Drop in routine vaccinations

Driven by an increase in vaccine exemptions and misinformation.

CDC released the latest vaccine exemptions and routine vaccination rates data for last school year. This, coupled with new data on growing acceptance of vaccine misinformation, shows a slow, painful bleed.

Here’s the data story.

Routine vaccinations decline

A few years ago, rates of routine vaccines (i.e., DTaP, measles, mumps, rubella, and polio) began to decline. Last school year, vaccine coverage among kindergarten students hit a new low—93%.

This seems high. It is high. But we must keep it that way because some diseases, like measles, require 95% coverage to maintain herd immunity.

Unfortunately, concerning trends are developing on a state level. For example, thirty-six states are below the MMR (measles, mumps, rubella) coverage threshold of 95% for kindergartners. The state with the lowest vaccination rate is Idaho (81%). This means 250,000 kindergartners are at risk for measles infection today.

This provides large pockets of unvaccinated people—a breeding ground for infectious diseases. Take Ohio, for example, which had the 9th lowest coverage in MMR vaccination last year. It’s no coincidence that there was a measles outbreak last year—85 children got sick, and 36 were hospitalized.

The role of exemptions

School mandatory vaccination is one the biggest drivers of vaccination. Exemptions—parents opting out for medical or non-medical reasons—are low (3%) but rapidly increasing. Non-medical exemptions—for religious or philosophical reasons—are driving the change. Research shows that non-medical exemptions are more common in areas with a higher percentage of a White population and higher income.

Ten states have exemptions exceeding 5% of kindergarteners. Idaho has by far the highest exemption rate at 12%.

The states with the fastest-growing rate of vaccine exemptions are Hawaii, Idaho, Oklahoma, Louisiana, and Oregon. This acceleration started in 2020 and hasn’t slowed.

Five states do not allow non-medical exemptions. For example, after the massive Disneyland measles outbreak in 2015, California eliminated non-medical exemptions from school-entry vaccination requirements. While some parents found workarounds, this policy change had an overall direct impact on exemptions. Maine has a similar story.

What is indirectly causing a decline in vaccinations?

Misinformation is increasing. Our information landscape has dramatically changed—false news spreads 6 times faster than the truth on social media, and 70% of Americans get health news on social media. Public health has not kept up.

This is directly impacting behaviors like getting vaccinated. A recent Annenberg report asked Americans whether certain statements about vaccines were true. They found a consistent theme: a growing acceptance of vaccine misinformation. For example, 1 in 8 people believe there are toxins, like antifreeze, in vaccines.

Loss of trust in institutions also drives misinformation and behaviors. This isn’t unique to public health but will surely have dire consequences to communities.

Disruption in care. During the pandemic, many children missed their regular doctor visits and thus missed their vaccines. Routine vaccination is rebounding, but specific demographics, like those living in poverty or rural areas, remain lower than pre-pandemic rates.

What does this mean for you?

Depending on where you live, measles, polio, and other outbreaks may start popping up around you and in the news, like the measles outbreak in Ohio or the polio outbreak in New York that prompted a state of emergency.

If your child is fully vaccinated, there isn’t cause for concern. But, many children <12 months cannot be fully vaccinated because they aren’t eligible yet.

Bottom line

We are moving backwards, which means we will likely see the resurgence of infectious diseases once considered 19th-century problems. It’s hard to watch this slow bleed because it is preventable.

Love, YLE

---

In case you missed it:

• The science (and business) behind COVID-19 disinformation.

• COVID-19 vaccines and sudden deaths: Separating fact from fiction

  ---

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH Ph.D.—an epidemiologist, wife, and mom of two little girls. During the day, she is a senior scientific consultant to several organizations, including the CDC. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health world so that people will be well-equipped to make evidence-based decisions. This newsletter is free, thanks to the generous support of fellow YLE community members. To support this effort, subscribe below: