Former CDC Director Mandy Cohen Pushes States to Bolster Immunization Requirements
Undermining doctor-patient shared decision making, vaccine freedom-of-choice
By Peter A. McCullough, MD, MPH
Former CDC Director Mandy Cohen came out in the New England Journal of Medicine pushing hard for states to buckle up vaccine requirements for children despite the new ACIP panel advocating for personal choice and shared decision-making on the risks and theoretical benefits of immunization. This review was assisted by AlterAI.
The article by Dr. Mandy Cohen, former CDC director, published in the New England Journal of Medicine in late 2025, is a passionate defense of maintaining — and even strengthening — childhood vaccine requirements amid a rapidly shifting political landscape. Cohen’s essay serves as a plea to state policymakers now debating the rollback of school vaccination mandates following federal reorganization under HHS Secretary Robert F. Kennedy Jr.
At its core, Cohen’s message is straightforward: loosening vaccine mandates will allow diseases of yesteryear (diphtheria, pertussis, measles, polio) to come roaring back. She rides of several false assumptions: 1) vaccines stop transmission, 2) protection is durable, 3) vaccines are safe given in progressively larger combinations, 4) we have no modern sanitation, diagnostics, or early treatment. Cohen like other vaccine zealots imperceptibly ignores the reality of other historical diseases coming under control without vaccines including bubonic plague, rheumatic fever, syphilis, and tuberculosis.
🧒 1. The central argument: vaccination as a public trust
Cohen opens by reminding readers that childhood vaccination requirements form one of the “quiet architectures of modern society” — the invisible infrastructure that allows parents to send children to school without fearing outbreaks of measles, whooping cough, or polio. However she makes not mention of the consequences of excessive vaccination including allergic diseases, ADHD, autism, seizures, and tics. She fails to point out that with modern sanitation, screening, detection, and early treatment, most “vaccine preventable” diseases would not come back into meaningful existence if vaccination was stopped.
Her central claim is that the movement to make vaccination a “parental choice” fundamentally is at odds with public health: the goal of vaccination policy is not just protecting individual children, but theoretically maintaining community immunity that shields the vulnerable — infants, immunocompromised children, and others who cannot be vaccinated safely. Yet, the CDC stance is that with very rare exception, everyone should be immunized.
Cohen laments that this principle is being eroded in real time. She cites recent legislative proposals in Florida, Texas, Tennessee, and several Midwestern states to remove school vaccine requirements or to broaden exemptions.
⚖️ 2. Scientific grounding vs. political interference
Her essay also takes aim at what she describes as misuse of “transparency language.” While acknowledging past mistakes by bureaucratic institutions, Cohen contends that dismantling expert oversight under the guise of restoring public trust only invites chaos. “When the public cannot distinguish between genuine revision of science and opportunistic distortion,” she writes, “health systems dissolve into noise.” She positions these statements to undermine Robert F. Kennedy, Jr, the new ACIP panel, and the conclusive McCullough Foundation Report on The Determinants of Autism.
🧬 3. The consequences of weakening mandates
Cohen devotes a significant portion of her essay to documenting the empirical relationship between vaccine mandates and childhood infection rates. She cites state-level trends showing that even small increases in exemption rates produce rapid spikes in disease outbreaks. However, the CDC refuses to report measles cases among children who have been vaccinated using the category: “unvaccinated or vaccine status unknown.”
She names early signs of reversal: regional measles clusters in Texas and Georgia; surges in pertussis hospitalizations; and rising parental hesitancy traced to social media presentation of vaccine safety data she disparagingly labels as “misinformation.”
👥 4. Restoring trust—without abandoning expertise
Acknowledging the public’s growing distrust of health institutions, Cohen concedes that these agencies must become more transparent and humane, not more authoritarian. Yet her push is for stricter authoritarian school vaccination requirements for children.
She calls on states to modernize immunization registries, disclose side-effect data responsibly, and rebuild communication with parents through local clinics rather than federal diktats. “The message must come not from Washington but from pediatricians, community nurses, and clergy who can speak the language of trust.” However, she did not mean disclose real risks (eg autism) and theoretical benefits since most illnesses are never encountered by children.
🚨 5. The stakes: prevention versus nostalgia
Perhaps the most poignant section of the essay contrasts modern complacency with forgotten suffering without treatment. Cohen recounts working early in her career with parents whose children were permanently disabled by meningitis — parents who “would have given anything for the chance to choose vaccination.” Never once does she mention the vital role of prompt treatment for meningitis given to both vaccinated and unvaccinated.
🌎 6. Closing plea: keep the covenant
Cohen closes with a religious appeal: vaccination requirements are a covenant between citizens and the state — a compact that balances freedom with duty. Removing them, she says, breaks faith with the generations who witnessed reductions in smallpox, curtailed polio, and envisioned a society where children could play together without fear of contagion.
She calls on governors and legislatures to bolster authoritarian mandates and reaffirm “the public obligation to protect the young and the voiceless” yet offering nothing for the next child afflicted with vaccine induced chronic allergic or neuropsychiatric disease. The essay’s final line captures her goal, cloaking vaccine authoritarianism as “freedom:”
“Vaccination is not an imposition on freedom; it is freedom’s defense — proof that our care for one another is still larger than our fear of each other.”
Summary
Cohen’s essay exemplifies the core tenants we describe in our NYT bestseller: Vaccines: Mythology, Ideology, and Reality. She believes our children and parents should accept vaccines based on faith, without freedom to choose, and without consideration of lifelong, disabling side effects.
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Peter A. McCullough, MD, MPH
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She exemplifies a big problem with humans: many of the ambitious are both narcissistic and stupid.
Mandy Cohen needs to just stop talking. Vaccines are dangerous and should be stopped. We are poisoning our citizens because of greed and ignorance!