In mid-February, a measles outbreak started at the Manatee Bay Elementary School in Broward County in South Florida. There are now at least nine cases in the county and one additional one in Polk County in Central Florida.

Several public health researchers say Florida’s current response to the outbreak goes against well-established public health guidance. Florida’s surgeon general, Dr. Joseph Ladapo, has so far not urged parents of unvaccinated children at the school with the outbreak to get their children vaccinated, or to quarantine them. In a Feb. 20 letter, Ladapo left it up to parents to decide whether to send their kids to school.

“I’m flummoxed about this,” says Dr. Ali Khan, dean of public health at the University of Nebraska. “I’ve never heard of a surgeon general who didn’t at least advocate for best public health practice.”