Vaccine exemptions rise among US kindergartners as measles cases climb
A record share of U.S. kindergartners had an exemption for a required vaccination last school year, and coverage for all reported vaccines – including the measles vaccine – was lower than the year before, according to new published Thursday by the Centers for Disease Control and Prevention.
About 3.6% of incoming kindergartners in the 2024-25 school year had an exemption for a required vaccine, leaving about 138,000 new schoolchildren without full coverage for at least one state-mandated vaccine, the new data shows. Exemptions jumped more than a full percentage point over the past four years, the CDC data shows, and the vast majority – all but 0.2% – were for non-medical reasons.
About 286,000 kindergartners had not completed the measles-mumps-rubella (MMR) vaccination series in the 2024-25 school year, as cases climbed this year to the highest they’ve been since the disease was declared eliminated in the U.S. a quarter-century ago.
MMR coverage dropped to 92.5%, marking the fifth year in a row that coverage has been below the federal target of 95%, according to the CDC data. The vast majority of this year’s measles cases have been in unvaccinated children.
“Vaccination remains the most effective way to protect children from serious diseases like measles and whooping cough, which can lead to hospitalization and long-term health complications,” the CDC said in a statement. “CDC is committed to working closely with state and local partners by providing tools, resources, and data that help communities promote vaccine access and awareness.”
But the statement also echoed language that is often used by Health and Human Services Secretary Robert F. Kennedy Jr., saying that “the decision to vaccinate is a personal one. Parents should consult their healthcare providers on options for their families.”
Vaccine exemptions increase
Forty-five states allow religious beliefs to be used as a basis for a vaccine exemption for children beginning school, and 15 states allow exemptions for other personal or philosophical reasons, according to the American Academy of Pediatrics.
“As pediatricians, we know that immunizing children helps them stay healthy, and when everyone can be immunized, it’s harder for diseases to spread in our communities,” Dr. Susan Kressly, president of the AAP, said in a statement. “At this moment when preventable diseases are on the rise, we need clear, effective communication from government leaders recommending immunizations as the best way to ensure children’s immune systems are prepared to fight dangerous diseases.”
This week, the organization its longstanding position that non-medical exemptions to school immunization requirements should be eliminated.
“The science behind vaccines demonstrates that the benefits greatly outweigh any potential risks,” said Dr. Sean O’Leary, a pediatric infectious disease specialist and chair of the AAP Committee on Infectious Diseases. “There really aren’t good reasons to opt out.”
However, in the 2024-25 school year, vaccine exemptions increased in 36 states, according to the new CDC data. In 17 states, more than 5% of kindergartners had exemptions – meaning reminders from administrators to complete paperwork or doctor’s visits won’t be enough to raise coverage to the 95% for two doses of MMR vaccine set by HHS, a threshold necessary to help prevent outbreaks of the highly contagious disease.
“There are more and more states where even the potentially achievable coverage that we can get by catching everyone up who’s overdue is getting lower and lower,” said Dr. Josh Williams, a pediatrician with Denver Health and associate professor at the . “So we are now in a situation where in many states, and certainly in many communities within certain states, there’s simply not enough herd immunity to protect against outbreaks of these vaccine-preventable diseases, especially measles.”
In a from 2019, Williams and fellow researchers found interesting patterns in vaccine exemptions: When both religious and personal belief exemptions are available in a state, religious exemptions tend to be low, but rates of religious exemptions increase significantly when the personal belief exemption goes away.
“That leads to the kinds of recommendations that you see from organizations like the AAP, basically saying it appears that these exemption policies are not really doing what they were intended to do, that people are kind of using these perhaps in the ways that they were not intended,” he said.
Only five states limit vaccine exemptions to medical reasons, according to the AAP: California, Connecticut, Maine, New York and West Virginia. Numbers on MMR coverage in West Virginia were not available in the latest data from the CDC, but the four other states are among the small group of 10 states that reached the federal goal of 95% coverage among kindergartners.
In 2023, a federal court paved the way for religious exemptions to be added to Mississippi school vaccination policy. Exemption rates immediately jumped in the state, and MMR coverage has dropped about 1 percentage point, CDC data shows.
A small change with big risks
Overall, nationwide MMR coverage among kindergartners dropped from 92.7% in the 2023-24 school year to 92.5% in the 2024-25 school year, according to the CDC.
Experts say that a change like this may seem small but can significantly raise risks.
“It’s a small percentage point change that adds up if it happens year over year, and that is what we’ve been seeing,” Williams said, and the change isn’t distributed evenly. “Individuals who tend to refuse vaccines tend to cluster together. … It’s probably that the areas where there have been low uptake now have even worse uptake, and the areas where there have been more reasonable uptake continue to stay reasonable.”
The vast majority of measles cases reported in this record-breaking year have been concentrated in Texas.
MMR coverage in the state has been trending down for at least the past decade, CDC data shows, with just 93.2% coverage among kindergartners. Exemptions have surged past 4% – well above the national rate – and a passed by the state legislature this year would make it even easier to get an exemption. Starting in September, the affidavit form to file for an exemption will be available to print from the state health department’s website, without the need to file a written request.
There was a lot of testimony opposing this change, said Dr. Philip Huang, director of the Dallas County health department.
“We were making the point during the whole thing that there needs to be a consistent message of unequivocal support for vaccinations from the top,” he said. “We’re very concerned about what’s happening with HHS and the messaging sort of undermining that.”
Experts say that vaccines can sometimes be “victims of their own success,” with people not realizing how much protection they offer until they see the suffering that can happen when they’re not utilized.
This year’s measles outbreak – which has led to three deaths and dozens of hospitalizations, mostly among children – may raise the urgency around the need to vaccinate and help to start to turn the trend around, experts say.
“The declines that we’re seeing for measles and for other vaccines are always concerning, but perhaps in the context of one of our larger measles outbreaks in recent memory, I think a lot of people have it in mind with returning to school this fall,” Williams said. “In my clinical practice here in Denver, we are getting requests from families who are worried about measles transmission in school and in day care. We’ve had some families coming in who want to get that protection on board prior to the school year beginning to make sure that their child is going to be as protected as possible prior to going back to school this fall.”
Williams says he likes to remind parents that most people support vaccination and that he works hard to gain the trust of parents who are hesitant.
“It’s always good to remember that the vast majority of parents vaccinate their kids on time and according to the recommended schedule,” he said. “When that’s not true in a school or in a community, I think that’s an opportunity for advocates to speak up and talk to other parents and be partners in the process of improving vaccine confidence.”
