The record share of U.S. kindergarten children was exempt from required vaccinations last year, with coverage of all reported vaccines, including the measles vaccine, being lower than in previous years.
Around 3.6% of kindergarten children from 2024-25 received a required vaccine exemption, leaving around 138,000 new school children without fully covering at least one nationally mandated vaccine, new data shows. The exemption jumped above the full percentage point over the past four years, CDC data shows, with the majority (all but 0.2%) being due to non-medical reasons.
Approximately 286,000 kindergarteners had not completed the 2024-25 measles-mampsulvera (MMR) vaccination series.
According to CDC data, MMR coverage has dropped to 92.5%, falling 95% below the federal government’s target for the fifth consecutive year. The majority of this year’s measles incident is with children who have not been vaccinated.
“Vaccinations are the most effective way to protect children from serious illnesses such as measles and pertussis, and can lead to hospitalization and long-term health complications,” the CDC said in a statement. “The CDC is committed to working closely with state and local partners by providing the tools, resources and data that will help communities promote vaccine access and awareness.”
However, the statement reflects the language commonly used by US Department of Health and Human Services Secretary Robert F. Kennedy Jr., who states, “the vaccine decision is personal. Parents should consult their healthcare provider about family options.”
45 states allow religious beliefs to be used as the basis for vaccine exemptions for children starting schools, and 15 states allow exemptions for other personal or philosophical reasons, according to the American Academy of Pediatrics.
“As pediatricians, we help children vaccinating children stay healthy and everyone knows it’s difficult for them to spread disease in our community,” AAP president Dr. Susan Cresley said in a statement. “In this moment when preventable diseases are on the rise, we need clear and effective communication from government leaders who recommend vaccination as the best way for children’s immune systems to combat dangerous diseases.”
This week, the organization reaffirmed its longstanding position that non-healthcare exemptions should be eliminated for school vaccination requirements.
“The science behind vaccines shows that their benefits outweigh the potential risks,” said Dr. Sean O’Leary, a pediatric infectious disease expert and chair of the AAP Infectious Diseases Committee. “There’s really no good reason to opt out.”
However, between 2024 and 25, vaccine exemptions increased in 36 states, according to new CDC data. In 17 states, more than 5% of kindergarten children received exemptions. This is not sufficient to apply to a 95% target for MMR vaccines that have been set up two MMR vaccines by HHS, in a reminder from the administrator to a document or doctor’s visit.
“We’ve seen a lot of trouble with our children,” said Dr. Josh Williams, a pediatrician with Denver Health and Associate Professor at the Colorado Anschutz Medical Campus. “So we are in a situation where we are currently in many states, and certainly many communities within certain states, where there is not enough herd immunity to protect against diseases that can be prevented by these vaccines, particularly measles outbreaks.”
In a 2019 study, Williams and fellow researchers discovered an interesting pattern of vaccine exemptions. If exemptions for both religious and personal beliefs are available in the state, religious exemptions tend to be low, but when the exemptions for personal beliefs disappear, the proportion of religious exemptions increases significantly.
“That leads to the kind of recommendations you see from organizations like AAP. Essentially, they say that these exemption policies don’t seem to actually do what they’re trying to do.
According to California, Connecticut, Maine, New York and West Virginia, they limit vaccine exemptions to medical reasons. While figures on West Virginia’s MMR coverage were not available in the latest CDC data, the other four states are one of a small group in 10 states that have reached a federal target of 95% coverage among kindergarteners.
In 2023, federal courts paved the way for religious exemptions to be added to Mississippi school vaccination policies. The exemption rate quickly jumped into the state, with MMR coverage dropping by about 1 percentage point, according to CDC data.
Overall, according to the CDC, national MMR coverage for kindergarteners has decreased from 92.7% for the 2023-24 grade to 92.5% for the 2024-25 grade.
Experts say that such changes may appear small, but they can significantly increase risk.
“It’s a small percentage point change that we’ll add up if it happened year over year, and that’s what we’ve seen,” Williams said, and the changes aren’t evenly distributed. “People who tend to reject the vaccine tend to come together. …Perhaps areas where there are low intakes are getting worse, and areas where there are more reasonable intakes continue to be reasonable.”
The majority of measles cases reported in this record-breaking year are concentrated in Texas.
MMR coverage in the state has been popular for at least the past decade with just 93.2% coverage among kindergarteners for at least the past decade. The exemptions have skyrocketed above 4%, significantly exceeding national fares. The law passed by the state legislature this year will make exemptions even easier. Starting in September, the affidavit form applying for the exemption can be printed from the state health department’s website without the need to submit a written request.
Dr. Philip Fan, director of the Dallas County Health Department, said there were many testimonies against the change.
“We were all insisting that there was a need for a consistent message of clear support for vaccinations from above,” he said. “We’re very concerned about what’s going on with HHS and what sort of message that undermines it.”
Experts say vaccines can sometimes be “a victim of their own success.” People don’t realize how much protection they provide until they see the possible pain they may have when they are not used.
This year’s measles outbreak has led to three deaths and dozens of hospitalizations, primarily among children, but experts say it could encourage the need to get vaccinated and start changing trends.
“There’s always been concern about the decline in seeing measles and other vaccines, but I think that in one context of our larger measles outbreak in recent memory, many people are in mind returning to school this fall,” Williams said. “In my clinical practice here in Denver, I have received requests from families who are worried about measles transmission at schools and daycare. Families who want to receive that protection come before the grade have come and have been able to take care of their children as much as possible before returning to school this fall.”
Williams says he likes to remind his parents that most people support vaccinations and that they work hard to gain the trust of their hesitant parents.
“It’s always good to remember that the majority of parents will vaccinate their children on time and on recommended schedules,” he said. “When that’s not true in schools or in the community, I think it’s an opportunity for supporters to talk to other parents and become partners in the process of improving vaccine trust.”
