Kindergarten Vaccination Coverage Hits New Low as Exemptions Increase
Many public health officials aren’t surprised by the decline in vaccine coverage, although its underlying causes present unique challenges.
During the 2023-2024 school year, vaccination coverage among kindergartners in the US decreased for all reported vaccines compared to the previous year, while exemptions simultaneously peaked at a record high, according to a report by the CDC.1
Child receiving band aid after vaccination / Drazen - stock.adobe.com
Data revealed that vaccination coverage ranged from 92.3% for diphtheria, tetanus, and acellular pertussis vaccine to 92.7% for measles, mumps, and rubella vaccine (MMR), with a decline seen in more than 30 states. Notably, the 2023-2024 season marked the fourth consecutive year that national MMR coverage in kindergartners remained below the Office of Disease Prevention and Health Promotion’s Healthy People 2030 target of 95%.2
What’s more, exemptions from one or more vaccines rose to an all-time high of 3.3% from 3.0% the previous year. These were concentrated in 40 states and DC, with 14 states reporting exemptions exceeding 5%, translating to about 127,000 children opting out of vaccination during the 2023-2024 school year.
Investigators noted that “exemptions in excess of 5% limit the level of vaccination coverage that can be achieved, which increases the risk of outbreaks of vaccine-preventable diseases.”2 The greatest percentage of exemptions was in Idaho, where 14.3% of children chose not to receive one or more vaccines.1
These numbers follow a trend that began during the COVID-19 pandemic, whereby routine vaccination rates for kindergartners declined after 10 years of near 95% nationwide vaccination coverage and have continued to slide.2
READ MORE: US Adults’ Feelings Toward Vaccination Against Respiratory Illnesses
All US states and territories require that children attending childcare centers and schools be vaccinated against measles, MMR, polio, tetanus, whooping cough and chickenpox. Simultaneously, all states allow medical exemptions for children who cannot receive certain vaccines due to health conditions, and most states permit exemptions based on religious beliefs or nonmedical reasons. But while the number of kindergartners with medical exemptions has sat at around 0.2% in the past 10 years,3 the number of nonmedical exemptions has increased. In the 2022-2023 school year, over 93% of all exemptions were attributed to nonmedical reasons.2
Many public health officials aren’t surprised by the decline in vaccine coverage, although its underlying causes present unique challenges, as the COVID-19 pandemic brought with it a shift in drivers of vaccine hesitancy.
The rapid development of COVID-19 vaccines fueled skepticism and mistrust, with online misinformation further exacerbating these concerns. Additionally, the repeated administration of booster shots contributed to waning adherence. These factors have created a landscape where parental concerns about vaccines often arise from personal beliefs and political ideologies rather than doubts about their effectiveness or safety. According to Glen Nowak, lead author of a study reviewing data on vaccination rates and acceptance published in Pediatric Clinics of North America,4 whereas health care professionals are trained to address concerns based on effectiveness or safety, “successfully addressing vaccine hesitancy based on philosophical or political values is a much harder hurdle for health care providers and public health experts to overcome.”
The decline in vaccination rates has contributed to a surge in preventable disease. Measles—which was previously eliminated in 2000—and whooping cough cases are at their highest levels since 2019.3 Additionally, the number of flu-related pediatric deaths this season is already at its highest level since the 2009 pandemic.5
Key players have implemented several initiatives to increase vaccine uptake. One notable change has been expanding the role of pharmacists. In at least 33 states, pharmacists are permitted to administer vaccines to children under the age of 7.6
Additionally, the federal Vaccines for Children (VFC) program offers free vaccines to children whose families cannot afford them, as recommended by the CDC’s Advisory Committee on Immunization Practices. To ensure eligible children receive these vaccines, at least 2 states have acted: Arkansas allows pharmacists participating in VFC to administer vaccines to children aged 3 to 6, and in Colorado, pharmacists who administer vaccines to children through the medical assistance program are eligible for reimbursement, provided their pharmacy is enrolled in VFC.7
Despite efforts to improve vaccination rates, nationwide coverage among kindergarten students remains below pre-pandemic levels, and exemptions have increased. Since clusters of unvaccinated children can lead to outbreaks, it’s crucial that immunization programs, schools, and providers ensure children are fully vaccinated prior to school entry. Further, a deeper understanding of the underlying reasons behind exemptions can guide the development of policies that can increase vaccination coverage.2
READ MORE: Immunization Resource Center
