A significant increase in vaccine exemptions for religious or personal beliefs has been observed across many counties in the United States, particularly among children entering kindergarten. This trend, which has accelerated since the COVID-19 pandemic, is detailed in a recent study published in JAMA and conducted by NBC News in collaboration with Stanford University.
The research analyzed data from 3,053 U.S. counties and jurisdictions from 2010 to 2024. It found that the rate of families opting out of vaccinations for religious or personal reasons jumped from 0.6% during the 2010-2011 school year to 3.1% by the 2023-2024 school year. In the years following the pandemic, more than 53% of counties reported an increase of over 1% in kindergarteners exempting themselves from vaccinations due to these beliefs.
Dr. Nathan Lo, an assistant professor of infectious diseases at Stanford University and a co-author of the study, expressed concern over the rising numbers. He noted, “These may look like small numbers, but they may be enough to be the tipping point for something like measles.”
All U.S. states mandate certain vaccinations for children entering public schools, while also allowing exemptions for medical reasons. The study noted that rates of medical exemptions have remained stable. In contrast, states reporting the highest rates of nonmedical exemptions since the pandemic include Utah, Idaho, Oregon, Wisconsin, and Arizona, with some areas in Utah and Idaho exceeding 20%.
The U.S. is currently facing its largest outbreaks of measles and whooping cough in years, predominantly affecting school-age children. In Spartanburg County, South Carolina, a recent measles outbreak has escalated, with at least 434 cases reported since September, over half of which were diagnosed in the last week. Some schools in Spartanburg County have vaccination rates as low as 20%, according to Dr. Linda Bell, the state epidemiologist for the South Carolina Department of Public Health.
Dr. Bell remarked, “What’s going on in Spartanburg County now is the best example that even small pockets of under-vaccinated people can result in widespread transmission for this highly infectious virus.”
Dr. Jesse Hackell, a fellow of the American Academy of Pediatrics, highlighted the risks associated with even a small number of vaccine exemptions. “There are many counties where the vaccine rate is between 90% and 95% and that’s low enough to produce a risk for widespread dissemination of a disease,” he stated.
Dr. Walter Orenstein, a professor emeritus at Emory University, acknowledged the challenges in predicting whether vaccine exemptions will continue to rise. He identified factors contributing to this trend, including mistrust of healthcare professionals, the spread of vaccine misinformation on social media, and the absence of visible diseases that vaccines prevent. “Vaccines in a sense, are victims of their own success, because people don’t understand what these diseases are,” he explained, adding that many do not fear them due to lack of exposure.
Recent changes to the childhood vaccine schedule by Health Secretary Robert F. Kennedy Jr. may further complicate public perception. The Centers for Disease Control and Prevention (CDC) continues to recommend vaccinations for measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type B (Hib), pneumococcal disease, HPV, and chickenpox. Additional vaccines will be recommended for “high-risk” groups or based on shared clinical decision-making.
“My fear is it’s going to take major resurgences of some of these diseases, like polio, before people realize that the benefits of vaccines far, far exceed any risks. And these can be terrible diseases,” Dr. Orenstein concluded, emphasizing the critical role vaccination plays in public health.
The implications of rising vaccine exemptions are profound, posing significant challenges for public health officials and raising concerns about the potential for disease outbreaks in communities across the nation.
