A sign at a University of Utah clinic warns visitors about the spread of measles. Under the Trump administration, federal health officials have cut the number of recommended vaccinations, and more states are offering exemptions for parents who don’t want to vaccinate children attending public schools. (Photo by McKenzie Romero/Utah News Dispatch)
States that were leaders in vaccinating children before the pandemic are losing ground as exemptions and unfounded skepticism take hold, encouraged by the stance of the Trump administration under U.S. Health and Human Services Secretary Robert F. Kennedy Jr.
Expanded exemptions for parents are likely to cause both Mississippi and West Virginia to fall from the national top spots they held before the pandemic, according to a Stateline analysis Federal data. Other states like Florida, Idaho, Louisiana and Montana are also pushing the limits when it comes to choosing a vaccine.
The analysis found that at least 33 states did not reach herd immunity in the 2024-25 school year, compared to 28 states before the pandemic in 2018-2019. Herd immunity refers to the percentage of people who must be vaccinated or otherwise immune to an infectious disease in order to contain its spread.
Research shows that in the case of measles – a highly contagious disease – states must maintain at least 95% vaccination rates to protect people who cannot be vaccinated. Other diseases have similar herd immunity rates. People who cannot be vaccinated may include infants who are too adolescent to receive certain vaccines and those with underlying medical conditions.
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Misinformation and expressions of distrust from influential leaders are impacting parents, doctors say, as are modern government exemptions that make it easier for families to forego vaccinations.
Some people who have never questioned vaccines before are noticing a national debate and are confused, Dr. Patricia Tibbs, a pediatrician in rural Mississippi and president of the Mississippi chapter of the American Academy of Pediatrics. New religious exemptions could already be leading to a rise in whooping cough, also known as whooping cough, in Mississippi, she said.
“If they hear something about it on the news, they think it must be right,” Tibbs said. “We’re just following the guidelines and informing patients that this is a scientific discussion. The science hasn’t changed. But people who don’t know the science are making decisions.”
Nothing has changed in science. But people who don’t know the science make decisions.
– Dr. Patricia Tibbs, a pediatrician from Mississippi
Under Kennedy’s leadership, federal support for vaccinations has continued to decline, with many states joining in Movement to chart their own course by following more scientifically based recommendations from doctors. On January 26, the Governors Public Health Alliance, a group of 15 Democratic governors, endorsed vaccinating children and adolescents Standards by the American Academy of Pediatrics and not the federal government.
Federal health officials in the Trump administration have reduced the number of recommended vaccinations. The chairman of a vaccine advisory committee, pediatric cardiologist Kirk Milhoan, suggested in a Jan. 22 podcast that individual freedom is more essential than protecting community health through vaccines, even for measles and polio.
New leading states
According to the Stateline analysis, Mississippi and West Virginia had the highest kindergarten vaccination rates in the country before the pandemic. Approximately 99% of kindergarten students in every state received required vaccinations before attending public schools during the 2018-2019 school year.
In the latest statistics for 2024-25, Connecticut ranked first, followed by New York and Maine. These states have narrowed exemptions from school vaccination requirements, while Mississippi and West Virginia have begun allowing additional exemptions.
West Virginia did not report any vaccinations to the federal Centers for Disease Control and Prevention for the 2024-25 school year. The state Department of Health told Stateline the data would not be available until later this year.
But the state will likely be pushed out of the top 10. Republican Gov. Patrick Morrisey issued an executive order a year ago giving parents the right to request exemptions for religious reasons. So far, the state has approved 693 such requests for the current school year, spokeswoman Gailyn Markham wrote in an email. That alone is enough to significantly shift the country’s ranking.
Stateline calculated an average of required kindergarten vaccination rates to compare states. The analysis uses 2018-19 as a pre-pandemic baseline because a gigantic number of states did not report the information in 2019-20 in the chaos that followed the early COVID-19 spikes and school closures.
A January study The study, published by JAMA Pediatrics, found increased vaccination rates among kindergartners in states that repealed nonmedical exemptions, suggesting that the repeals “played a role in maintaining vaccination rates in repeal states during a time of increased vaccine hesitancy.”
Requirements and Exceptions
All 50 states and the District of Columbia require students to have certain vaccinations before attending public school. They all also allow exemptions for children who cannot receive vaccinations for medical reasons, and most states allow exemptions for non-medical purposes, often for religious or sometimes personal reasons. But the administration of Republican Florida Gov. Ron DeSantis did suggested to drop all requirements, and Idaho enacted a Law of 2025 Allow exemptions from vaccinations for any reason. Idaho had the lowest rate of kindergarten vaccinations, about 80%, in the 2024-25 school year before the law took effect last July.
Louisiana passed a law in 2024 drop COVID-19 vaccine requirements for public schools, and the state has decided to do so Stop the advertising about flu shots and ending public vaccination clinics.
A Florida bill The bill, which passed out of committee in January, would maintain school vaccination requirements but expand exemptions to include “reasons of conscience,” as well as medical and religious reasons.
Dr. Jennifer Takagishi, a Tampa pediatrician and vice president of the Florida chapter of the American Academy of Pediatrics, said the organization opposes both the DeSantis administration’s proposal to lift the vaccination requirement and the bill that would expand the exemptions. Florida’s kindergarten vaccination rate has fallen from 94% before the pandemic to about 90% in 2024-25, according to the Stateline analysis.
“They are ignoring the 90% of their voters who want vaccines and want to stay safe,” Takagishi said. “Lawmakers are listening to the louder voice of anti-vaccination activists and not to the majority. We also know that there are teachers in the school system and school nurses who are resisting this because it puts them at risk.”
All states except Montana report kindergarten vaccination statistics to the federal government. Montana enacted a 2021 law Making vaccination status private and unavailable for statistical reporting, despite the objections of medical experts. The law also made medical exemptions easier for families who believe their children have been harmed by vaccines.
said Dr. Lauren Wilson, pediatrician and then-vice president of the Montana chapter of the American Association of Pediatrics in a hearing that the law would result in “vaccination information becoming unavailable to respond to and mitigate public health emergencies.”
“Vaccines have saved millions of lives. I have personally seen cases of tetanus, whooping cough, measles and meningitis and the tragedies they cause to families,” Wilson said in her statement.
A Court order 2023 forced Mississippi to accept religious exemptions. West Virginia allows religious exemptions under the governor’s order last year.
Tibbs, who practices pediatrics in rural Jones County, Mississippi, said she has seen more whooping cough than usual and believes vaccine exemptions could be a factor.
In Mississippi, where 394 religious exemptions were reported for the 2024-25 school year, overall rates this year remained high enough, at about 97.8%, to ensure “herd immunity” in most cases.
Mississippi has granted 617 religious immunization exemptions for kindergarten students this school year, about 1.8% of the class, according to Amanda Netadj, immunization director for the state health department. Approximately 96.3% of kindergarten students have received all required vaccinations this year.
But the number of whooping cough cases in the state last year was at its highest in at least a decade, health officials said in September announced An infant had died from the disease – the first death from whooping cough in the state in 13 years.
“We have a lot of people who get the religious exemption,” Tibbs said. “Still, most of my patients will be vaccinated on any given day. We’re keeping our fingers crossed that the numbers stay high enough.”
Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.
This story was originally produced by State borderwhich is part of States Newsroom, a nonprofit news network that includes West Virginia Watch, and is a 501c(3) public charity supported by grants and a coalition of donors.
