With the measles outbreak in West Texas and New Mexico growing, and cases cropping up in communities across the country, experts say it’s time for school leaders to take stock of their local vaccination rates.
School districts have little control over the vaccinations students are required to get before starting classes, but experts say it’s important for leaders to be aware that communities with lower vaccine rates could be more vulnerable to disease outbreaks—and to take steps for the possibility of an outbreak.
Outbreaks of once-eradicated diseases, like measles, are becoming increasingly common and more severe as childhood vaccination rates decline. In recent years, more families have opted out of vaccines for their children using religious and philosophical exemptions allowed by state laws, rather than just for medical reasons, such as when an autoimmune disease or other medical condition keeps a child from being able to get a shot.
State laws—not federal law or individual district policies—dictate which vaccines are required for local students and the reasons for which parents may opt their children out of receiving those vaccines. All 50 states have vaccine requirements for children entering school, and nearly all allow parents to opt children out of those vaccines for nonmedical reasons.
The exact language varies state to state, but, states generally allow children to be opted out of vaccine requirements for religious reasons. Every state allows students to opt out for medical reasons.
Just a fraction of states don’t offer nonmedical exemptions of any kind, according to an Education Week analysis of state statutes. The four states that only allow medical exemptions are California, Connecticut, New Mexico, and Maine.
West Virginia Gov. Patrick Morrisey in January signed an executive order allowing parents and guardians to opt their children out of immunization requirements based on philosophical or religious reasons, and lawmakers are considering legislation to enshrine that order into state statute. The state Senate has already passed that legislation.
The rate of families seeking nonmedical exemptions has been on the rise.
In the 2023-24 school year, vaccination coverage among kindergartners in the United States decreased for all reported vaccines from the year before, while exemptions from one or more vaccines among kindergartners increased to 3.3 percent, from 3 percent the year prior. Exemptions increased in 40 states and the District of Columbia, with 14 states reporting exemptions exceeding 5 percent of kindergartners for one or more vaccine.
All states require a vaccination for kindergartners that protects against measles, mumps, and rubella. When administered the recommended two times, the MMR vaccine is about 97 percent effective and usually protects the recipient for life.
But, nationally, the vaccination rate for measles for kindergartners in 2023-24 was just under 93 percent, more than 2 percentage points lower than the 95 percent experts recommend striving for to achieve herd immunity. The MMR vaccination rate in the 2019-20 school year was 95.2 percent.
Most states with kindergarten measles vaccination rates above 95 percent are in the Eastern half of the United States, and most Eastern states’ rates are above 90 percent, according to an EdWeek analysis of national data.
Many of the states with rates below 90 percent are in the West. The states with the lowest measles vaccination rates are Idaho (79.6 percent) and Wisconsin (84.8 percent). The states with the highest rates are West Virginia (98.3 percent) followed by New York and Connecticut (97.7 percent).
The statewide rates can obscure major differences within states.
In Texas, where a deadly measles outbreak had sickened 259 people—mostly school-aged children—as of March 14, the statewide kindergarten MMR vaccination rate is 94 percent. Most confirmed cases, however, are concentrated in a Gaines County where nearly 18 percent of kindergartners had a conscientious exemption to vaccine requirements for the 2023-24 school year. That’s one of the highest rates in Texas, and Gaines County has had one of the highest exemption rates for years.
Nationally, 3.3 percent of kindergartners in the 2023-24 school year had an exemption for one or more required vaccine. Nonmedical exemptions are far more common than medical ones. Less than one half of 1 percent of kindergartners had a medical exemption, and 3.1 percent had a nonmedical exemption.
Nonmedical exemptions accounted for almost 100 percent of the increase in exemptions from 2022-23, when the exemption rate was 3 percent.
