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:
“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:
Katelyn,
I think you misplace blame on social media for the drop in routine vaccinations.
Facebook was launched in 2004, Twitter in 2006. RFK Jr published "Deadly Immunity" in Salon and Rolling Stone in 2005. On The Daily Show Jon Stewart favorably interviewed RFK Jr later that year [1]. Joe Rogan launched his podcast the end of 2009. By 2022 Rogan had on some 2,000+ guests before finally interviewing RFK Jr. (I'm going to use RFK Jr as a surrogate for the spread of "disinformation").
All the tools for "mis/dis/mal information" have existed for a generation. Look at the google trend for RFK Jr [2]. Zero interest in him for 16 years following his Daily Show appearance. Clearly the arrival of social media did nothing for his reach.
What did make interest in his ideas explode?
As you said:
"Loss of trust in institutions"
Why does this only get a single sentence when it is the *primary* reason for the drop in routine vaccinations in your piece today?
You have a unique position to help the CDC. If you are truly interested in "righting the ship", there has to be self-reflection and accountability for the many mistakes made the past 3 years.
"The Institutions" were wrong about cloth masks, closing schools, vaccine mandates, and the vaccine making you a "dead end" for the virus [4] - all of which were incorrect ideas spread through social media. I'm not here to debate those points because they should be self-evident at this point.
-No one - republican or democrat - is wearing masks any more despite the high support 3 years ago in the West. (barring small echo chamber pockets on social media claiming to do so)
-Even you have admitted that closing schools was an area you were mistaken.
-Every country rolled back it's vaccine mandate once they became overrun with Covid despite 95% coverage.
-All countries except 4 now only recommend the vaccine to 60-65. This year boosters are at 5% uptake so it can't be just "republicans".
-Countries around the world are throwing away unused doses and cancelling contracts.
-Pfizer stock is at a 7 year low, Moderna back to pre-vaccine price of October 2020.
Again, self evident.
The globe has rejected the Covid vaccine just as fast as it embraced it. And it's not a "chicken or egg" philosophical question how this happened. RFK didn't somehow crack into the mainstream conversation, despite 18 years of trying, on his own - it was the failure of PH which made the public go searching elsewhere for answers, and they stumbled upon him.
Public Health suspended the key ethic of informed consent, convinced over half the world that they should mock, fire, and shun anyone who resisted, and is now left holding the bag" after cases and deaths exploded despite their predictions.
People who took the shot and felt like crap, only to feel like crap again when they got the virus anyway are not being "swayed by misinformation" in now rejecting further shots. They are clearly asking a logical question "If Public Health could be wrong on this, what else were they wrong on?"
That is why routine vaccines dropped. It's not rocket science. This was a self inflicted error by PH which created a chasm in trust. Trust is very hard to reclaim.
When someone wants to regain trust, they begin by acknowledging their mistakes and demonstrate contrition. That is what public health needs to do.
All I see is blame. Blame the republicans. Blame social media. Blame Joe Rogan. Blame Facebook, Twitter, YouTube and Reddit because they stopped censoring wrong-think.
Step back for a minute. Our government actually paid comedians and screenwriters [3] to promote a brand new pharma product which didn't do what it was supposed to [4], and lead to some of the most cringeworthy television in history [5], and there is no apology for Colbert's "VaxxScene" dance. He used to be funny. Now look at him. [6]
Do you truly want to help PH regain trust? What would that take?
______________________
[1] This is wild to watch to remember how controversial subjects used to be hashed out:
https://www.cc.com/video/uwf623/the-daily-show-with-jon-stewart-robert-f-kennedy-jr
(someone should archive this video for posterity)
[2] https://trends.google.com/trends/explore?date=all&geo=US&q=RFK%20Jr&hl=en
[3] https://thepeoplesvoice.tv/bidens-hhs-and-cdc-paid-screen-writers-and-comedians-to-mock-the-unvaccinated/
[4] https://docs.google.com/document/d/1ndHlJkSnQ7wqYxUQROcN6jBY154HZOK4Z8pZATC0DbQ/edit?usp=sharing
[5] https://www.youtube.com/watch?v=sSkFyNVtNh8&t=2s
[6] https://www.thewrap.com/the-late-show-canceled-tuesday-stephen-colbert-has-covid/
My son's 2nd grade class just had a child return from having chicken pox. How do you not vaccinate against chicken pox? And why would you want to expose your child to that? Plus the risk of shingles later in life? It's unbelievably scary what misinformation is doing.