Growing Vaccine Hesitancy Puts U.S. Communities at Risk
Vaccine refusal among U.S. children is on the rise, leaving more communities exposed to preventable illnesses like measles, which is spreading at alarming rates in several states. Recent research highlights that exemption rates for school-required immunizations are climbing, particularly for nonmedical reasons, creating riskier gaps in population immunity.
Nonmedical Exemptions Drive the Trend
A study published in JAMA examined county-level vaccination data and found that more than half of U.S. counties have seen a rise in nonmedical exemptions since the COVID-19 pandemic began. These exemptions, often citing personal or religious beliefs, have grown significantly, while medical exemptions — for children with serious allergies or immune system issues — have remained relatively steady.
“The science supporting vaccines has not changed,” said Dr. Jesse Hackell, pediatrician and lead author of a policy statement from the American Academy of Pediatrics. “Vaccines are safe, effective, and lifesaving. What has changed is the spread of misinformation and political debates around them.”
The analysis compared kindergarten vaccination data from before the pandemic to recent figures. Researchers found that the median nonmedical exemption rate rose from 0.6% in 2010-2011 to over 3% in 2023-2024. About 53% of counties recorded at least a one-point increase, while roughly 5% of counties saw increases of five points or more.
Localized Outbreaks Highlight the Risk
Small areas with low vaccination rates can have a disproportionate impact on public health. Dr. Nathan Lo, infectious disease expert at Stanford University, emphasized that national averages often hide “hot spots” where outbreaks are more likely.
Spartanburg County, South Carolina, serves as a stark example. Nonmedical exemptions there jumped from 2% in 2014 to nearly 8% in 2024, coinciding with a growing measles outbreak that now involves more than 400 confirmed cases. Hundreds more remain quarantined after exposure, and the outbreak continues to spread through schools, churches, and public events.
“The undervaccinated pockets are connected through geography and daily interactions,” Lo explained. “Even counties with higher vaccination rates can experience outbreaks if nearby areas have large exemption clusters.” Cases linked to Spartanburg travel have already been reported in North Carolina and New Mexico.
Most measles infections have occurred in unvaccinated children, underscoring the role of immunization in preventing outbreaks. Experts warn that clusters of low vaccination coverage put not just local communities, but entire regions, at risk.
Policy and Prevention Strategies
Several states, including California, Connecticut, Maine, and New York, have successfully removed nonmedical exemptions, resulting in higher vaccination coverage. Conversely, states such as Florida are moving to eliminate school vaccine mandates, raising concerns about future disease spread.
Legislation remains the most effective tool to maintain high immunization rates. Alongside legal measures, consistent guidance from healthcare providers and public health messaging are critical to addressing vaccine hesitancy.
“The majority of parents continue to vaccinate,” Hackell said. “Choosing to immunize reflects a commitment to protecting not only one’s own child but also the wider community. Vaccination remains the social norm and the best defense against preventable diseases.”
Despite rising exemptions, federal data show that over 96% of kindergartners nationwide were vaccinated in 2024-2025. However, growing pockets of hesitancy highlight the ongoing need for vigilance and targeted interventions at the local level.
