Jen Fisher can do only so much to keep her son safe from the types of infections that children can encounter at school. The rest, she said, is up to other students and parents in their hometown of Franklin, Tennessee.<\/p>\n
Fisher\u2019s son Raleigh, 12, lives with a congenital heart condition, which has left him with a weakened immune system. For his protection, Raleigh has received all the recommended vaccines for a child his age. But even with his vaccinations, a virus that might only sideline another child could sicken him and land him in the emergency room, Fisher said.<\/p>\n
\u201cWe want everyone to be vaccinated so that illnesses like measles and things that have basically been eradicated don\u2019t come back,\u201d Fisher said. \u201cThose can certainly have a very adverse effect on Raleigh.\u201d<\/p>\n
For much of Raleigh\u2019s life, Fisher could take comfort in the high childhood vaccination rate<\/a> in Tennessee \u2014 a public health bright spot in a conservative state with poor health outcomes and one of the shortest life expectancies in the nation.<\/p>\n Mississippi and West Virginia, two similarly conservative states with poor health outcomes and short life expectancies, also have some of the highest vaccination rates for kindergartners in the nation \u2014 a seeming contradiction that stems from the fact that childhood vaccination requirements don\u2019t always align with states\u2019 other characteristics, said James Colgrove<\/a>, a Columbia University professor who studies factors that influence public health.<\/p>\n \u201cThe kinds of policies that states have don\u2019t map neatly on to \u2018red\u2019 versus \u2018blue\u2019 or one region or another,\u201d Colgrove said.<\/p>\n Advocates, doctors, public health officials, and researchers worry such public health bright spots in some states are fading: Many states have recently reported an increase in people opting out of vaccines for their kids as Americans\u2019 views shift.<\/p>\n During the 2023-24 school year, the percentage of kindergartners exempted from one or more vaccinations rose to 3.3%<\/a>, the highest ever reported, with increases in 40 states and Washington, D.C., according to Centers for Disease Control and Prevention data. Tennessee and Mississippi were among those with increases. Nearly all exemptions nationally were for nonmedical reasons.<\/p>\n Vaccine proponents worry anti-vaccine messaging<\/a> could accelerate a growing \u201chealth freedom\u201d movement that has been pushed by leaders in states such as Florida. Momentum against vaccines is likely to continue to grow with the election of Donald Trump as president and his proposed nomination of anti-vaccine activist Robert F. Kennedy Jr. as secretary of the Department of Health and Human Services.<\/p>\n Pediatricians in states with high exemption rates, such as Florida and Georgia, say they\u2019re concerned by what they see \u2014 declining immunization levels for kindergartners, which could lead to a resurgence in vaccine-preventable diseases such as measles. The Florida Department of Health reported nonmedical exemption rates as high as 50%<\/a> for children in some areas.<\/p>\n \u201cThe religious exemption is huge,\u201d said Brandon Chatani<\/a>, a pediatric infectious disease doctor in Orlando. \u201cThat has allowed for an easy way for these kids to enter schools without vaccines.\u201d<\/p>\n In many states, it\u2019s easier to get a religious exemption than a medical one, which often requires signoff from a doctor.<\/p>\n Over the past decade, California, Connecticut, Maine, and New York have removed religious and philosophical exemptions from school vaccination requirements. West Virginia has not had them.<\/p>\n Idaho, Alaska, and Utah had the highest exemption rates<\/a> for the 2023-24 school year, according to the CDC. Those states allow parents or legal guardians to exempt their children for religious reasons by submitting a notarized form or a signed statement.<\/p>\n Florida<\/a> and Georgia<\/a>, with some of the lowest reported minimum vaccination rates for kindergartners, allow parents to exempt their children by submitting a form with the child\u2019s school or day care.<\/p>\n Both states have reported declines in uptake of the measles, mumps, and rubella vaccine, which is one of the most common childhood shots. In Georgia, MMR coverage for kindergartners dropped to 88.4% in the 2023-24 school year from 93.1% in 2019-20, according to the CDC<\/a>. Florida dropped to 88.1% from 93.5% during the same period.<\/p>\n Andi Shane, a pediatric infectious disease specialist in Atlanta, traces Georgia\u2019s declining rates to families who lack access to a pediatrician. State policies on exemptions are also key, she said.<\/p>\n \u201cThere\u2019s lots of data to support the fact that when personal belief exemptions are not permitted, that vaccination rates are higher,\u201d she said.<\/p>\n In December, Georgia public health officials put out an advisory saying<\/a> the state had recorded significantly more whooping cough cases than in the prior year. According to CDC data<\/a>, Georgia reported 280 cases in 2024 compared with 96 the year before.<\/p>\n Until 2023, Mississippi was one of the few states that allowed parents to opt out of vaccinating their kids only for medical reasons \u2014 and only with the approval of a doctor. That gave it among the highest vaccination rates in the nation as of the 2023-24 school year.<\/p>\n \u201cIt\u2019s one of the few things Mississippi has done well,\u201d said 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\u2019s one \u201cshining star.\u201d<\/p>\n But that changed in April 2023 when a federal judge ordered<\/a> state officials to start allowing religious exemptions. The ruling has emboldened many families, Henderson said.<\/p>\n \u201cWe are seeing more and more skepticism, more and more vaccine hesitancy, and a lack of confidence because of this ruling,\u201d she said.<\/p>\n State officials have granted more than 5,000 religious exemptions since the court order allowing them, according to the state health department. Daniel Edney<\/a>, the state health officer, said most of the requests have come from \u201cmore affluent\u201d residents in \u201cpockets\u201d of the state.<\/p>\n \u201cMost people listen to the expert opinions of their pediatricians and family medicine doctors to stay on the vaccine schedule, because it\u2019s what is best to protect their children,\u201d he said.<\/p>\n West Virginia\u2019s vaccine law \u2014 which hasn\u2019t allowed nonmedical exemptions \u2014 also could soon change, Matthew Christiansen<\/a> said in December before he resigned as the state\u2019s health officer.<\/p>\n A bill that would have broadened exemptions made it through the legislature last year but was vetoed by outgoing Republican Gov. Jim Justice. The new governor, Republican Pat Morrisey, has been a vocal critic<\/a> of vaccine mandates. And just a day after being inaugurated, he issued an executive order<\/a> to propose provisions by Feb. 1 that could allow religious and conscientious exemptions.<\/p>\n \u201cI want to send a message that if you have a religious belief, then we\u2019re going to have an exception,\u201d he said at a Jan. 14 press conference<\/a>. \u201cWe\u2019re not going to be the outlier.\u201d<\/p>\n People asserting their personal freedoms to decline vaccines for their kids can ultimately curtail the ability of others to live full lives, Christiansen said. \u201cKids getting measles and mumps and polio and being paralyzed for their whole life is an impediment on personal freedom and autonomy for those kids,\u201d he said.<\/p>\n Since the covid pandemic, anti-vaccine sentiment has been growing in Tennessee. One organization, Stand for Health Freedom, drafted a letter<\/a> for constituents to send to their state lawmakers calling for the resignation of the medical director of Tennessee\u2019s Vaccine-Preventable Diseases and Immunization Program. The group said she demonstrated a \u201clack of respect for the informed consent rights\u201d of the people.<\/p>\n \u201cThey feel emboldened by the idea that this presidential administration seems to feel very strongly that a lot of these issues should be taken back to the states,\u201d said Emily Delikat<\/a>, director of Tennessee Families for Vaccines, a pro-vaccine group.<\/p>\n Ultimately, like many effective public health interventions, vaccines are a victim of their own success, said Henderson, the Mississippi pediatrician. Most people haven\u2019t seen outbreaks of measles or polio, so they forget how dangerous the diseases are, she said.<\/p>\n \u201cIt may unfortunately take a resurgence of those diseases to raise awareness to the fact that these are dangerous, these are deadly, these are preventable,\u201d she said. \u201cI hope it doesn\u2019t come to that.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n