Sharp rise reported in nonmedical vaccine exemptions

Researchers have found increased rates of nonmedical vaccine exemptions, publishing their findings in JAMA.¹

A decline in vaccination rates has been observed among US children, leading to concerns about a resurgence of vaccine-preventable infectious diseases. The American Academy of Pediatrics has advocated for the elimination of nonmedical exemptions to school-based childhood vaccination requirements in US states, as these have been linked to reduced vaccine coverage and increased outbreaks.

“Although vaccination data are often tracked at the state level, county-level data are more relevant to population immunity and infectious disease risk,” wrote investigators.

Study examines county-level trends in vaccine exemptions

The study was conducted to identify county-level trends in both nonmedical and medical exemptions to school-based childhood vaccine requirements. County-level data from 2010 to 2024 was obtained through requests sent to all 50 states and the District of Columbia, with most participants being children entering kindergarten. Publicly available data was also assessed.

Investigators defined nonmedical exemptions as those granted for personal beliefs or religious reasons. Alongside outcome measures, the years of data, age group, data processing steps, and relevant data notes were reported, with quantile regression used to evaluate statistically significant temporal trends.

There were 3053 counties across 45 states and the District of Columbia included in the final analysis. Of these, 91.1% included at least 5 years of data, and 98% included at least 1 year of data between 2021 and 2024.

Nonmedical exemptions increase significantly over time

A significant increase in the county-level nonmedical exemption rate was reported across the study period, from 0.6% between 2010 and 2011 to 3.1% between 2023 and 2024. However, the rate of medical exceptions did not significantly shift between this period.

Between 2010 and 2020, the annual increase in percentage points of the nonmedical exception rate was 0.11, rising to 0.52 percentage points annually between 2021 and 2024. There were also significant variations in county-level nonmedical exemption rates between states, with 53.5% of included counties reporting an increase of over 1%.

Additionally, only 5.3% of counties reported an increase of over 5%. States with the greatest rates of nonmedical exemptions between 2021 and 2024 included:

• Utah
• Idaho
• Wisconsin
• Arizona

In comparison, declines were reported in states eliminating nonmedical exemptions during this timeframe, including New York, Maine, California, and Connecticut. Overall, the data indicated an increase in nonmedical vaccine exemptions, mostly occurring in a fraction of US counties.

“Continuation of these increases in nonmedical exemptions could contribute to declining vaccination and resurgence of vaccine-preventable infectious diseases in the [United States],” wrote investigators.

Expert commentary on recent changes to immunization recommendations

Additional concerns about vaccination delivery have been reported following the recent changes to US childhood and adolescent immunization recommendations, as discussed by Robert Hopkins, MD, professor of internal medicine and pediatrics at the University of Arkansas for Medical Sciences, in an interview with Contemporary Pediatrics.²

According to Hopkins, these revisions differ from the usual evidence-based process that includes recommendations from multiple professional societies, potentially leading to difficulties for clinicians attempting to interpret the changes. Hopkins stressed that most vaccines previously recommended for children remain clinically indicated.

These include the influenza and COVID-19 vaccines, which have been linked to reduced hospitalizations and deaths. Hopkins highlighted positive results from continued safety monitoring, showing few serious adverse events when these vaccines are administered to pediatric patients.

“The evidence is that influenza vaccine and COVID-19 vaccine reduce the risk for your child ending up hospitalized with those diseases or having severe adverse outcomes,” said Hopkins.

References

1. Fattah M, Stoffel LA, Bubar KM, et al. Trends in county-level childhood vaccination exemptions in the US. JAMA. 2026. doi:10.1001/jama.2025.24407
2. Hopkins RH. Robert Hopkins, MD, on CDC vaccine schedule changes raising concerns. Contemporary Pediatrics. January 13, 2026. Accessed January 26, 2026. https://www.contemporarypediatrics.com/view/robert-hopkins-md-on-cdc-vaccine-schedule-changes-raising-concerns