Childhood Vaccination Rates Continue to Decline as Trump Heads for a Second Term

Routine vaccination rates for kindergarten children continue to decline in the U.S., while exemptions from school vaccination requirements, particularly non-medical exemptions, have increased. These trends began with the COVID-19 pandemic (Figure 1) and appear to be related to increasing vaccine hesitancy, fueled in part by vaccine misinformation. Furthermore, public opinion on vaccine requirements has become increasingly partisan. This policy watch provides an update on the latest trends in children’s routine vaccination and exemption rates.

Whether and how these trends are affected by the change in Presidential administration remains to be seen. While states and local jurisdictions, not the federal government, set vaccine requirements for school children, the federal government has a long-standing, evidence-based system for approving and recommending vaccines for the public, including the childhood vaccination schedule, which is used by states, pediatricians, and parents. President Trump has supported anti-vaccination attitudes and shared vaccine misinformation. On the campaign trail, he vowed to “stop all COVID mandates” and said he would cut federal funding to schools with a “vaccine mandate or a mask mandate.” Trump also announced he will be nominating RFK Jr., the former independent candidate for president who has a long record of opposing immunizations and spreading vaccine misinformation, to run the Department of Health and Human Services (HHS). If the Trump administration chooses to question or reject vaccine evidence, seeks to change the current system for recommending vaccines, or otherwise pressures states to make different decisions, it could further drive down vaccination rates among children.

What are recent trends in kindergarten children’s routine vaccination rates?

The share of kindergarten children up to date on their vaccinations continues to decline. Data collected and aggregated annually by the CDC from state and local immunization programs found that less than 93% of kindergarteners had been vaccinated with all state required vaccines, including MMR, DTaP (diphtheria, tetanus, and acellular pertussis), polio, and varicella in the 2023-2024 school year, down from 95% in the 2019-2020 (pre-pandemic) school year, and below coverage levels of the past decade. In all four school years since the pandemic began, the MMR vaccination rate has fallen below the Healthy People 2030 “target” rate of 95%, the level needed to prevent community transmission of measles, a highly contagious and life-threatening virus. This means approximately 280,000 school children were unvaccinated and unprotected against measles, and research shows the more unvaccinated children in a school, the larger risk of an outbreak becomes. While noting that widespread measles transmission risk remains low, the CDC reported as of November 7, 2024 that there have been 16 measles outbreaks in 2024 compared with four outbreaks in 2023.

Over three-quarters (39) of states had MMR vaccination rates below the “target” rate of 95% for the 2023-2024 school year, an increase from 28 states during the 2019-2020 (pre-pandemic) school year (Figure 2). Further, 14 states reported rates below 90% for the 2023-2024 school year, compared to only three states in the 2019-2020 school year. In the last year alone, over 30 states experienced declines in vaccination rates across all state required vaccines, including MMR, DTaP, polio, and varicella. There is also substantial variation in vaccination rates across states, with MMR coverage rates among kindergarteners for the latest school year ranged from a low of 79.6% in Idaho to a high of 98.3% in West Virginia. There can also be variation in vaccination coverage within states, and, when there are clusters of unvaccinated people within a specific community, the risk of an outbreak is higher.

What are recent trends in kindergarten children’s vaccine exemption rates?

At the same time, the share of kindergarten children with an exemption from one or more required vaccinations increased. The share of children claiming an exemption from one or more vaccinations rose from 2.5% in the 2019-2020 school year to 3.3% in the 2023-2024 school year, the highest national exemption rate to date. Increases in non-medical exemptions accounted for nearly all of the recent increases. Non-medical exemptions increased from 2.2% to 3.1% while medical exemptions actually declined slightly from 0.3% to 0.2% from 2019-2020 to 2023-2024. While a seemingly small increase in non-medical exemptions, any increases limit the overall share of children able to be vaccinated and make it more difficult to reach vaccination rate goals. Studies have also shown that increases in exemption rates are associated with increased risk for disease outbreaks.

Fourteen states in the 2023-2024 school year had vaccine exemption rates over 5% compared with eight states during the pre-pandemic school year (Figure 3). Those states could not reach vaccination coverage rates at or above 95% even if all non-exempt children were vaccinated (rates shown here are for exemptions to one or more vaccines, so potentially achievable coverage rates could vary by vaccine type). In the last year alone, over three quarters of states (41) have experienced an increase in the share of kindergarteners claiming an exemption for one or more vaccines. Higher exemption rates are associated with lower vaccination coverage rates, and some groups and state legislators have pushed to expand vaccine exemptions or relax vaccine requirements for school children in recent years.