US Child Vaccination Rates Decline as Non-Medical Exemptions Hit Record High

The safety net of community immunity is fraying. For decades, the standard for public health was simple: maintain a 95% vaccination rate to protect those who cannot be immunized, such as infants or the immunocompromised. Now, that threshold is slipping. According to an analysis by Stateline, 33 states fell below herd immunity in the 2024-25 school year, a rise from the 28 states that were below that mark in 2018-2019.

The consequences are no longer theoretical. These immunization gaps have triggered measles outbreaks in multiple states and resulted in the highest number of cases since the U.S. declared the disease eliminated in 2000.

The Shift Toward Non-Medical Exemptions

While medical exemptions have remained stable at 0.2%, the surge in parents opting out for personal or religious reasons is driving the decline. In the 2024-25 school year, non-medical exemptions hit a record 3.4%, meaning roughly 138,000 kindergartners received an exemption from at least one vaccine.

The disparity between states is stark. In Connecticut, which stopped allowing religious exemptions in 2021, the non-medical exemption rate is just 0.1%. Conversely, Idaho allows both personal and religious exemptions, and 15% of its children have a non-medical exemption for at least one vaccine. This correlation is reflected in the coverage rates: Connecticut reported 98.2% MMR coverage, while Idaho reported just 78.5%.

This trend has flipped the national leaderboard. Before the pandemic, Mississippi and West Virginia led the nation with roughly 99% kindergarten vaccination rates in 2018-2019. By the 2024-25 year, Connecticut, New York, and Maine took the top spots because they reined in exemptions to school requirements.

Political Influence and the ‘Science’ Debate

The decline isn’t happening in a vacuum. Doctors point to the influence of federal leadership and a growing culture of distrust. Under U.S. Health and Human Services Secretary Robert F. Kennedy Jr., federal support for vaccination has slid, and federal health officials have cut back the number of recommended vaccines.

“If they hear something about it in the news, then it must be right, they think… Nothing has changed about the science. But people who don’t know science are making decisions.”

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Dr. Patricia Tibbs, Mississippi pediatrician

The tension has reached a breaking point among state leaders. On January 26, a group of 15 Democratic governors known as the Governors Public Health Alliance endorsed vaccination standards from the American Academy of Pediatrics, explicitly choosing those over the federal government’s guidelines. This move comes as some federal advisory figures, including pediatric cardiologist Kirk Milhoan, have suggested in public forums that individual freedom may outweigh community health protections for diseases like polio and measles.

Enforcement Failures in Pennsylvania

While some parents are using legal exemptions, others are entering classrooms without shots and without any legal excuse. A six-month investigation by the Pittsburgh Post-Gazette revealed a systemic failure in Pennsylvania, where school leaders allowed thousands of children into classrooms in violation of state vaccine laws.

The numbers suggest a crisis of oversight.

This failure is particularly poignant in Pittsburgh, where the Arsenal Elementary School was the site of the first public trial of the polio vaccine in 1954, led by Dr. Jonas Salk.

The Counter-Trend: Accessibility and Education

Despite the national decline, localized efforts show that the trend can be reversed. In Keighley, West Yorkshire, Dr. Zoyah Hussain has helped her community buck the national trend by focusing on accessibility and visibility. By moving clinics into shopping centers and using welcoming environments with toys and beanbags, her network has seen a dramatic shift in uptake.

Vaccine Metric (Keighley Network)	Previous Rate	Recent Rate
First MMR Dose Uptake	54%	87%
First Set of Immunizations (under age 1)	62%	92%

Hussain’s approach emphasizes that the root cause of vaccine hesitancy is often a lack of understanding.

The path forward remains a tug-of-war between policy and public trust. As IVAC Executive Director Dr. William Moss noted, reversing these declines requires strengthening public trust in the safety and effectiveness of vaccines. Without that trust, or the strict enforcement of existing laws, the gap between current coverage and herd immunity will continue to leave children vulnerable to diseases that were once considered conquered.