School-Age Vaccine Exemptions Reach New High

November 13, 2023

Exemption rates for kindergarten immunizations reached an all-time high this year, according to a new report from the CDC.

The data in a recent Morbidity and Mortality Weekly Report highlight a growing public health concern about vaccine coverage for preventable diseases and the potential for outbreaks.

“Nationwide vaccination coverage among kindergarten students remains below pre-pandemic levels, and exemptions have increased,” the report noted. “Because clusters of under-vaccinated children can lead to outbreaks, it is important for immunization programs, schools, and providers to make sure children are fully vaccinated before school entry, or before provisional enrollment periods expire.”

Here’s what you need to know:

• Overall:  Vaccine coverage among kindergartners remained near 93 percent for all reported vaccines during the 2022–2023 school year, but the exemption rates climbed 0.4 percentage points to 3 percent.
  • Pre-pandemic vaccine coverage was at or near 95 percent, which is usually seen as the critical threshold to ensure adequate community protection.
• In Pennsylvania:  In Pennsylvania, 3.8 percent of kindergarteners had a vaccine exemption during the 2022–2023 school year, a 0.5 percentage point increase from the previous year. The vaccination rate for all reported vaccines was near 94 percent.
• State trends:  Exemptions exceeded 5 percent in 10 states (Alaska, Arizona, Hawaii, Idaho, Michigan, Nevada, North Dakota, Oregon, Utah, and Wisconsin) and have increased in 41 states.
  • Idaho had the highest exemption rate, with 12 percent of kindergarteners having a vaccine exemption during 2022.
• Action steps:  The report points to several steps to improve vaccination coverage, including “enforcement of school vaccination requirements, school-based vaccination clinics, reminder and recall systems, and follow-up with under-vaccinated students.”
• Quotable:  “It is not clear whether this reflects a true increase in opposition to vaccination, or if parents are opting for nonmedical exemptions because of barriers to vaccination or out of convenience,” the report notes. “Whether because of an increase in hesitancy or barriers to vaccination, the COVID-19 pandemic affected childhood routine vaccination.” 

HAP and Pennsylvania hospitals support the commonwealth’s effort to ensure protection against vaccine-preventable diseases. The CDC report is available to review online.