Increase in the proportion of U.S. kindergartners who remained unvaccinated last year, coinciding with an upsurge in measles cases.
Rising Non-Medical Vaccine Exemptions and Measles Outbreaks in the US
A concerning trend in the US is the increase in non-medical vaccine exemptions among kindergartners, reaching a record 4.1% exemption rate in the 2024-25 school year. This marks the third consecutive year of increasing exemptions, predominantly for nonmedical reasons such as parental refusal.
This increase in exemptions has coincided with a decline in measles-mumps-rubella (MMR) vaccination coverage, which fell to 92.5% of kindergartners in 2024-25, down from 95% before the COVID-19 pandemic. The recent drop below the critical 95% threshold raises the risk of measles outbreaks.
The worst measles outbreak in more than three decades in the US has seen over 1,300 reported cases so far in 2025. This surge in measles cases aligns with the declining vaccination rates and rising exemptions, illustrating the direct public health impact of lax vaccine requirements and higher exemption levels.
Research on policy interventions indicates that stricter immunization laws eliminating non-medical exemptions can effectively increase vaccination rates and reduce outbreaks. For example, California's 2016 law removing non-medical exemptions correlated with a significant rise in vaccination coverage.
In Texas, MMR coverage has been trending down for at least a decade, with just 93.2% coverage among kindergartners. Starting in September, the affidavit form to file for an exemption will be available to print from the state health department's website without the need for a written request.
Health experts, such as Williams, are expressing concern over the increasing number of requests from families worried about measles transmission in schools and daycare centers. The decline in vaccination coverage for measles and other diseases is always concerning, but the ongoing measles outbreak may raise the urgency around the need to vaccinate.
| Aspect | Trend/Impact | |-----------------------------|----------------------------------------------------------------------| | Non-medical exemptions | Increasing, now at 4.1% nationwide for kindergartners | | MMR vaccination coverage | Declined to 92.5%, below herd immunity threshold (~95%) | | Measles outbreaks | Worst in 30+ years, with over 1,300 cases in 2025 | | Policy efficacy | States removing non-medical exemptions see increased vaccination rates | | MMR coverage in Texas | Trending down, with 93.2% coverage among kindergartners | | Exemption process in Texas | Simplified, with affidavit form available online | | Concerns among health experts | Increasing, due to the risk of measles transmission in schools and daycare centers |
This data demonstrates a clear association between rising non-medical exemptions and declining vaccination coverage, resulting in increased measles outbreaks in the US. Strengthening immunization laws to limit or eliminate these exemptions is a key strategy to improve vaccination rates and protect public health.
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