Kids’ Vaccine Exemptions Tick Upward

Vaccine exemptions are slowly rising in the US, and researchers compare kids’ vaccination rates before and after the start of COVID-19.

By Erin Miller Lo

Since the first strategic vaccination campaigns of the 1950s, many of the childhood diseases that once inspired dread among families with young children are now almost entirely preventable by vaccines. In under two generations, the availability of vaccines put these diseases in our collective rearview mirror, a remarkable feat of medicine and public health. Yet today, some of the diseases our parents and grandparents once feared, like measles, whooping cough, and tuberculosis, are on the rise once again in the US. Even paralytic polio has made at least one reappearance in the last five years. Why is this happening? 

US childhood vaccination rates are declining

A collaboration of eight researchers from Columbia University, Stanford University, and Baylor College of Medicine examined vaccine exemption data for incoming kindergarteners in more than 3,000 US counties. Their goal was to describe the trends in vaccine exemptions at the county level during the time span of 2010 to 2024. They categorized the vaccine exemptions as either medical or non-medical (typically for personal beliefs or religious reasons). The researchers learned in their examination of the data that non-medical exemptions are on the rise, directly contributing to the decline of vaccination rates among children in the US. 

The researchers wanted to identify any changes in vaccine exemptions before and after the start of the COVID-19 pandemic in 2020. They separated the 15-year time span into two periods: 2010 to 2020, and 2021 to 2024, using the pandemic (2020) as the break point. They examined the vaccine exemption data at the county level, giving them a closer look at local trends. This revealed details that were not evident when looking at higher-level state data. 

Data on vaccine rates in periods pre- and post-2020

In their examination, the researchers learned that non-medical exemptions for childhood vaccines had increased since the start of the pandemic, while medical exemptions had stayed about the same for the duration of the study time period. The median rate of non-medical exemptions had increased from 0.6 percent in 2010, to 3.1 percent by 2024. In the data for the years that followed the start of the COVID-19 pandemic, researchers identified a notable increase in the median rate of non-medical vaccine exemptions compared to before 2020. The researchers used the median as a stable measure of the typical vaccine exemption rate, as it is not skewed by extremely high or extremely low rates across the country.

While the percentages are very small, an increase from 0.6 percent median rate of non-medical exemptions to 3.1 percent is a substantial and meaningful change. This type of attentiveness to even the smallest changes over time helps researchers and public health authorities identify current trends and make predictions about the future.

The COVID-19 pandemic’s influence on vaccine exemptions 

In this study, the researchers identified substantial differences in non-medical vaccine exemptions between the time period before COVID-19, and in the five years that followed. As the study authors note, a decline in vaccinations can contribute to the return of diseases once eliminated in the US by vaccines. 

The role of vaccine skepticism very likely plays a part in the increase in exemptions. Vaccine reluctance, confusion about how vaccines work and why they are needed, and disbelief in the safety of vaccines are all barriers to vaccination that are as old as vaccines themselves. The COVID-19 pandemic accelerated vaccine skepticism and politicization, and as the data in this study show, lingering fears and doubts from that era may have long-term effects on the vaccination of school-age children. 

RELATED: Vaccine Misinformation and Social Media

We can see the effects of politicization of vaccines reflected today in our federal government. In a nod to vaccine skepticism and personal choice, Robert F. Kennedy Jr., Secretary of Health and Human Services (HHS) and known anti-vaccine activist, cut six childhood vaccines from the Center for Disease Control’s (CDC) recommendations in January 2026. This action was unusual in part because it bypassed the usual CDC advisory review channels, while providing no new data or scientific evidence for the changes. Meanwhile, at the state level, hundreds of bills with goals of loosening vaccine requirements across the US have been introduced since 2021, with some states moving toward changes that could lead to further increases in non-medical exemptions. Based on their findings, the study’s authors recommend reconsideration of these policies to prevent the return of vaccine-preventable diseases in the US.

Americans still largely trust vaccines

The decline of vaccination rates is a concerning trend, and one that public health authorities should continue to monitor. But to put it into perspective, as recently as 2024, the majority of parents in a large CDC survey agreed with the importance of vaccines. More than three quarters of the parents surveyed agreed that children should be vaccinated for school. 

Many of the medical societies in the US that are influential in shaping clinical practice have vocally rejected the new CDC guidelines, in part for lack of scientific evidence for eliminating the six vaccines. Among these are the American Academy of Pediatrics, as well as the many individual pediatricians interviewed by news organizations after the CDC’s change. Most private health insurances will continue to cover the vaccines, as will government insurances such as Medicaid and Children’s Health Insurance Program. Finally, the majority of world religions continue to encourage vaccines for their adherents, as they have for years. 

This study was published in the peer-reviewed journal JAMA, the Journal of the American Medical Association.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

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