In our recent analysis, we found that nonmedical exemptions for childhood vaccinations are on the rise across the United States, a trend we should find deeply troubling. Data from 3,053 counties in 45 states and Washington, D.C. show that these exemptions have grown dramatically from just 2021 to 2024. This inflection point could not be more opposite from trends seen over the past 10 years. With vaccination rates dropping across the United States, experts are cautioning that we may soon see a return of vaccine-preventable diseases.
The report looked specifically at nonmedical exemptions data for children entering public kindergartens, underscoring the rising alarm of public health officials. The data paints a pretty clear picture. Increased Nonmed Exemptions Compared to the baseline from 2010–2020, 53.5% of the 2,842 counties with data were affected by a nonmedical exemption increase of greater than 1%. Even more alarmingly, 5.3% of counties reported an increase of greater than 5% over the same period.
Increase in Exemption Rates
The median nonmedical exemption rate has indeed increased significantly overtime. In 10 years between 2010 and 2020, this rate climbed by an average of 0.11 percentage points per year. After the arrival of SARS-CoV-2, the median rate jumped to [20] a new yearly increase of 0.52 percentage points.
By 2023-24, the median county-level nonmedical exemption rate had risen to 3.1%, compared to only 0.6% in school year 2010–11. Medical exemptions did not increase in this timeframe. That means that nonmedical reasons are driving the choice to be unvaccinated trend away from vaccinations.
Wide Variations Across States
The project’s analysis uncovered the considerable extent of county-level and between-state variations in nonmedical exemption rates, which have been climbing ever since. The states with the fastest growth rates between 2021 and 2024 were Arizona, Idaho, Oregon, Utah and Wisconsin. During this same period, California, Connecticut, Maine, and New York acted to remove nonmedical exemptions. In doing so, they experienced a drop in exemption rates.
The study found that 91.1 percent of counties had a minimum of five years of data. Further, 97.9% of the counties represented at least one year of data from the latter period. This rich dataset highlights the need for policymakers to reexamine where policy is allowing and in some cases encouraging nonmedical exemptions.
Implications for Public Health
Childhood vaccination rates are falling. Public health experts are concerned that this decline could cause a return of preventable infectious diseases. As the study authors point out, the time to act on this is now.
“US childhood vaccination rates are declining, posing the risk that vaccine-preventable infectious diseases will resurge,” – The study authors.
Given these results, the public health community is currently engaged in a vigorous discussion surrounding whether or not nonmedical exemptions contribute to lower vaccination rates.
“These findings support the need to reconsider policy on use of nonmedical exemptions, which are actively being debated, to address declining childhood vaccination in the US,” – The authors.
