Childhood vaccination rates continue to dip as exemptions reach record high
Tracey Gardone
A growing number of U.S. kindergarteners are starting school without vaccinations due to rising exemptions, according to new data from the U.S. Centers for Disease Control and Prevention.
Vaccination rates among kindergarten children for the 2023-24 school year declined from the previous year, while exemptions reached record highs, the CDC found.
The percentage of U.S. children entering kindergarten with their required immunizations dipped from 95% in the 2019-2020 school year to less than 93% in the 2023-24 school year.
Meanwhile, the vaccination exemption rate rose from 2.5% in 2019-20 to 3.3% last year – the highest level ever reported.
Vaccination coverage among kindergarteners decreased for all of the reported vaccines, the CDC stated. That includes vaccines for measles, mumps and rubella (MMR); diphtheria, tetanus and acellular pertussis (DTaP); poliovirus (polio); and varicella (chickenpox).
Exemptions increased in 40 states and Washington, D.C., with 14 states reporting exemptions exceeding 5% compared with eight states during the pre-pandemic school year.
That percentage point might seem small, but that’s more than 126,000 kindergarteners who are not getting at least one of the vaccinations for the 2023-24 school year, according to the CDC.
It is the fourth consecutive year that vaccination rates have fallen below the target vaccine rate of 95%, the rate recommended for ‘herd immunity,” which occurs when there are enough immunized people to make the spread of an illness among unimmunized people less likely.
It’s up to each state to set vaccine requirements for schoolchildren, and all states allow exemptions for children with medical conditions that prevent them from receiving certain vaccines. Additionally, 45 states permit exemptions for religious or other reasons.
While medical exemptions have remained relatively flat over the past decade, non-medical vaccination exemptions have steadily risen.
The trend is alarming to public health officials, who worry that outbreaks of vaccine-preventable diseases – like recent measles outbreaks in Ohio and Minnesota – will become more common.
For example, as of Nov. 7, the CDC had recorded 277 measles cases and 16 outbreaks nationwide. In comparison, 59 measles cases were reported during all of 2023. Whooping cough cases are at their highest levels since 2019, with a month-and-a-half remaining in the year.
Within states, clustering of unvaccinated kids can be even more concentrated in particular communities or schools, the CDC noted. For example, according to CDC data, 14.3% of kindergarteners in Idaho were granted an exemption to one or more vaccines. But in Connecticut, fewer than 1% got exemptions.
Experts fear that vaccine hesitancy and skepticism of science that arose during the COVID-19 pandemic, along with online misinformation and the politicization of public health, are contributing to the decrease in vaccine coverage.
“It’s concerning,” said Dr. Joseph Aracri, System Chair of Pediatrics with AHN Pediatric Institute. “There’s been a general distrust of the medical community following the pandemic, and it’s continuing. As physicians, we find vaccines are incredibly important to the overall health of the child and to the population.”
According to Dr. Michael Faust, a pediatrician at UPMC Washington, the public’s interest in following public health advice and requirements has been waning since the pandemic started.
“Ultimately, physicians want what is best for their patients. It is hard to watch a family make a decision regarding the health of their child based on flawed information,” said Faust. “Kudos to the population of Western Pennsylvania, though. We have historically followed accepted medical practice when it comes to routine childhood immunizations. Consequently, we have not faced some of the challenges other areas of the country have faced with the reemergence of some vaccine-preventable illnesses.”
Indeed, vaccination rates for students in schools in Fayette, Greene and Washington counties exceed the national average reported by the CDC. In Greene County, 97.08% of kindergarteners had received the required immunizations, while 94.8% of Washington County students and 93.6% of Fayette County students reached that benchmark in 2023-24. In Fayette County, 4.5% of kindergarteners were granted a philosophical exemption, and 1.8% received a religious exemption. In Greene County, .3% received a religious exemption and 2.2% received a philosophical exemption. In Washington County, .3% of students had a medical exemption in 2023-24 while 2.4% were granted religious exemptions and 1.8% received philosophical exemptions.
Faust and Aracri said it’s normal for parents to have questions and to be concerned about their children’s medical treatment, and noted it’s important that they get reliable medical information from expert sources.
“I encourage all parents to find a medical provider that you trust and have a discussion with them,” said Faust. “Ask them what decision they have made for themselves or their own children.
Said Aracri, noting vaccines protect children and those around them, “If you’re at all concerned about the safety and efficacy of vaccines, have that conversation with your provider, and make sure you’re getting information from the right sources.”
For a link to the CDC’s information on vaccinations, visit
https://www.cdc.gov/schoolvaxview/data/index.html