Rising Vaccine Exemption Rates Across the U.S.
Opt-out rates for childhood vaccines are increasing across most of the United States, which may increase vulnerability to preventable diseases like measles. Measles continues its spread across the country.
New research published in the medical journal JAMA on Wednesday indicates that exemption rates for school-required vaccines have risen in over half of US counties since the start of the Covid-19 pandemic. This trend is primarily driven by nonmedical exemptions, often cited as religious or personal beliefs, while exemptions for medical reasons have remained stable.
Expert Commentary and Research Details
Dr. Jesse Hackell, a New York pediatrician and lead author of an American Academy of Pediatrics policy statement, noted that the science supporting immunizations has not changed, but political discourse and misinformation have influenced public discussion. The AAP statement advocates for the elimination of nonmedical exemptions.
In the analysis, researchers compared vaccine exemption rates among kindergartners at the county level before and after the Covid-19 pandemic. They found that the median rate of nonmedical exemptions increased from an average of 0.6% in 2010-2011 to more than 3% in 2023-2024. Approximately 53.5% of US counties experienced at least a 1% increase in nonmedical vaccine exemptions between 2010-2020 and 2021-2024, with about 5% of counties seeing a rise of at least 5%.
CDC Findings and Local Impact
The US Centers for Disease Control and Prevention (CDC) suggests that increased vaccine hesitancy may be contributing to the rise in exemptions. A 2024 CDC survey indicated that most parents support school vaccine requirements. However, among those seeking an exemption, philosophical or personal belief objections were the most common reason, cited by over a third of respondents. Difficulty meeting deadlines was also reported by about 23% of parents.
Dr. Nathan Lo, an infectious disease physician and scientist at Stanford and an author of the new research, highlighted the importance of understanding local trends, as small differences in vaccine coverage can have significant impacts. He stated that areas with low vaccine coverage and high exemption rates are key drivers of vaccine-preventable disease outbreaks.
Measles Outbreak in South Carolina
Spartanburg County, South Carolina, is currently the center of a significant measles outbreak. Nonmedical exemptions for school-required vaccines in this county increased from 2% in 2014 to nearly 8% in 2024. The South Carolina measles outbreak has recently doubled in size, with over 400 reported cases and more than 400 individuals quarantined due to exposure without vaccination protection.
Exposures have occurred at schools, churches, and other public locations, including the South Carolina State Museum. Holiday activities have been identified as contributing factors to the spread, particularly in areas with lower vaccination rates. The vast majority (92%) of current measles cases in the outbreak are among children, almost all of whom were unvaccinated with the MMR vaccine.
High exemption rates in specific communities increase the risk of localized epidemics and can lead to broader spread to surrounding areas, even those with lower exemption rates. Cases in North Carolina have been linked to travel to Spartanburg County, SC, and New Mexico issued a warning about possible measles exposure from a visitor from South Carolina.
Policy and Vaccination Trends
Some states, including California, Connecticut, Maine, and New York, have enacted laws eliminating nonmedical vaccine exemptions. Counties within these states generally observed a decrease in overall exemptions, indicating an increase in vaccine coverage. Conversely, Florida has moved to end all vaccine mandates, including those for school attendance.
Experts suggest that legislative action is the most effective large-scale intervention for changing vaccination trends. Additionally, increasing vaccination coverage depends on individual conversations between families and healthcare providers, coupled with consistent public health messaging. Nationally, 3.6% of kindergartners in the 2024-25 school year had an exemption for a required vaccine, meaning over 96% were vaccinated. Dr. Hackell emphasized that immunization remains the social norm, aligning with scientific consensus for protecting children and communities.