.

While emphasizing that medical procedures are not based on anecdotal occurrences, Cornett recalled the sad story as an example of what can happen when children do not get the vaccinations recommended by leading health organizations.

“Luckily, it’s very rare,” said Cornett, a pediatrician with Watson Clinic based in Lakeland. “But that’s the kind of thing where, this was a normal child who, within a day, this escalated and got really, really nasty. And so, that’s the kind of thing we’re trying to prevent.”

Cornett, a pediatrician for 23 years, is concerned about a recent downward trend in childhood vaccination rates, both in Polk County and throughout Florida.

Polk County’s level of immunization for kindergartners dropped from 96.3% in 2021 to 93.2% in 2023, the most recent year for which the Florida Department of Health posts records.

That still placed Polk County above the statewide immunization rate of 90.6% for 2023. Florida’s rate declined from 94.1% in 2017. The agency’s numbers are based on reports from public and private schools.

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Polk County ranks in the second of four tiers for immunization levels established by the Florida Department of Health. Eighteen counties are labeled in red on a map on the agency’s website, denoting those with rates of 84.2% to 90.2%.

Three counties bordering Polk are in that lowest category — Osceola (86.9%), Lake (88.6%) and Highlands (89.6%).

Doctor: Rates are troubling

State law requires students to provide proof of recommended childhood vaccinations unless their parents seek exemptions for religious or health reasons.

The Ledger requested figures for exemptions submitted in recent years to Polk County Public Schools. The request had not been fulfilled as of Friday afternoon.

The state and county rates are no surprise to Dr. Christina Canody, a pediatrician and medical director for the BayCare Kids Pediatric Institute.

“Absolutely, we’re seeing it locally,” Canody said. “We’re seeing it in our state, and we’re seeing it nationally. Post-pandemic has been one of the biggest times of change that we’ve seen for vaccinations and a decrease in those rates, and it’s something that is concerning, because Florida is actually one of the states where now our immunization rates have declined to rates where we can start to see some of those diseases that we haven’t seen in quite some time, because herd immunity may be lapsing.”

Herd immunity is the concept of communal protection from a contagious disease. If enough people become immune, either through vaccinations or exposure, the infection cannot spread across individuals, giving protection to those who are not immunized.

The required rate varies by disease, with immunity thresholds of 80% for polio and about 95% for measles, according to the World Health Organization.

“When you look at those herd immunity rates, you really need about 92% of the public to be vaccinated,” Canody said. “Nationally, the measles vaccination rate has fallen to about 93%. Here in Florida, this year, in kindergarten, that rate fell under 90%. So that that is very concerning, that we may start to see more and more of those measles cases.”

The CDC recommends an array of vaccinations during childhood, with some starting weeks after birth. While the measles-mumps-rubella vaccine is perhaps the best known, the recommended inoculations target such diseases as rotavirus, diphtheria, hepatitis A and B, polio and meningococcal disease, which can cause meningitis or blood infections.

Some vaccinations require multiple doses over a period of years.

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Pandemic’s double impact

While there has always been resistance to childhood vaccinations among some parents, the COVID-19 pandemic fostered increased skepticism about vaccines more generally. Florida Surgeon General Joseph Ladapo has cast doubt on the safety of the COVID vaccines, and the Florida Department of Health now recommends against the vaccines, citing Ladapo’s claims that the material used in the shots can include DNA fragments.

Major health organizations have said that the COVID vaccines are safe and effective.

A search of the website for the Florida Department of Health in Polk County found no material promoting childhood vaccinations. The agency declined an interview request from The Ledger. All county health agencies are required to route interview requests through the Florida Department of Health office in Tallahassee.

Robert F. Kennedy Jr., nominated by President Donald Trump to lead the Department of Health and Human Services, has a history of questioning the need for vaccinations.

Cornett said that no parents have specifically mentioned Ladapo or Kennedy in raising questions about having their children vaccinated. Cornett said that pediatricians at Watson Clinic strongly encourage parents to have their children follow the recommended immunization schedule.

“It’s easy to make these speculations about vaccination when you’re not in the middle of a polio epidemic, you’re not in the middle of measles outbreaks, you’re not the middle of pertussis, strep-pneumo, Haemophilus meningitis, diphtheria, moms worried about their babies getting congenital rubella,” Cornett said. “These things are invisible to people because you haven’t seen them in forever. It’s easy to demonize the vaccines because the success has been for so long, we kind of forget about it.”

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One lasting effect of the COVID pandemic is that many children fell behind on their recommended vaccinations after missing “well visits,” Canody said.

“During the time around the pandemic, so many people didn’t want to go to the doctor just because they were well, and so a lot of children missed their well visits, which is very important in receiving their preventative vaccinations,” she said. “So a lot of the kids missed those standard schedules, and it took some time to get them back in the office to do what we call catch-up schedules.”

The other continuing effect of the pandemic is increased skepticism about vaccines in general among some parents, Canody said. Though she said she believes the COVID vaccines were needed and saved many lives, Canody said that the vaccines — developed with unprecedented speed — probably resulted in a higher rate of side effects than more established inoculations do.

“We see a wide variation,” Canody said. “We have some families who value what the vaccines do and the illnesses that they prevent, so they haven’t had any hesitancy in continuing on those schedules. For some, they’re asking a few more questions, but once they understand and have their concerns answered, then most of them are still continuing to do so.

“And then there are some who have gone on what we call a slower schedule and then those that have decided that they no longer want to continue to vaccinate their children.”

It is possible to catch up after falling behind schedule on most childhood vaccinations, Canody said. An exception is the rotavirus vaccine, which is administered orally and must be given before 32 weeks, when a child’s gut is still immature, she said.

Seeking to educate parents

Some parents ask Canody whether the vaccines used in the recommended childhood series include messenger RNA, or mRNA, a compound used in two of the vaccines initially developed to protect against COVID-19.

Those vaccines introduced a piece of mRNA corresponding to a viral protein, allowing cells in the body to produce the protein and trigger the creation of antibodies against the infection. That process primed the immune system to fight off the virus that causes COVID-19.

Despite widespread claims, health authorities have said that mRNA vaccines do not affect the recipient’s genetic structure. Even so, Canody assures parents that established childhood vaccines use a different method of triggering an immune response, as they contain antigens — weakened or dead bacteria or viruses or bacterial toxins treated to be non-toxic.

Cornett said he seeks to “validate” parents’ concerns about vaccinations, even as he firmly recommends them.

“I always tell them — and just follow me here — I tell them, ‘Don’t throw the baby out with the bathwater,” Cornett said. “Some of the concerns that they may have about the COVID vaccine, some of them are truly legitimate. And I tell them, ‘Don’t extrapolate those for every other vaccine that’s been around for decades.’”

Though he tries to be understanding and seeks to educate parents, Cornett made it clear that parents should follow the recommendations for childhood immunizations.

“Our job is to prevent illness, and so, that’s just one of those things where, especially with a pediatrician, more than I think any other (doctor), it’s about trust,” he said. “You have to have a trusting relationship, and if someone chooses that they don’t want to vaccinate a child — OK, we respectfully disagree, and no one’s going to force you to do that. But it’s just one of those things where the relationship with the pediatrician from the start is going to be a very strained one.”

Canody also seeks to engage with parents who have concerns about childhood vaccinations. She tells parents that she has been practicing long enough to remember treating patients for illnesses that have largely subsided because of vaccinations.

“So, part of my discussion with families is really, ‘Let’s break down what the vaccines do, how they interact with the body’s immune system,’” she said. “Let’s look at the relative benefits vs. risks, and that way you’re making an informed decision about your child’s preventative health care.”

Americans often focus solely on mortality rates in assessing health outcomes, Cornett said. But he said lesser effects of diseases also must be considered. For example, chickenpox can cause severe illness and even hospitalization, but vaccinations against that illness — routine since the mid-1990s — prevent virtually all severe cases.

Declining childhood vaccination rates can endanger more than just children, Canody said.

“I think it’s very concerning, because when you practice in an area where you start to see that herd immunity fall, not only does it put children at risk who are not vaccinated, but it puts adults at risk, who, likely, some of their immunity from vaccines they got when they were a child have started to go down,” she said. “So we can start to see things like the measles, mumps, rubella, even polio, start to come back in those populations, because we don’t have those kinds of immunity levels to protect us anymore.”

Gary White can be reached at gary.white@theledger.com or 863-802-7518. Follow on X @garywhite13.