Public health experts are growing increasingly concerned about a rise in anti-vaccination rhetoric among elected officials and right-wing media as a new wave of coronavirus infections begins to wash over Americans who have yet to get vaccinated.
Legislators in more than 40 states have introduced measures to bar vaccine passports, and many Republican governors have signed executive orders or laws barring their use.
In some cases, Republican governors and legislators are now repeating far-right talking points questioning the safety and effectiveness of coronavirus vaccines, in spite of the overwhelming scientific evidence that the vaccines developed in the past year are some of the safest and most effective ever created.
The Biden administration has pushed back forcefully against Republican governors in states such as Missouri and South Carolina who have complained that a door-to-door vaccination effort smacks of government overreach. The administration's plans have called for local health officials and trusted community voices to encourage more vaccine acceptance, and those governors have quietly backed off.
Public health experts were especially alarmed earlier this week when Tennessee's Department of Health fired Michelle Fiscus, the state's top vaccine official, after the state legislature raised concerns about public health guidance she issued for teenagers seeking to receive the coronavirus vaccine.
At a hearing of the Joint Government Operations Committee, legislators accused Department of Health officials of targeting young people for vaccination. One Republican member of the committee suggested dissolving the Health Department in the midst of an ongoing global pandemic.
"It's shocking. It's not shocking that we had a fringe group that's anti vaccine. That's been true since the first vaccine," said Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia. "It is shocking to me that people who are representing the public and the health and well-being of the public are choosing to take this dramatic anti-science stance."
The Tennessee Department of Health has since stopped all vaccine outreach to minors - including regular shots that have been the most effective weapon against preventable disease in modern history.
"It's really unconscionable," said state Sen. Heidi Campbell (D), a member of the committee who attended the hearing. "It's had a chilling effect on the state in general and county health departments."
The number of coronavirus cases reported on the average day in Tennessee has grown more than seven-fold over the past two weeks, according to data from the Centers for Disease Control and Prevention.
Fifty-three percent of Tennessee residents over the age of 18 have received at least one dose of vaccine against the coronavirus, and 47.5 percent are fully vaccinated. Both rates lag well behind the national average.
In an email, state Rep. John Ragan (R), the House chairman of the joint committee, said Fiscus had been fired for misspending taxpayer money on an advertising campaign urging younger people to get vaccinated against a disease that has an extremely low mortality rate among those under the age of 18.
"For such a low mortality risk, why would the Department of Health's Dr. Fiscus authorize spending millions of taxpayer dollars advertising to these minors encouraging them to get an emergency use authorization vaccine without parental consent?" Ragan wrote. "Dr. Fiscus advocated giving the vaccine to children without parental involvement in spite of General Assembly members' objections."
Ragan declined to say whether he had been vaccinated against the coronavirus. He said the data indicated that currently available vaccines are "90 [percent] or more effective."
None of the other Republicans on the committee responded to a request for comment.
The Republican rhetoric - amplified by far-right hosts on cable television - comes as a summer wave of the coronavirus sweeps over the United States, which now almost entirely afflicts the unvaccinated.
Daily average case counts over the past two weeks have more than doubled in Alabama, Alaska, Arkansas, California, Florida, Georgia, Illinois, Kansas, Iowa, Louisiana, Massachusetts, South Carolina and Vermont. Experts say the new spread is being driven by the delta variant, first identified in India, which they say is both more transmissible and more virulent.
In recent months, more than 99 percent of people who have died in America from the coronavirus have been unvaccinated, according to state and federal data.
The anti-vaccination movement has existed for a century. In the past few decades, it has been fueled by a study published in The Lancet by the former physician Andrew Wakefield, since retracted, which claimed a link between vaccines and autism that has been thoroughly debunked.
But modern technology - and social media - have allowed the retracted study to live on, giving voice to those who were once a marginal fringe.
"The rise of social media has allowed individuals who held these beliefs but otherwise didn't have contact with others to connect and spread these beliefs," said Timothy Callaghan, an assistant professor at Texas A&M University's School of Public Health who has studied the anti-vaccine movement.
In a study published last month, Callaghan found about 1 in 12 Americans say they always identify as an anti-vaxxer, and a much higher proportion, 22 percent, identifies with the movement on at least some occasions.
"We need to recognize that a much larger portion of the American public than we might anticipate at least sometimes identifies as anti-vaxxer," Callaghan said.
More recent hesitancy or downright opposition to receiving a vaccine has fallen along starkly partisan lines, as supporters of former President Trump say they are most reluctant to be vaccinated. There is an irony to that stand, given both that Trump has demanded credit for the Operation Warp Speed program that delivered a vaccine in record time and that he himself has been vaccinated.
"It may be a consequence of what was the previous administration, which was really an administration of science denialism," Offit said. "You have the magic ticket. You have a way out. And still that's denied."
The consequences of vaccine hesitancy are now a prolonged pandemic in a nation where more than 607,000 people have died so far. And there may be follow-on effects if skepticism about the coronavirus vaccine extends to other common and safe preventative measures to battle other preventable diseases.
"The risk is that the rhetoric surrounding COVID-19 could lead more people towards being self-identified anti-vaxxers," Callaghan said. "Having the ideas and beliefs of what were formerly fringe groups legitimized by political leaders has consequences."