Florida’s controversial surgeon general is drawing criticism for his handling of an elementary school’s measles outbreak, telling parents of unvaccinated children it is their choice whether their students attend class — a contravention of federal guidelines calling for their mandatory exclusion.

Dr. Joseph Ladapo, nationally known for his outspoken skepticism toward the COVID-19 vaccine, sent a letter this week to parents at Manatee Bay Elementary School near Fort Lauderdale after six students contracted the highly contagious and potentially deadly virus. Such outbreaks are rare in the United States, though reported cases have spiked from 58 for all of 2023 to 35 already this year.

The letter notes that when a school has a measles outbreak, it is “normally recommended” that unvaccinated students who haven’t previously had the disease be kept home for three weeks “because of the high likelihood” they will be infected.