Vaccine Exemptions: A Growing Concern in the US

The decision to skip childhood vaccines is becoming more popular in many parts of the United States. This trend is making it easier for preventable diseases like measles to spread. New research shows that more than half of US counties have seen an increase in vaccine exemptions since the start of the Covid-19 pandemic.

Nonmedical Exemptions on the Rise

Most of these exemptions are for nonmedical reasons, such as personal or religious beliefs. Medical exemptions, which are for people who can't get vaccinated for health reasons, have stayed about the same. Experts say the science behind vaccines hasn't changed, but misinformation and politics have made it harder for people to make informed decisions.

The research looked at vaccine exemption rates in kindergartners before and after the pandemic. They found that the average rate of nonmedical exemptions went from 0.6% in 2010-2011 to more than 3% in 2023-2024. Medical exemptions stayed the same. About 53.5% of US counties saw an increase in nonmedical exemptions of at least 1% between 2010-2020 and 2021-2024. More than 5% of counties saw an increase of at least 5%.

Understanding the Trends

The Centers for Disease Control and Prevention (CDC) says that vaccine hesitancy is one reason for the increase in exemptions. A survey of parents found that most support vaccine requirements for school. But among those seeking an exemption, the most common reason was a personal belief objection to vaccination. Difficulty meeting school requirements by the deadline was also a reason for exemption.

Experts say that small differences in vaccine coverage can have a big impact. Understanding local trends is important because national and state-level trends can miss pockets of communities with low vaccination rates. These pockets are where outbreaks of preventable diseases often start.

The Impact on Public Health

In Spartanburg County, South Carolina, nearly 8% of children had nonmedical exemptions for school-required vaccines in 2024, up from 2% in 2014. This county is at the center of a large, ongoing measles outbreak. The outbreak has been growing rapidly since early October, with exposures reported at multiple schools, churches, and other public locations.

The outbreak has been spreading quickly, especially in areas with low vaccination rates. Holiday activities, including school breaks, gatherings, and travel, have contributed to the spread. Experts say that the pockets of unvaccinated people are interconnected and growing.

Most measles cases in the current outbreak have been among unvaccinated children. Communities with high exemption rates are most susceptible to outbreaks of preventable infectious diseases. But these outbreaks also raise the risk for others, as unvaccinated people can spread diseases to those who are susceptible.

Legislative Actions and Future Steps

A few states have passed laws that remove the option for nonmedical vaccine exemptions. The new research shows that counties in these states saw a decrease in overall exemptions. Experts say that legislative action is the only large-scale intervention that has been shown to effectively change vaccination trends. Increasing vaccination coverage will depend more on individual conversations between families and their doctors and consistent messaging over time.

The vast majority of parents in most places choose to immunize their children. Nationally, 3.6% of kindergartners in the 2024-25 school year had an exemption for a required vaccine, federal data shows. This means that more than 96% were vaccinated. Experts say that parents who choose to vaccinate their children are not being careless or thoughtless. The social norm is to immunize and protect not only their own children but also the children around them.