A sign at the University of Utah Health Clinic warns visitors about the spread of measles. Under Trump, federal health officials have narrow the number of vaccines they recommend, and more states are offering waivers for parents who don’t want to vaccinate children entering public schools. (Photo by McKenzie Romero/Utah News Dispatch)
States that were leaders in childhood vaccinations before the pandemic are among those losing ground as waivers and unfounded skepticism spread, encouraged by the stance of the Trump administration under U.S. Secretary of Health and Human Services Robert F. Kennedy Jr.
Stateline’s analysis shows that expanded parental leave will likely drop both Mississippi and West Virginia from the top national rankings they held before the pandemic. federal data. Other states such as Florida, Idaho, Louisiana and Montana are also pushing the boundaries on vaccine choices.
The analysis shows that in the 2024-25 school year, at least 33 states had a lower herd immunity level than 28 states before the 2018-2019 pandemic. Herd immunity refers to the percentage of people who need to be vaccinated or otherwise immunized against an infectious disease to limit its spread.
Studies show that for measles, a highly contagious disease, countries must maintain at least a 95% vaccination rate to protect people who cannot get vaccinated. Other diseases have similar rates of herd immunity. People who cannot be vaccinated include infants who are too teenage to receive certain vaccines and people with underlying health conditions.
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Doctors say misinformation and expressions of distrust from powerful leaders are having an impact on parents, as are fresh state waivers making it easier for families to avoid vaccines.
Some people who have never questioned vaccines before are taking notice of the national debate and feeling confused, said Dr. Patricia Tibbs, a pediatrician in rural Mississippi and president of the Mississippi chapter of the American Academy of Pediatrics. The fresh religious exemptions may already be causing an enhance in cases of whooping cough, also known as whooping cough, in Mississippi, she added.
“If they hear something about it on the news, it must be true, they think,” Tibbs said. “We just follow the guidelines and let patients know that this is a scientific discussion. Nothing has changed in the science. But the decisions are made by people who don’t know the science.”
Nothing has changed in science. But people who don’t know science make decisions.
– Dr. Patricia Tibbs, Mississippi pediatrician
Under Kennedy’s leadership, federal support for vaccinations continued to decline, with many states joining the so-called movement chart your own course by following more science-based recommendations from your doctors. On January 26, the Governors Public Health Alliance, a group of 15 Democratic governors, approved vaccinations for children and adolescents standards from the American Academy of Pediatrics, not the federal government.
Federal health officials in the Trump administration have narrow the number of recommended vaccines. The chairman of the vaccine advisory committee, pediatric cardiologist Kirk Milhoan, suggested in a Jan. 22 podcast that individual freedom is more crucial than protecting community health with vaccines, even for measles and polio.
New leading states
Before the pandemic, Mississippi and West Virginia had the nation’s highest preschool vaccination rates, according to Stateline’s analysis. Approximately 99% of kindergartners in each state received required vaccinations before entering 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 narrow exemptions from school vaccination requirements, while Mississippi and West Virginia have begun allowing more exemptions.
West Virginia has not reported vaccinations to the federal Centers for Disease Control and Prevention for the 2024-25 school year. The state health department told Stateline the data won’t be available until later this year.
However, the state will likely be pushed out of the top ten. Republican Gov. Patrick Morrisey issued an executive order a year ago giving parents the right to request religious exemptions. So far, the state has approved 693 such applications for the current school year, spokeswoman Gailyn Markham wrote in an email. This alone is enough to significantly change the country’s position in the ranking.
To compare states, Stateline calculated the average rate of required vaccinations for preschools. The analysis used 2018-2019 as a pre-pandemic baseline because a enormous number of states did not report 2019-2020 information amid the chaos that followed early surges in Covid-19 cases and school closures.
AND January studies published by JAMA Pediatrics found increased vaccination rates among preschoolers in states that repealed nonmedical exemptions, suggesting that the repeal “played a role in maintaining vaccination coverage in repealing states during a period of increased vaccine hesitancy.”
Requirements and exemptions
All 50 states and the District of Columbia require students to undergo certain vaccinations before entering public schools. All also allow exemptions for children who cannot receive vaccinations for medical reasons, and most states allow non-medical exemptions, often for religious and sometimes personal reasons. But Florida’s Republican Gov. Ron DeSantis’ administration does he suggested dropping it all requirements, and Idaho passed Act of 2025 allowing exemptions from vaccinations for any reason. Idaho had the lowest kindergarten vaccination rate, about 80% in the 2024-25 school year, before the law went into effect last July.
Louisiana passed the bill in 2024 throw Covid-19 vaccine requirements for public schools, and the state has decided so stop the publicity on flu vaccinations and end public vaccine clinics.
AND Florida bill that emerged from committee in January would maintain school vaccine requirements but expand exemptions to include “conscience” as well as medical and religious considerations.
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 rescind vaccine requirements and the bill to expand exemptions. Florida’s preschool vaccination rate dropped from 94% pre-pandemic to about 90% in 2024-2025, according to a Stateline analysis.
“They are ignoring the 90% of their constituents who want vaccines and want to stay safe,” Takagishi said. “Legislators, rather than the majority, are listening to the loud voices of those who want to oppose vaccines. We also know that there are teachers and school nurses in the school system who are fighting this because it puts them at risk.”
All states except Montana report preschool vaccine statistics to the federal government. Montana passed Act of 2021 making vaccine status private and unavailable for statistical reporting, despite opposition from medical experts. The law also made it easier to take ailing leave for families who believe their children have been injured by vaccinations.
Dr. Lauren Wilson, a pediatrician and then-vice president of the Montana chapter of the American Pediatric Association, said at the hearing that the law would make “vaccination information unavailable for responding to and mitigating public health emergencies.”
“Vaccines have saved the lives of millions of people. I have personally seen cases of tetanus, whooping cough, measles and meningitis and the tragedies they mean for families,” Wilson said in her testimony.
AND Court order of 2023 forced Mississippi to accept religious exemptions. West Virginia allows religious exemptions under last year’s governor’s executive order.
Tibbs, who practices pediatrics in rural Jones County, Mississippi, said she’s seeing more cases of whooping cough than usual and thinks vaccine exemptions may be a factor.
In Mississippi, which reported 394 religious exemptions for the 2024-25 school year, overall rates remained high enough this year at about 97.8% to provide “herd immunity” in most cases.
Mississippi has granted 617 religious vaccine exemptions to kindergartners this school year, representing about 1.8% of the class, according to Amanda Netadj, director of immunizations for the state health department. About 96.3% of preschoolers have all required vaccinations this year.
But last year, the number of whooping cough cases in the state was the highest in at least a decade, and in September health officials announced An infant died from this disease – it was the first case of death from whooping cough in 13 years.
“A lot of people take exemptions for religious reasons,” Tibbs said. “Despite this, on any given day, the majority of my patients will still receive their vaccines. Fingers crossed that this number stays high enough.”
Stateline reporter Tim Henderson can be reached at: thenderson@stateline.org.
This story was originally produced by state linewhich is part of States Newsroom, a nonprofit news network that includes the Ohio Capital Journal and is supported by grants and a coalition of donors as a 501c(3) public charity.
