Jen Fisher can do only so much to keep her son safe from the types of infections that children can encounter at school. The rest, she said, is up to other students and parents in their hometown of Franklin, Tennessee.
Fisher’s son Raleigh, 12, lives with a congenital heart condition, which has left him with a weakened immune system. For his protection, Raleigh has received all the recommended vaccines for a child his age. But even with his vaccinations, a virus that might only sideline another child could sicken him and land him in the emergency room, Fisher said.
“We want everyone to be vaccinated so that illnesses like measles and things that have basically been eradicated don’t come back,” Fisher said. “Those can certainly have a very adverse effect on Raleigh.”
For much of Raleigh’s life, Fisher could take comfort in the high childhood vaccination rate in Tennessee — a public health bright spot in a conservative state with poor health outcomes and one of the shortest life expectancies in the nation.
Mississippi and West Virginia, two similarly conservative states with poor health outcomes and short life expectancies, also have some of the highest vaccination rates for kindergartners in the nation — a seeming contradiction that stems from the fact that childhood vaccination requirements don’t always align with states’ other characteristics, said James Colgrove, a Columbia University professor who studies factors that influence public health.
“The kinds of policies that states have don’t map neatly on to ‘red’ versus ‘blue’ or one region or another,” Colgrove said.
Advocates, doctors, public health officials, and researchers worry such public health bright spots in some states are fading: Many states have recently reported an increase in people opting out of vaccines for their kids as Americans’ views shift.
During the 2023-24 school year, the percentage of kindergartners exempted from one or more vaccinations rose to 3.3%, the highest ever reported, with increases in 40 states and Washington, D.C., according to Centers for Disease Control and Prevention data. Tennessee and Mississippi were among those with increases. Nearly all exemptions nationally were for nonmedical reasons.
Vaccine proponents worry anti-vaccine messaging could accelerate a growing “health freedom” movement that has been pushed by leaders in states such as Florida. Momentum against vaccines is likely to continue to grow with the election of Donald Trump as president and his proposed nomination of anti-vaccine activist Robert F. Kennedy Jr. as secretary of the Department of Health and Human Services.
Pediatricians in states with high exemption rates, such as Florida and Georgia, say they’re concerned by what they see — declining immunization levels for kindergartners, which could lead to a resurgence in vaccine-preventable diseases such as measles. The Florida Department of Health reported nonmedical exemption rates as high as 50% for children in some areas.
“The religious exemption is huge,” said Brandon Chatani, a pediatric infectious disease doctor in Orlando. “That has allowed for an easy way for these kids to enter schools without vaccines.”
In many states, it’s easier to get a religious exemption than a medical one, which often requires signoff from a doctor.
Over the past decade, California, Connecticut, Maine, and New York have removed religious and philosophical exemptions from school vaccination requirements. West Virginia has not had them.
Idaho, Alaska, and Utah had the highest exemption rates for the 2023-24 school year, according to the CDC. Those states allow parents or legal guardians to exempt their children for religious reasons by submitting a notarized form or a signed statement.
Florida and Georgia, with some of the lowest reported minimum vaccination rates for kindergartners, allow parents to exempt their children by submitting a form with the child’s school or day care.
Both states have reported declines in uptake of the measles, mumps, and rubella vaccine, which is one of the most common childhood shots. In Georgia, MMR coverage for kindergartners dropped to 88.4% in the 2023-24 school year from 93.1% in 2019-20, according to the CDC. Florida dropped to 88.1% from 93.5% during the same period.
Andi Shane, a pediatric infectious disease specialist in Atlanta, traces Georgia’s declining rates to families who lack access to a pediatrician. State policies on exemptions are also key, she said.
“There’s lots of data to support the fact that when personal belief exemptions are not permitted, that vaccination rates are higher,” she said.
In December, Georgia public health officials put out an advisory saying the state had recorded significantly more whooping cough cases than in the prior year. According to CDC data, Georgia reported 280 cases in 2024 compared with 96 the year before.
Until 2023, Mississippi was one of the few states that allowed parents to opt out of vaccinating their kids only for medical reasons — and only with the approval of a doctor. That gave it among the highest vaccination rates in the nation as of the 2023-24 school year.
“It’s one of the few things Mississippi has done well,” said Anita Henderson, a pediatrician who has practiced in the southern part of the state for nearly 30 years. In terms of health, she said, childhood vaccination rates were the state’s one “shining star.”
But that changed in April 2023 when a federal judge ordered state officials to start allowing religious exemptions. The ruling has emboldened many families, Henderson said.
“We are seeing more and more skepticism, more and more vaccine hesitancy, and a lack of confidence because of this ruling,” she said.
State officials have granted more than 5,000 religious exemptions since the court order allowing them, according to the state health department. Daniel Edney, the state health officer, said most of the requests have come from “more affluent” residents in “pockets” of the state.
“Most people listen to the expert opinions of their pediatricians and family medicine doctors to stay on the vaccine schedule, because it’s what is best to protect their children,” he said.
West Virginia’s vaccine law — which hasn’t allowed nonmedical exemptions — also could soon change, Matthew Christiansen said in December before he resigned as the state’s health officer.
A bill that would have broadened exemptions made it through the legislature last year but was vetoed by outgoing Republican Gov. Jim Justice. The new governor, Republican Pat Morrisey, has been a vocal critic of vaccine mandates. And just a day after being inaugurated, he issued an executive order to propose provisions by Feb. 1 that could allow religious and conscientious exemptions.
“I want to send a message that if you have a religious belief, then we’re going to have an exception,” he said at a Jan. 14 press conference. “We’re not going to be the outlier.”
People asserting their personal freedoms to decline vaccines for their kids can ultimately curtail the ability of others to live full lives, Christiansen said. “Kids getting measles and mumps and polio and being paralyzed for their whole life is an impediment on personal freedom and autonomy for those kids,” he said.
Since the covid pandemic, anti-vaccine sentiment has been growing in Tennessee. One organization, Stand for Health Freedom, drafted a letter for constituents to send to their state lawmakers calling for the resignation of the medical director of Tennessee’s Vaccine-Preventable Diseases and Immunization Program. The group said she demonstrated a “lack of respect for the informed consent rights” of the people.
“They feel emboldened by the idea that this presidential administration seems to feel very strongly that a lot of these issues should be taken back to the states,” said Emily Delikat, director of Tennessee Families for Vaccines, a pro-vaccine group.
Ultimately, like many effective public health interventions, vaccines are a victim of their own success, said Henderson, the Mississippi pediatrician. Most people haven’t seen outbreaks of measles or polio, so they forget how dangerous the diseases are, she said.
“It may unfortunately take a resurgence of those diseases to raise awareness to the fact that these are dangerous, these are deadly, these are preventable,” she said. “I hope it doesn’t come to that.”
–Daniel Chang and Sam Whitehead, NBC News/Kaiser Health News
Lisa says
Vaccines are intended to protect the individual who receives the vaccine. If you have yours, don’t worry about whether someone else does/ does not. I’m not sure how else you’d think they would work, but it’s not super-complicated.
Laurel says
Lisa: You are correct, but let’s not forget that some people are carriers and do not feel or show the effects of some diseases. That leaves the possibility of bringing disease to the more vulnerable.
I don’t particularly agree with mandates, however, at the same time, I would hope for a more considerate society. Then again, I’m often disappointed.
Laurel says
Okay, I’m going to tell you why I believe this anti-vax stuff is just another manipulation of the masses. For starters, there is no evidence, to date, that vaccines cause autism. But it certainly does distract from the fact that all of us, and I mean all of us, have particles of plastics in our bodies. We are exposed to pesticides, chemicals in our food, chemicals in our environment, chemicals in our homes, chemicals in our makeups and personal care products, along with an over abundance of plastics.
Do you hear any of the big chemical corporations stating the possibility of their products causing autism, or cancer? Nah. But, it is interesting to me that the business friendly (“Corporations are people, my friend”) political party is the first to jump on the anti-vax train.
Take care of your children.
Endless dark money says
The guy in charge of the department of health is anti vaccine. Health is woke. Diaper donny the felon is a global embarrassment. Elect clowns get a circus.
Marlow says
Two issues are in play here. #1. The lack of trust in the industry. #2. Why bother to vaccinate when millions are crossing our borders without them? The trust is gone.
Samuel L. Bronkowitz says
The Biden administration’s response to the covid pandemic reiterated to the public that the CDC is a political organization that doesn’t serve to protect the welfare of the American people. The educated opinions of scientists and doctors don’t matter whatsoever when it comes to protecting the public’s health as a whole – what matters is the education opinion of the CEO of Delta. Again, it’s all about protecting capital.
That said, Lisa is only partially correct. Vaccines do protect the individual, but also serve to protect the public as a whole. As an example, consider the polio vaccine. There have been a number of studies of paralytic polio post-1980 in places like Taiwan, The Gambia, and Nigeria that show efficacy of about 82% after the first dose of the vaccine, 96% after the second dose, and 98% after three or more doses. That means that there’s a nonzero chance of you getting polio having been fully vaccinated – in Palm Coast, which has a population of about 100k people, that’s 1000-2000 people assuming everyone is exposed and vaccinated. That’s obviously not realistic due to how people mill about but the goal here is to minimize the possibility of spreading the disease, thereby reducing the overall exposure.
On a positive note, reducing the number of immunizations kids get does have a positive effect by generating more capital. Iron lungs are expensive and so is lifelong care, so really you’re creating more jobs by not vaccinating your kids.
Endless dark money says
Crossing your border? Are you a native American? Do you typically trust felons and convicts with diarrhea of the mouth?
Dr. Stru says
Both my kids are not vaccinated. One is in their 20s and the other is a toddler. Neither are ever sick, allergies, asthma, bronchitis or mental illnesses etc..We believe in real food in our household. No fast foods, soda and junk food. Happy and healthy. Keep trusting those doctors that don’t give a dam about you! Take your health into your own hands.