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Vaccination exemption rates among kindergarteners in the U.S. have reached record highs, according to the CDC. Johner Images/Getty Images
  • A new CDC report shows vaccine exemptions among kindergarten-age children are increasing across 41 states.
  • The increase in medical and nonmedical exemptions is part of a larger trend illuminated by COVID-era barriers to vaccination.
  • Public health experts and pediatricians say following routine immunization schedules is the most effective way to prevent school outbreaks.

Parents are increasingly opting out of state-required vaccinations for young children in the United States for various reasons — medical and nonmedical or religious.

But not getting vaccinated against infectious diseases like measles, mumps, and rubella (MMR) can lead to outbreaks that could have been prevented.

A new report released November 10 by the Centers for Disease Control and Prevention (CDC) shows the percentage of vaccine exemptions among unvaccinated kindergarteners during the 2022–2023 school year is at an all-time high.

Though the increase in exemptions compared to the previous school year is minor — 3% versus 2.6% — the percentage is still the highest on record.

According to the report, the rise in nonmedical exemptions partially reflects lingering issues tied to COVID-era barriers to vaccination, such as limited access to appointments.

“It is not clear whether this reflects a true increase in opposition to vaccination, or if parents are opting for nonmedical exemptions because of barriers to vaccination or out of convenience. Whether because of an increase in hesitancy or barriers to vaccination, the COVID-19 pandemic affected childhood routine vaccination,” the report stated.

According to the CDC report, state-required vaccines among kindergartners fell from 95% during the 2019–2020 school year to 93% during 2021–2022.

Nationwide vaccine coverage in the 2022–23 school year held near 93% for all reported vaccines, but the exemption rate increased by 0.4 percentage points to 3.0% in 41 states.

In 10 states, the exemption rate exceeded 5%, with the highest rate reported in Idaho at 12.1%. Other states with high exemption rates included:

  • Arizona
  • Hawaii
  • Michigan
  • Nevada
  • North Dakota
  • Oregon
  • Utah
  • Wisconsin

The American Academy of Pediatrics (AAP) strongly recommends routine vaccinations for children and adolescents. They say following immunization schedules is the safest, most cost-effective way to prevent disease, disability, and death.

School-age children in the U.S. are required to get vaccinated against infectious diseases, including:

Dr. William Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center in Nashville, explained why children must follow routine vaccinations.

“The infections that these childhood vaccinations are designed to prevent — although largely diminished or absent in the United States — are still out there in the world, and if we do not protect our children, they will remain susceptible, and these other vaccine-preventable diseases will be imported, back to into the United States, infecting our children and spreading among them,” he told Healthline.

“So, we will reintroduce these infections and their impact on children here in the United States if we do not keep our protection high.”

Schaffner cited measles as an example.

“There’s the common notion, vaguely, that measles used to be a disease that everyone got and recovered from, so what’s the big deal, well of course that underestimates [the] impact of measles enormously,” he continued.

“It comes as a great surprise that before we had a measles vaccine, measles and its complications caused deaths of 400–500 deaths of children in the United States each year. Now we have zero deaths due to measles in children born in the United States, and that’s because we vaccinate them all. Now, what’s wrong with that?,” he said.

Dr. Monica Gandhi, professor of medicine and associate division chief of the division of HIV, Infectious Diseases, and Global Medicine at UCSF/ San Francisco General Hospital, said that many childhood diseases have been nearly eliminated in the U.S. due to the vaccination program.

“Vaccines are critical to keep young children safe from diseases such as measles, mumps, rubella, diphtheria, pertussis and multiple other infections. The importance of young children following the recommended immunization schedule cannot be stressed enough,” she told Healthline.

The CDC data echoes a recent Center for American Progress report explaining why childhood vaccination rates are decreasing. Factors contributing to the decline include:

  • pandemic era barriers to care that persisted
  • vaccine hesitancy (i.e., distrust in government or science)
  • rise in vaccine disinformation

Be that as it may, Schaffner pointed out that many pandemic-era barriers to getting vaccinated no longer exist.

“There are no financial barriers because children are either covered under private medical insurance or a variety of federal programs that provide vaccines for children. What does remain is hesitancy or skepticism about vaccines,” he said. “Aside from a small group of anti-vaccine people, there’s a large group of parents who are simply unacquainted with the illnesses and therefore do not respect or value the vaccines that their children are to receive.”

Schaffner said these parents need information and they need reassurance.”

“This is overlain, I’m afraid, by the political divisions that have affected COVID vaccines, and there’s been some spillover into concern and hesitancy about routine vaccinations. So, I think we all need to do our best to reach out, to provide information, and to provide comfort and reassurance that getting infants and young children appropriately vaccinated according to the schedule recommended by the American Academy of Pediatrics is the appropriate thing to do — in fact, it’s the essential thing to do,” Schaffner said.

Gandhi agreed that the medical community should work to dispel misconceptions about vaccines.

“I think the main barrier to childhood vaccination reflected in the CDC report is distrust of vaccines, especially since parents are applying for exemptions to getting their children vaccinated,” Gandhi said. “This distrust is partially from misinformation and partially from non-nuanced approaches to pandemic management during COVID-19 and we should work on both concerns.”

The CDC report says that vaccine exemptions greater than 5% raise the risk for outbreaks of diseases preventable by vaccination.

In November 2022, a measles outbreak in a Columbus, OH, school affected at least 44 children, 17 of whom were hospitalized. The CDC reported 94% of the cases were unvaccinated children younger than 5.

In September 2022, the poliovirus circulated in wastewater in several cities, including New York and London, indicating community spread among unvaccinated individuals. Polio most commonly affects children under 5.

Both outbreaks highlight the importance of maintaining at least 95% vaccine coverage for young children.

“Because clusters of undervaccinated children can lead to outbreaks, it is important for immunization programs, schools, and providers to make sure children are fully vaccinated before school entry, or before provisional enrollment periods expire,” the CDC report stated.

Schaffner said to interrupt the transmission of a highly infectious agent, such as measles, for example, you have to have very high levels of vaccination.

“If you reduce those levels you provide the opportunity for measles to once again get started. It may not cause huge epidemics — but you would get smaller outbreaks [at the community level],” he said.

“There’s a smaller issue here — among all the healthy children,” Schaffner added. “There are children who are frail, who are immunocompromised, who for medical reasons either cannot take the vaccines or the vaccines don’t work as well. We have a responsibility not only to our own children to vaccinate, but we have a responsibility to those children who are too frail to respond to vaccinations. The way we protect them is to have all the rest of us vaccinated.”

Federal data from the CDC shows that vaccine exemption rates are at an all-time high across 41 states.

The percentage of parents and caregivers requesting an exemption for their children is part of a lingering upward trend that was highlighted during the COVID-19 pandemic.

Some barriers to routine vaccination may still exist, such as lack of insurance or accessibility to a medical facility, but experts say there is also a growing distrust in vaccines.

Public health experts recommend that all children follow routine immunization schedules since vaccination against infectious diseases is the best way to prevent outbreaks.