Florida School Vaccine Rule 2026: Doctors Have Until Sept. 14

A mother brings her four-year-old to a pediatric office in Tampa next August for a kindergarten physical and asks whether the hepatitis B series is still required for school. Under a rule the Florida Department of Health published on August 24, 2026, the answer may be no, and the physician in that exam room will be the one explaining why a vaccine that has been on the school entry list for a generation came off it without a vote of the Legislature.

That rule, a proposed revision to Rule 64D-3.046 of the Florida Administrative Code, is open for public comment and hearing requests only through Monday, September 14. The Florida Chapter of the American College of Physicians filed a formal hearing request on Wednesday, September 9. Every other physician in the state has until Monday to add a voice.

What the Proposed Rule Changes

The notice, published in the Florida Administrative Register as Volume 52, Number 164, makes three changes.

The first removes what the Department calls the non-statutory requirements. Florida Statute 1003.22(3) requires immunization against poliomyelitis, diphtheria, rubeola, rubella, pertussis, mumps, and tetanus, and then adds “other communicable diseases as determined by rules of the Department of Health.” The vaccines that exist only in the rule, and would therefore be removed, are hepatitis B, varicella, Haemophilus influenzae type b, and pneumococcal conjugate. The statutory seven stay because the Department cannot remove them on its own.

The second change rewrites the religious exemption form. The statute at 1003.22(5)(a) allows a parent to object in writing that immunization “conflicts with his or her religious tenets or practices.” The proposed form would add “sincerely held moral or ethical belief(s)” to the grounds a parent may claim. The statute has not changed. The form has.

The third change lets parents, and adult students, opt out of having immunization records entered into Florida SHOTS, the state registry that school nurses, county health departments, and physician offices use to confirm a child’s status.

Surgeon General Joseph Ladapo approved the rule for publication on August 20. The 21-day comment period runs from August 24 through September 14, and comments may be filed through flrules.org or sent to vaccinerule@flhealth.gov.

Why This Is Happening by Rule and Not by Statute

The Governor and the Surgeon General announced in September 2025 that they intended to end every vaccine mandate in Florida. The plan went to the Legislature as part of the 2026 medical freedom package, which passed the Senate and died in the House. With four months left in its term, the administration has turned to the part of the school immunization list the Department controls by rule. That is lawful. Section 1003.22(3) delegates the “other communicable diseases” list to the Department, and what an agency adds by rule it can remove by rule.

The point physicians should not miss is the sequence. The Legislature considered the policy in 2026 and declined to adopt it. The agency then adopted as much of it as the statute would allow, through a Chapter 120 process most physicians never see, on a 21-day clock that opened in the first weeks of the school year. All of it was permitted. It is also how a policy gets made when the people who understand its consequences are not at the table.

The Two Horns, Seven Years Later

In the Summer 2019 issue of this magazine, I wrote a Better Care piece titled “To Vaccinate or Not to Vaccinate?” It borrowed the old Roman figure of the horns of the dilemma, the argumentum cornutum, to describe what happens when a contentious question is treated as a choice between two positions: whichever horn you avoid, the other one gets you. My argument then was that both camps had something legitimate to say: the evidence for vaccination as the single most important public health intervention of the modern era was not in doubt, and the loss of trust driving the other side was real and had to be answered rather than mocked. The way past the horns was individualized care guided by the physician’s own judgment, not a fight over mandates.

Seven years later the same two horns are in Tallahassee. One horn says the state should require every vaccine on the list and treat a hesitant parent as a problem to be managed. The other says the state should require as little as the statute allows and treat the evidence as a matter of personal belief. The proposed rule is the second horn written into administrative code, and the response from organized medicine, understandably, has been to lean hard on the first. A physician who signs on to either one without thinking has made the error I described in 2019.

What I wrote then about parents still holds, and it is the part of this debate that a rule cannot touch. A parent’s fear that a series of injections could cost a child something of the mind is, whether or not it is warranted, a valid concern, because protecting a child’s cognitive capacity is one of the most important jobs a parent has. I also raised, and still hold, the question of whether the timing and clustering of childhood immunizations deserved more individual clinical attention than the schedule gave it. That is a clinical question for a physician and a family to work through together. It is not an argument for removing Hib or pneumococcal conjugate vaccine from a school list, and it is not answered by adding “moral or ethical belief” to a state form.

What Changes in the Exam Room

The clinical evidence has not moved. The Florida Chapter of the American Academy of Pediatrics said in its August 24 response that removing the four requirements increases the risk that these preventable illnesses spread in schools, and it noted that Florida already ranks fifth in the nation for measles cases. The Florida Academy of Family Physicians made the narrower point that the rule changes what parents are told at the school office and nothing about what the evidence supports.

What does change is the conversation. Health News Florida reported this week on Miami pediatricians who already spend part of every clinic day answering questions about vaccines that were settled science when they trained. A rule that tells parents the state no longer considers Hib or pneumococcal vaccine necessary for school will not shorten those conversations. It will lengthen them, and it will move the burden of the state’s decision onto the physician who has to explain it.

That burden is also the opening. The third way I described in 2019 lives in exactly that conversation. A physician who separates three things for a parent, what the state requires, what the evidence supports, and what this particular parent is afraid of, has already done more for that child than either horn of the policy fight will. The recommendation stays grounded in the evidence. The parent’s concern gets heard as a concern about her child’s brain rather than dismissed as a political position. Where the timing of a series can reasonably be adjusted for a given child, that is a clinical decision made in the room, documented, and owned by the physician. No rule in Tallahassee can require that or forbid it.

The SHOTS opt-out has its own practical consequence. A record that a parent has withheld from the registry still has to be reconstructed somewhere, and the practice that inherits that child will be the one reconstructing it. Expect more paper certificates, more phone calls to previous offices, and more uncertainty about a child’s status in an outbreak. The medical exemption under 1003.22(5)(b) still requires a licensed physician to certify, in writing, that the child should be exempt “based upon valid clinical reasoning or evidence.” That standard is not changing, and it is the one place in this rule where the physician’s judgment is still the law.

What Florida Physicians Should Do Before September 14

1. File a comment on Rule 64D-3.046 by Monday, September 14. Use flrules.org (notice ID 31292411, comments capped at 8,000 characters) or email vaccinerule@flhealth.gov. Write as a clinician about what you see in your own practice. A comment from a physician who has treated a child with Hib meningitis or invasive pneumococcal disease carries weight that a form letter does not, and so does one that acknowledges the parents you have talked through their fears.
2. Request a public hearing, or join one that has already been requested. Under Chapter 120, a person affected by a proposed rule may request a hearing within 21 days of the notice, and the Florida Chapter of the American College of Physicians has already done so on behalf of its members. Adding your name through your specialty society tells the Department the request is not the position of a single organization.
3. Decide now what your practice will tell parents in the 2027 school entry season, and write it down. Draft the answer to “is this vaccine still required?” so that everyone in the office says the same thing, and so that the answer separates what the state requires from what the physician recommends. Then add the third sentence, the one that invites the parent to say what she is actually worried about.
4. Review how your office uses Florida SHOTS. If some families opt out of the registry, your office becomes the source of truth for those children. Confirm that your EHR records lot numbers and dates in a form you can print onto a DH 680 on request.
5. None of this constitutes legal advice, so if your practice is asked to sign, witness, or store the revised DH 681 exemption form, have a Florida health law attorney look at the new form once it is adopted. A physician who certifies a medical exemption on non-medical grounds has a licensure problem under Chapter 458 that the new form does not solve.

The Legislature meets again in March, and our April wrap-up of the 2026 session showed how much of what physicians got and lost in Tallahassee depended on who was in the room. The question of which vaccines Florida schools require will come back there. The debate itself will not be settled there. It will be settled, as I argued in 2019, one family at a time, by physicians who refuse both horns and do the harder work of individualized care. The comment period that closes Monday is the smallest version of that choice, and it is the one available this week.

Frequently Asked Questions

Which vaccines would Florida’s proposed rule remove from school entry requirements?

The proposed revision to Rule 64D-3.046 would remove hepatitis B, varicella, Haemophilus influenzae type b, and pneumococcal conjugate vaccines from the school and child care entry list. Polio, diphtheria, tetanus, pertussis, measles, mumps, and rubella are named in Florida Statute 1003.22 and cannot be removed by rule.

When is the deadline to comment on the Florida vaccine rule?

The 21-day comment period opened August 24, 2026 and closes September 14, 2026. Comments may be filed through flrules.org under notice 31292411 or emailed to vaccinerule@flhealth.gov. A request for a public hearing under Chapter 120 must be made within the same window.

Does the proposed rule change Florida’s medical exemption for physicians?

No. The medical exemption in Section 1003.22(5)(b) still requires a physician licensed under Chapter 458 or 459 to certify in writing, on a Department of Health form, that the child should be exempt for medical reasons based on valid clinical reasoning or evidence. The rule changes the religious exemption form to include moral or ethical beliefs, which does not involve a physician’s certification.

How should a Florida physician talk with a parent who is worried about vaccines?

Separate what the state requires, what the evidence supports, and what the parent is afraid of, and address each one directly. Most parental fear is about a child’s cognitive future, and it deserves a clinical answer rather than a political one. Where the timing of a series can reasonably be individualized for a given child, that is a documented clinical decision, not an exemption.

Why is the Florida Department of Health making this change by rule instead of through the Legislature?

Section 1003.22(3) names seven required immunizations and delegates any additional ones to Department of Health rules. The 2026 Legislature did not pass the broader medical freedom bill that would have ended vaccine mandates by statute, so the Department is removing the four vaccines that exist only in its own rule, which it has the authority to do through the Chapter 120 rulemaking process.

This article is general information for physicians and is not legal advice. Consult a Florida health law attorney about your practice’s specific obligations.

This article was drafted with the assistance of AI writing tools, then reviewed, edited, and approved by Dr. Sean C. Orr, M.D., who holds full editorial responsibility for its content. The header illustration was created with AI image tools.

References

1. Florida Department of Health, Notice of Proposed Rule 64D-3.046, Immunization Requirements: Public and Nonpublic Schools, Grades Preschool, Kindergarten Through 12, and Adult Education Classes. Florida Administrative Register Vol. 52, No. 164 (August 24, 2026), comment period August 24 to September 14, 2026. flrules.org
2. Florida Statutes § 1003.22, School-entry health examinations; immunization against communicable diseases; exemptions. flsenate.gov
3. Sean Orr, M.D., “To Vaccinate or Not to Vaccinate?” Florida Doctor Magazine, Summer 2019, Better Care, pp. 14-17. floridadoctormagazine.com (opens at page 14)
4. Florida Phoenix, “Doctors ask state for hearing on new proposed vaccine rule” (September 9, 2026). floridaphoenix.com
5. Health News Florida / WUSF, “Doctors ask state for hearing on new proposed vaccine rule” (September 10, 2026). wusf.org
6. Florida Chapter, American Academy of Pediatrics, “Response to FDOH Notice of Proposed Rule” (August 24, 2026). fcaap.org
7. Jacksonville Today, “Florida seeks repeal of four required vaccines for schools” (August 24, 2026). jaxtoday.org
8. CBS News Miami, “Florida continues push to repeal four required vaccines for public, private schools” (August 24, 2026). cbsnews.com
9. WFSU / Health News Florida, “As Florida moves to drop vaccine mandates, pediatricians brace for more distrust” (September 11, 2026). wfsu.org
10. American College of Physicians, “Ending Vaccine Requirements Puts Floridians and Others at Risk” (September 4, 2025). acponline.org