There’s little Jen Fisher can do to protect her son from the types of infections kids 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 received all the vaccinations recommended for a child his age. But even with his vaccinations, a virus that might just sideline another child could make him sick and land him in the emergency room, Fisher said.
“We want everyone to be vaccinated so that diseases like measles and other diseases that have been eradicated don’t come back,” Fisher said. “It can certainly have a very negative effect on Raleigh.”
For much of Raleigh’s life, Fisher was able to take solace in Tennessee’s high childhood vaccination rate — a public health bright spot in a conservative state with poor health outcomes and one of the shortest life expectancies in the country.
Mississippi and West Virginia, two equally conservative states with poor health outcomes and short life expectancies, also have some of the highest kindergarten vaccination rates in the country – an apparent contradiction that comes from fact that the requirements for childhood vaccinations do not always correspond to the requirements for childhood vaccinations. Other characteristics of states, said James Colgrove, a professor at Columbia University who studies factors that influence public health.
“The types of policies states are putting in place don’t clearly line up with ‘red’ versus ‘blue’ or one region or another,” Colgrove said.
Advocates, doctors, public health officials and researchers worry that these public health bright spots are fading in some states: Many states have recently reported an increase in the number of people forgoing vaccines for their children as Americans’ opinions change.
In the 2023-24 school year, the percentage of kindergartners exempt from one or more vaccinations reached 3.3%, the highest on record, with increases in 40 states and Washington, D.C., according to data from the Centers for Disease Control and Prevention. Tennessee and Mississippi were among those with increases. Almost all exemptions at the national level were for non-medical reasons.
Vaccine advocates worry that anti-vaccine messaging could accelerate a growing “health freedom” movement pushed by leaders in states like Florida. Momentum against vaccines will likely continue to grow with the election of Donald Trump to the presidency 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 are concerned about what they are seeing: a decline in vaccination levels of kindergartners, which could lead to a resurgence of diseases preventable by vaccination, such as measles. The Florida Department of Health has reported non-medical exemption rates as high as 50% for children in some areas.
“The religious exemption is huge,” said Dr. Brandon Chatani, a pediatric infectious disease specialist in Orlando, Florida. “This allowed these children to easily enter schools without vaccines. »
In many states, it is easier to obtain a religious exemption than a medical exemption, which often requires a doctor’s approval.
Over the past decade, California, Connecticut, Maine and New York have removed religious and philosophical exemptions from school vaccination requirements. West Virginia didn’t have one.
Idaho, Alaska and Utah had the highest exemption rates for the 2023-2024 school year, according to the CDC. These states allow parents or legal guardians to exempt their children for religious reasons by submitting a notarized form or signed declaration.
Florida and Georgia, with some of the lowest reported minimum vaccination rates for kindergartners, allow parents to exempt their children by submitting a form to the child’s school or daycare.
Both states reported a decline in uptake of the measles, mumps and rubella vaccine, which is one of the most common childhood vaccines. In Georgia, MMR coverage for kindergartners fell to 88.4% in the 2023-2024 school year, compared to 93.1% in 2019-2020, according to the CDC. Florida dropped to 88.1% from 93.5% during the same period.
Dr. Andi Shane, a pediatric infectious disease specialist in Atlanta, attributes the lower rates in Georgia to families who don’t have access to a pediatrician. State policies on exemptions are also key, she said.
“A lot of data supports the fact that when exemptions for personal beliefs are not allowed, vaccination rates are higher,” she said.
In December, Georgia public health officials issued an advisory saying the state had recorded significantly more cases of whooping cough than the previous year. According to CDC data, Georgia reported 280 cases in 2024, up from 96 the year before.
Until 2023, Mississippi was one of the few states that allowed parents to refuse to vaccinate their children solely for medical reasons – and only with a doctor’s approval. This gives it one of the highest vaccination rates in the country for the 2023-2024 school year.
“It’s one of the few things Mississippi has done right,” said Dr. 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 only “shining star.”
But that changed in April 2023 when a federal judge ordered state officials to begin allowing religious exemptions. The decision emboldened many families, Henderson said.
“We are seeing more and more skepticism, more and more vaccine hesitancy and a lack of trust because of this decision,” she said.
State officials have granted more than 5,000 religious exemptions since the court order allowing them, according to the state health department. Dr. Daniel Edney, the state health officer, said most requests came from “more affluent” residents in “pockets” of the state.
“Most people listen to the expert advice of their pediatricians and family doctors to stay on schedule because it is best to protect their children,” he said. declared.
West Virginia’s vaccine law — which doesn’t allow non-medical exemptions — could also change soon, said Dr. Matthew Christiansen, that state’s health officer until he resigned in December.
A bill that would have expanded the exemptions passed the Legislature last year, but was vetoed by outgoing Republican Gov. Jim Justice. The new governor, Republican Pat Morrisey, has sharply criticized the vaccination mandates.
People who assert their personal freedom to deny their children vaccines may ultimately restrict others’ ability to live fully, Christiansen said. “Children who contract measles, mumps and polio and remain paralyzed their entire lives are an obstacle to the personal freedom and autonomy of these children,” he said.
Since the Covid pandemic, anti-vaccine sentiment has increased in Tennessee. One organization, Stand for Health Freedom, has written a letter for voters to send to their state lawmakers calling for the resignation of the medical director of Tennessee’s vaccine-preventable disease and immunization program. The group said she demonstrated a “lack of respect for the population’s right to informed consent.”
“They feel emboldened by the idea that this presidential administration seems to be very convinced that a lot of these problems should be brought 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 victims of their own success, said Henderson, the Mississippi pediatrician. Most people have not witnessed outbreaks of measles or polio and therefore forget how dangerous these diseases are, she said.
“Unfortunately, it may take a resurgence of these diseases to raise awareness that they are deadly and preventable,” she said. “I hope it doesn’t come to that.”
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the major operating programs of KFF — the independent source for health policy research, polling and journalism.
