As a measles outbreak tears though Florida, the state’s surgeon general, Joseph Ladapo, is openly rejecting long-proven public health practices. He is not urging vaccination against this preventable, highly contagious, dangerous disease, and he advises parents to decide whether to keep unvaccinated kids at home. This is just the latest episode in a COVID-era pattern of peddling medical misinformation and unevidenced positions. Ladapo’s tenure stands as a microcosm of the deadly politicization of public health in the U.S. and a damning indictment of what happens when those happy to misrepresent evidence rise to a position of power and responsibility.
Ladapo rose to prominence in 2020 by writing opinion articles for the Wall Street Journal’s editorial page in which he decried public health measures such as masking and lockdowns to mitigate the spread of COVID despite his lack of specialization in infectious diseases or immunology. That same year, he stood with the advocacy group America’s Frontline Doctors at a press conference in front of the Supreme Court in which the group endorsed the false claim that hydroxychloroquinecould cure COVID. Embraced by right-wing media and then president Donald Trump, this dangerous fiction was rapidly debunked by medical scientists, and Lapado later justified his appearance with America’s Frontline Doctors as supporting “individual autonomy.” With the deployment of COVID vaccines, Ladapo pivoted to casting aspersions on their efficacy and safety, just getting started on his spree of peddling misinformation, the kind of which has been found to generally endanger public health.
These contrarian stances were poorly informed and directly contradicted by the best evidence from reputable public health bodies. Yet they resonated with a chorus ideologically opposed to public health measures. Florida governor Ron DeSantis made the cynical calculation that Ladapo’s Harvard degrees would elevate the governor’s utterly fringe claims and policy of health “freedom”—a euphemism for reckless inaction and antivaccine sentiment in the face of a deadly pandemic.
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This was deeply wrong. Science is founded upon evidence. Any apparent authority derived from someone’s credentials pivots on the individual’s views accurately reflecting the totality of evidence. When they fail to do so, as in Ladapo’s case, qualifications are irrelevant. Even so, he was fast-tracked for ordination as Florida’s surgeon general in 2021 at DeSantis’s behest, praised by the governor as the only doctor willing to “say I [DeSantis] was right”—a statement that was more revealing than intended.
Immediately Ladapo set to denigrating the office with a perverse inversion of his expected responsibilities. His first action quashed all quarantine requirements for children exposed to COVID infection, and he refused to mask when meeting a state senator who was undergoing breast cancer treatment, despite her repeated requests to do so. What followed was a litany of directives and claims that were completely at odds with national and international public health advice, with vaccination the chief focus of his misinformation campaign. Ladapo insisted in March 2022 that children not be vaccinated against COVID. This marked Florida as the first state to openly contradict best practicefrom both the American Academy of Pediatrics and the Centers for Disease Control and Prevention, it and drew the ire of researchers who were furious that Ladapo has mispresented their work to make outlandish claims.
This rebuke did little to stop unethical distortions of evidence, which rapidly distinguished his leitmotif. In October 2022 he cited an unscientific, unauthored, un-peer-reviewed and unpublished document to assert that men aged 18 to 35 should not be vaccinated. The claim was savaged by scientists, with surgeon David Gorski noting it was perhaps the “first time that we’ve seen a state government weaponize bad science to spread antivaccine disinformation as official policy.” A 2023 investigation by University of Florida, with which Ladapo is affiliated, found that his recommendation was the result of “careless and contentious research practice” and was a potential violation of research integrity policy. A report by Politico presented evidence that Ladapo had deliberately manipulated internal reports to create misleading impressions of danger from COVID vaccines. Ladapo subsequently mispresented data from a federal health database to wrongly frame COVID vaccines as dangerous, earning him another public rebuke from the CDC and the Food and Drug Administration for distorting evidence. This past January he was lambasted by scientists for falsely announcing that COVID vaccines alter human DNA.
Through the Florida Department of Health, I asked Ladapo how he responded to medical expert criticism of his measles and COVID vaccine recommendations. He did not reply.
Elevation of medical misinformers to public office, alongside the nationwide campaign of harassment against responsible public health officials, endangers everyone. Such behavior is a gross parody of what should be expected from any public health official genuinely concerned with societal well-being. Ladapo’s actions only make sense when viewed through the lens of a less noble motivation: partisan politics. Since the dawn of the pandemic, mitigation measures from lockdowns to vaccination have become alarmingly politicized. In counties with higher rates of Republican voters, vaccination rates are significantly lower, yielding higher rates of COVID deaths. Political partisanship on the topic has created a polarization that feeds into vaccine resistance, framing vaccination as an infringement on individual rights. Even support for mandatory measles-mumps-rubella vaccination, roughly consistent across the political aisle in 2016, has dropped precipitously in Republication voters. Ladapo’s elevation by DeSantis was nakedly political, with DeSantis leaning heavily into resurgent antivaccine sentiment in his failed presidential bid.
But therein lies the fundamental problem at the heart of such cynical tactics: reality does not care one jot for our beliefs. We are entitled to our own opinions but never to our own facts. Reframing sensible and once broadly supported public health measures as an affront to some vague conception of liberty is inherently foolish. As the outbreak in Florida demonstrates, measles is extremely infectious. Each case infects an average of 12 to 18 others, running rampant in unvaccinated populations with sometimes severe or even fatal consequences. Quite aside from emboldening the resurgent antivaccine movement, rejecting evidence-based health mitigation measures risks sacrificing human lives to appease baseless ideological follies.
Health is not the sole arena where needless politicization has confounded evidence-based action—the chorus of Republican presidential candidates casting doubt on human culpability for climate change is another unedifying example—but it is where consequences are often most immediate.Far from promoting public health and upholding the tenets of evidence-based medicine, Ladapo has captained an outright perversion of the office’s very fundamental raison d’être. His continual undermining of best evidence is a cautionary tale that elevating people to high office who are guided by ideological fervor puts everyone at risk.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.