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Childhood vaccination rates are dropping. Here’s why this matters

The number of incoming kindergarteners who’ve received their state-required vaccines has been dropping since the 2019-2020 school year, according to the CDC. 

A person inserts a needle of a vaccine into a child's arm.
Nationwide vaccine rates of incoming kindergartners has been falling since the 2019-2020 school year. Photo by Dinendra Haria / Sipa via AP Images

At the start of the 2019-2020 school year, vaccination rates for incoming kindergartners across the country were about 95%, according to the Centers for Disease Control and Prevention. At the start of 2022-2023 school year, this coverage dipped to 93%.

While the drop may seem small, it represents hundreds of thousands of children and a slip away from herd immunity for diseases like the measles, according to Neil Maniar, professor of the practice in health sciences at Northeastern University. This places people who cannot be immunized for medical reasons at risk of getting the measles, which is highly contagious and can lead to severe illness.

“In order to have herd immunity for the measles, you need 95% of the population immunized and in areas where we have childhood vaccination rates that have dropped down to 93% or even lower, it means that we’re not even reaching the threshold for herd immunity for some of these critical vaccinations,” Maniar said. “That is definitely troubling.”

The CDC reported that in the 2022-2023 school year, national coverage for the measles, mumps, rubella and polio was at 93.1%. The overall national exemption rate for vaccines increased to 3%, with 10 states having over 10% of incoming kindergartners with vaccine exemptions. Exemptions increased in 41 states nationwide.

Susan Mello, an associate communications studies professor and expert in health communications, said overall, the vaccination rates are high nationally, with some areas of the country vaccinating kindergartners with an exemption rate under 1%.

“Parents are actually doing a great job complying with these recommendations,” Mello said. 

But some areas are seeing a decline more than others. The CDC reported vaccine exemption rates among kindergartners at more than 5% in Hawaii, Michigan, Nevada and Oregon. Idaho’s vaccine exemption rate was over 12%. This puts these areas at a risk for disease outbreak.

While vaccine hesitancy and distrust was an issue prior to COVID-19, vaccination rates had remained steady for 10 years leading up to the pandemic. 

The drop in childhood vaccine rates can be attributed to several factors, Maniar said. This includes a disruption in routine health care during the pandemic, misinformation spreading about vaccines and a general distrust in public health.

“There has been sort of an increasing distrust in, not just vaccinations, but with the public health system,” Maniar said. “There’s a larger backlash in some areas around public health measures. … During the pandemic, there was also a lot of disruption in regular health care routines and … access to the health care system in general. Children being out of school for a period of time was also disruptive because parents might feel that because their kids are not going into school into a school building, (so) they don’t need to get vaccinated.”

Many parents worry childhood vaccines aren’t safe. This mindset isn’t new. But Maniar said social media allows for misinformation about vaccine safety to spread further than it has in the past. There’s also dissenting voices out there with significant platforms, such as Florida’s surgeon general, who went against guidance when it came to the state’s recent measles outbreak.

“One of the most important things that we can do, should continue to do, and do more of is to educate communities about the importance of (vaccines) to really make sure that the way in which information is being communicated is accessible to all different communities,” Maniar said. “We really do need to counter all of the misinformation that is out there. … The vaccines that are a part of the childhood vaccination schedule have been shown over and over again to be very safe (and) very effective.”

While vaccine mandates may seem like the answer, Maniar added that areas with higher COVID vaccination rates were ones in which communities got information about the vaccines and were able to make the decision to get vaccinated on their own.

One solution is for doctors to listen to concerns from parents unsure about vaccinations and remind them of the risks of not vaccinating, as well as presenting them with the facts.

“We’re always questioning because we love our children and we want them to be healthy and safe,” Mello said. “If there are parents out there who are yelling loudly and their voices are being picked up by mainstream media and in social media … it creates uncertainty. There are always going to be outliers. There will always be some scientists who, for whatever reason, go against the consensus. The safest bet is to align with the consensus.”

Mello said it’s also crucial that doctors not judge patients and prepare them for side effects of vaccines as studies show many children don’t get a second dose of vaccines if they had a negative reaction to the first one.

“It comes back to the inner personal interactions that we have with friends and family and with doctors,” she added. “From what I’ve seen, it’s showing empathy, showing concern and respect for the uncertainty that people are feeling, whether it’s in an interpersonal conversation or a conversation between a doctor and a patient or a parent who is always making space and listening to their concerns. You don’t want to have a doctor who seems like all of their concerns are unfounded.”