“There are some more conservative states where we are likely to see other non-COVID vaccine mandates under attack, and it is very worrisome,” says Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. “If we have some of these pediatric infectious diseases come back, it will be horrific.”

Even before President Joe Biden’s September 9 announcement of a litany of aggressive COVID vaccine mandates—covering an estimated 100 million Americans, including federal health workers and companies with more than 100 employees—evidence of changes in policy and sentiment toward such rules was cropping up, led by the right. This summer the Tennessee Department of Health, reportedly pushed by GOP lawmakers, directed its staffers to stop conducting “proactive outreach regarding routine vaccinations,” including those for childhood diseases, HPV and influenza. Larry Elder, the top Republican vote-getter in the failed recall effort against California’s Democratic Governor Gavin Newsom, told the Los Angeles Times editorial board in August, “I don’t believe that the state should tell a parent whether or not a child should be vaccinated. That’s an intrusion of state power.” In Minnesota this month, the conservative group Action 4 Liberty, which boasts an email list of more than 100,000 recipients, began hammering a leading Republican candidate for governor for refusing to sign the group’s “Stop Vaccine Mandates” pledge…

In all, some 22 percent of Americans now identify as “anti-vaxxers,” defined as people who support vaccine refusal and “embrace the label as a form of social identity,” according to a report by researchers at Oklahoma State University, Texas A&M University and others, published in the journal Politics, Groups, and Identities. Underscoring concerns of public health experts, the study also found identifying as an anti-vaxxer to be predictive of increased opposition to childhood vaccine requirements.

Meanwhile, signs are also mounting about the partisan nature of growing opposition to vaccines and vaccine mandates, and the shift from medical to libertarian reasoning. Asked in a survey by the Kaiser Family Foundation whether getting the COVID vaccine is a matter of “personal choice” or “part of everyone’s responsibility to protect the health of others,” more than 70 percent of Republicans saw it as a personal choice vs. just 27 percent of Democrats.