Fewer Wisconsin children and adolescents got vaccinated last year for many childhood illnesses, raising the risk of outbreaks and clusters that could lead to more widespread illness, the state health department reported Monday.

Vaccination rates for a group of seven childhood diseases that public health experts recommend in the first two years after birth fell to 66.9% in 2025. In 2024, the rate was 68.8%, according to the Department of Health Services.

“While nearly seven out of every 10 children had the recommended vaccines in this series by 24 months of age, we know that three out of 10 kids did not,” said Stephanie Schauer, who manages the Wisconsin immunization program for DHS. That’s a decline of almost 2 percentage points — about 1,200 children, she said at an online press briefing Monday.

“We use data like this as an alert system,” said Paula Tran, state health officer and administrator at the DHS Division of Public Health, said in a DHS statement. “Today that alert system is sending a clear signal that the health and well-being of Wisconsin kids and communities are at risk.”

Details of vaccination rates for children and adolescents are published on the Department of Health Services website. 

In 2025, 79.8% of children 2 or younger were fully vaccinated against measles — dropping below 80% for the first time. In 2013, 88.2% of Wisconsin 2-year-olds were fully vaccinated with the MMR vaccine, which protects against mumps and rubella as well as measles.

“Measles is a very infectious disease and really requires a very high level of immunity in a community such that it won’t spread,” Schauer. “So it is something that we are concerned with as we continue to see that drop.”

Measles outbreaks have been popping up across the country in the last year especially. The MMR vaccination rate in Wisconsin has been slowly but steadily declining over the last dozen years, and last year it fell by 1.6 percentage points from 2024.

“That’s headed in the wrong direction. We need more children protected, not fewer,” Schauer said. “We really need to be closer up around 95% of a community protected so that we don’t have an outbreak if measles is introduced into a community.”

With spring break coming soon and with it travel plans, the health department is also encouraging families to review their children’s measles immunization records, Schauer said, because most recent measles outbreaks and clusters across the country “are due to individuals who have been traveling where measles is occurring and then bringing them back.”

There have been some positive trends, Schauer said. In contrast to most other vaccine types, the rates of vaccine against meningitis — which is given in adolescence — have been increasing over the last decade and the last couple of years in particular.

She attributed the increase both to increased awareness and to the health department’s addition of the vaccine in 2024 to the list of required shots for students going into grades 7 and 12. Previous attempts to add the meningitis vaccine to the required list were blocked by the Republican majority on the state Legislature’s Joint Committee for the Review of Administrative Rules.

With more families asking about the meningitis vaccine and more doctors talking about it with their patients, “that shows that school immunization requirements can and do help ensure that our kids are protected,” Schauer said

Schauer said there are two broad reasons for the decrease in vaccinations: public mistrust and lack of access.

“We understand that there’s a lot of misinformation and disinformation out there, that maybe people are questioning vaccines, or they may be delaying or spreading vaccines out,” she said.

To overcome mistrust, the state health department looks to health care providers to serve as the best messengers to the families in their care. Research has shown that 86% of the public “had a fair degree of confidence in their primary health care providers to provide them information on public health matters, and that would include vaccines,” Schauer said.

“We continue to recognize that parents have questions, and that’s appropriate and OK, but we want to make sure that they’re getting those questions answered,” Schauer said.

The message to families is to encourage them to turn to their health providers with questions, she added, “so that they can feel reassured that providing vaccines is really the most safe and effective way of preventing some of these really nasty diseases.”

Others, however, may lack any information at all about vaccines, have difficulty getting access to them because they lack regular access to health care.

Vaccines for Children, a program in place for more than 30 years, is intended to make it possible for families whose health care is covered by Medicaid or who have no insurance or inadequate insurance to get the vaccines they need, Schauer said. The program is also available to Alaska Native and American Indian children.

DHS lists providers across the state who participate in the Vaccines for Children program. More than 720 pharmacies and other providers take part, and the department continues to recruit more.

“We don’t want any children to go without vaccines because they weren’t aware of this program,” Schauer said.

DHS also funds 25 community organizations and tribal health departments in a program to make connections in their communities. Those agencies are “the trusted messenger and talking about vaccines and vaccine safety and why they are important in their communities,” she said.

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In Johnson County, Iowa, the number of tuberculosis cases has increased in recent years — and so has the cost of containing it.

The cost of contact tracing and surveillance, traveling each day to patients’ homes to ensure they take their meds or booking hotel rooms to quarantine patients, has surged from $17,000 in 2020 to $65,000 last year.

That doesn’t include $13,000 spent last year for language translation, as many of the cases were among the local immigrant communities, said Danielle Pettit-Majewski, director of the Johnson County public health department. She said the rise in spending is directly tied to the increase in diagnoses since 2020, with latent infections tripling, from 27 that year to 90 last year.

Last week, the state informed the county that the greater number of cases had made it too costly to help pay for the home visits, forcing the county to pay for them on its own.

“I was kind of dumbfounded,” Pettit-Majewski said. “It was surprising.”

Tuberculosis cases have been rising nationwide since 2021, and in 2024 — the most recent year for which data is available — they reached the highest level since 2011. Thirty-four states and the District of Columbia reported increases in TB case counts and rates from 2023 to 2024, according to the federal Centers for Disease Control and Prevention.

In 2024, there were 10,347 reported cases nationwide, up 8% from the 9,622 cases reported the year before.

The case numbers for 2025 won’t be released until the end of March. But the Trump administration’s immigration crackdown last year might have dissuaded some people from seeking care, perhaps leading to fewer recorded diagnoses, some TB experts say.

Some states, however, are reporting preliminary data to the National Tuberculosis Coalition of America that shows that the number of cases grew from 2024 and 2025 by between 10% and 20%, said Donna Hope Wegener, the coalition’s executive director.

“There are a number of [tuberculosis] program managers that are reporting double-digit increases,” Wegener said, adding that the cost of antibiotics to treat TB is rising. “These back-to-back increases that states are contending with are certainly alarming.”

In San Antonio, Texas, case numbers have been steady, but the local public health department is still struggling to cover treatment costs.

Tommy Camden, health program manager at the City of San Antonio’s tuberculosis clinic, said the city has proposed eliminating a full-time specialist position that assists with TB contact tracing, blood draws and home visits.

Whatever the 2025 numbers show, many public health agencies are struggling to keep up, especially as they also contend with a growing measles outbreak that so far has affected 26 states.

Tuberculosis is a bacterial infection with both active and latent stages. A person with active tuberculosis disease, which can be deadly, can spread the disease. A person with a latent infection can’t, but they can develop the disease at any point.

Consistent, daily antibiotic treatment for four to nine months, with no skipped doses, is crucial to knocking it out. Skipping doses can allow the germs to mutate into drug-resistant TB, which is one reason health agencies spend so much to ensure patients take their medication.

In the U.S., the disease disproportionately affects people born in countries where it’s more common, as well as Hispanic, Black, Asian American, Pacific Islander and Indigenous communities, according to the CDC.

Immigrant communities tend to be disproportionately affected, in part because the disease can spread more easily in multigenerational households and other crowded home and work settings. Poverty, a lack of access to health care because of language, transportation and cultural barriers, and the stigma around the disease also can make those communities more vulnerable, Pettit-Majewski explained.

The California Department of Public Health says the cost of drugs to prevent a latent tuberculosis infection from turning into full-blown disease can be about $857 for what is usually three to four months of treatment. In contrast, diagnosing and treating one infected person who develops active tuberculosis disease can cost about $43,900.

While there is a vaccine for tuberculosis, it isn’t recommended for use in the U.S. because it can cause false positives in TB tests taken by skin sample. The vaccine also isn’t consistently effective against adult pulmonary tuberculosis.

Research has been underway for developing a new vaccine. But the Trump administration’s antipathy toward vaccines of all kinds is dampening investment in new products.

Immigration crackdown

Before the COVID-19 pandemic, tuberculosis was the world’s deadliest infectious disease, killing about 1.5 million people each year, according to the World Health Organization. It remains a leading infectious disease killer globally. Immigrants coming to the U.S. are screened for active TB and connected with treatment, and U.S. residents may be asked about travel abroad during routine checkups.

Many immigrants might be reluctant to seek care amid the Trump administration’s immigration crackdown, said Dr. Michael Lauzardo, a University of Florida associate professor at the division of infectious diseases and global medicine and director of the Florida TB Physicians Network.

“I think the numbers will be lower because people are afraid,” Lauzardo said of the soon-to-be-released 2025 data. “A lot of the people at risk for TB are not seeking care, I suspect.”

Munira Maalimisaq, a family nurse practitioner in Minneapolis, said such fear has been rampant across immigrant communities in her area. After President Donald Trump was elected, a health care center where she worked had to drop a routine question on patient intake forms that asked where a patient is from, because people were scared to answer it. The question was meant to assess exposure to TB in countries where it’s more common.

“That was a big barrier, because people would just not answer that question, or would not even want to engage and say ‘yes’ or ‘no,’” said Maalimisaq, CEO of a nonprofit health care center in Minneapolis, Inspire Change Clinic.

She said such fear could cause more active cases later on, as people with latent TB may not get diagnosed or get care — increasing the risk that they’ll develop the disease and become contagious.

“The whole thing delays seeking care,” she said. “If I don’t get screened for it, there’s no way that my provider is going to diagnose me.”

In Iowa, Pettit-Majewski said she hopes that Johnson County residents won’t be scared to seek care.

“If you are a Johnson County resident, you are our neighbor, and it is our responsibility to keep you safe and healthy — and we take that very seriously,” said Pettit-Majewski. “We want to make sure that folks are able to get the best care, regardless of immigration status, regardless of where you came from.”

People in detention or correctional facilities also are disproportionately at risk of infection. In recent weeks, two tuberculosis cases cropped up at a U.S. Immigration and Customs Enforcement facility in El Paso, Texas. Last year, California, Alaska and Arizona also saw cases at ICE detention facilities.

ICE didn’t respond to Stateline’s questions about the recent two cases at the El Paso facility. On a recent visit to the detention center, Democratic U.S. Rep. Veronica Escobar, who represents El Paso, said she saw agents go into a community pod, which can hold between 30 to 70 detainees, without protective attire.

“I was about to walk into a pod with the ICE agents, and the security guard said, ‘No, no, ma’am, you don’t want to walk in there. They’ve not been tested for TB yet,’” Escobar told Stateline.

“But I did see contractor staff coming in and out of the pod, and so I asked, ‘Why are they not wearing [personal protective equipment]? Why aren’t they wearing a mask?’ And my concerns were pretty much dismissed, and I was told it’s their choice and they don’t have to if they don’t want to.”

Cuts to public health funding 

Earlier this month, the Trump administration told Congress it intends to rescind $600 million in public health funds to four Democratic-led states: California, Colorado, Illinois and Minnesota. Many of the grants targeted HIV, and some also targeted tuberculosis.

The four states have sued to stop the cuts, arguing that the administration is targeting them with “devastating funding cuts to basic public health infrastructure based on political animus and disagreements about unrelated topics such as federal immigration enforcement.”

A federal judge has temporarily halted the cuts, saying the administration’s statements suggest “hostility to what the federal government calls ‘sanctuary jurisdictions’ or ‘sanctuary cities.’” An agency action, U.S. District Judge Manish S. Shah said, can’t be honored “if it is arbitrary or capricious.”

One of the California grants affected is a grant to the Tuberculosis Elimination Alliance, a partnership of community-based organizations that conduct outreach and education about tuberculosis.

The group received notice Feb. 11 that its grants were ending — putting in jeopardy $100,000 the alliance distributes to groups serving high-risk communities across California, Illinois, Washington state, the District of Columbia and U.S. island territories.

One of the largest tuberculosis outbreaks in recent weeks occurred at a San Francisco Bay Area high school, where latent TB was detected in more than 200 students and staff.

“It’s just such a scary and confusing time for our communities,” said Chibo Shinagawa, associate director of infectious diseases at the Association of Asian Pacific Community Health Organizations, which leads the Tuberculosis Elimination Alliance.

“The instability, the uncertainty right now — it’s such a disruption to public health, to the trust we’ve built in our communities.”

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

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Three cases of measles has been confirmed in Wisconsin in recent weeks, the latest involving an out-of-state traveler who traveled through Milwaukee Mitchell International Airport to Walworth County on Jan. 29. 

Milwaukee Health Commissioner Michael Totoraitis said during a news conference Tuesday that there were six individuals on the flight from the city of Milwaukee who may have been exposed as well as others.

“We have been in communication with those (six) individuals, and there’s also likely other contacts from the airplane that we do not have,” he said.

Measles is a serious disease that can cause high fevers and a spreading rash and lead to life-threatening complications such as pneumonia. 

Lindsey Page, director of immunizations and communicable disease with the Milwaukee Health Department, said measles is highly contagious and the risk of it hitting the city is real. 

Extremely contagious but can be prevented

According to the Wisconsin Department of Health Services, measles can spread from person to person through the air from coughs or sneezes. The department states that measles is so contagious that 90% of unvaccinated people who are around someone who is infected may also be infected.  

Page said the measles, mumps and rubella, or MMR, vaccine is highly effective at preventing the spread of measles. Still, vaccine rates in the city are below the recommended rate for herd immunity. Herd immunity for measles is reached when 95% of people in the community have the MMR vaccine. 

“It certainly poses a threat, which is why we’re obviously emphasizing the vaccination, which is key in preventing disease from spreading before it starts,” Page said. “The measles vaccine is one of the most effective and well-studied vaccines ever used.”

Three-fourths of 6-year-olds in Milwaukee have received both recommended MMR doses, according to the Milwaukee Health Department. Among 18-year-olds in Milwaukee, that number increases to 88%. 

The Milwaukee Health Department and Milwaukee Public Schools are working to get residents access to vaccinations to increase those rates and keep them safe. 

According to the International Vaccine Access Center, childhood vaccination rates in the U.S. have declined, and only 10 states had MMR rates above 95% during the 2024-25 school year.

Vaccination rates low in many Milwaukee schools

Of the 152 Milwaukee public, private and charter schools with available vaccine data, only 11% have reached herd immunity levels of 95% for the MMR vaccine, according to data from the Washington Post. 

Only two Milwaukee Public Schools for which data was available, Highland Community School and Cooper Elementary School, had an MMR vaccination rate of 95%.

Just 7% of Milwaukee schools have a 95% immunization rate for all required vaccinations.

Milwaukee Public Schools notifies families if immunization records are missing or incomplete, and students may be excluded from school if requirements are not met within a reasonable time, said Stephen Davis, MPS media relations manager. 

Students are allowed to attend school while families work to get their required vaccinations or submit a valid exemption as allowed by state law, Davis said. 

Wisconsin DHS allows vaccination exemptions for medical, religious or personal conviction reasons. Davis said exemption requests in the district have fluctuated from year to year.

Page said the Milwaukee Health Department runs vaccine clinics inside select MPS schools at the beginning of the school year. Students take home vaccine consent forms for parents to sign so those students can get their required immunizations in school. 

In the near future, the department will set up targeted clinics in schools with low MMR vaccination rates, Page said.

MPS prepares for potential measles cases

MPS is monitoring measles in the region and maintains regular communication with local and state public health partners, Davis said. 

Davis said the district has an infectious disease response plan, which the district reviews periodically and updates as public health guidance changes. The district last reviewed the plan in 2025. 

“While no increased risk has been identified within our schools at this time, we are remaining vigilant and prepared to respond if conditions change,” Davis said. 

If a case of measles is identified in the city, Davis said MPS would implement its response plan, including coordinating with key staff and reinforcing illness reporting procedures.

“Schools would follow established exclusion, cleaning and notification procedures in accordance with public health guidance,” Davis said.

Where can I get vaccinations?

The Milwaukee Health Department and the Wisconsin Department of Health Services offer several resources to check your vaccination status and access free vaccinations. 

Page said you can check your vaccination status with your pediatrician or doctor, look up your status on the Wisconsin Immunization Registry or contact the city Health Department at 414-286-6800.

Page said the Health Department offers free MMR vaccines to all residents at three immunization clinics regardless of age or insurance status.

These clinics also offer other vaccines, available for free for people without health insurance. Eligibility for certain vaccines depends on factors like age, and some vaccines are not always available.

Check vaccine availability by calling 414-286-8034.

Immunization clinic services in Milwaukee

Keenan Health Center, 3200 N. 36th St.

Open for vaccines on Thursdays from 1 to 4 p.m.

Northwest Health Center, 7630 W. Mill Road

Open for vaccines on Wednesdays from 3 to 6 p.m.

Southside Health Center, 1639 S. 23rd St.

Open for vaccines on Mondays from 3 to 6 p.m. and Tuesdays from 1 to 4 p.m. 

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Alex Klaus is the education solutions reporter for the Milwaukee Neighborhood News Service and a corps member of Report for America, a national service program that places journalists in local newsrooms to report on under-covered issues and communities. Report for America plays no role in editorial decisions in the NNS newsroom.

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Jonathan Aguilar is a visual journalist at Milwaukee Neighborhood News Service who is supported through a partnership between CatchLight Local and Report for America.

Measles is in Wisconsin. Are Milwaukee schools vulnerable? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

With three measles cases in three different Wisconsin communities since New Year’s Day, the state could be vulnerable to a larger outbreak, according to public health experts.

“We’ve gotten three cases in the state of Wisconsin so far in 2026, and there’s been many years in which we had zero,” said Dr. Joe McBride, a pediatric infectious disease physician at UW Health Kids and assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health. If the cases spread, “those are incredibly, incredibly difficult for us to slow down and to prevent.”

“There may be only three people with measles, but the cases are occurring in three different places,” said Ajay Sethi, director of the Master of Public Health Program at the UW medical school. “These are three separate public health responses, and that is significant given the potential for spread to others from just one person with measles.”

In January, state health officials reported a measles infection in a Waukesha resident. This month, measles infections have been identified in Dane County and in a person who traveled through Milwaukee County’s Mitchell International Airport to Walworth County. The Wisconsin Department of Health Services has also identified possible locations when other people might have been exposed in the Dane County and Mitchell Airport cases. All three were described as connected to travel. 

“It’s good, in that they don’t seem to be related, and we don’t see an outbreak,” McBride said. “But it’s also bad because that means there’s a lot of measles,” he added. “It’s kind of a tinderbox, and we have large cohorts of our population who are not immune.”

The year 2025 saw a resurgence of measles nationwide, approaching 2,000 cases, Stateline reported in December, with outbreaks in Texas, Arizona, South Carolina, Utah and New Mexico.

Sethi said an August 2025 cluster of cases in Oconto County started with a case in St. Croix County in someone who was visiting from out of state. Across Wisconsin in 2025, “Ultimately 36 people got measles, and two of them needed hospitalization,” he said.

‘Incredibly infectious’ illness

Although most widely known for its trademark rash, the measles virus “is a respiratory virus, just like really any other cough and cold virus that we think about,” said McBride. “However, it’s incredibly, incredibly infectious.”

The virus is airborne, McBride said, and can hang in the air for up to two hours. In one landmark case, at the 1991 Special Olympics at the Minneapolis Metrodome, a participant on the field had measles, McBride said, “and people who were susceptible to the infection got the infection who were sitting in the upper deck.”

Vaccination is the primary tool to stop measles, and in Wisconsin as well as in much of the U.S. vaccination rates are below the 95% that public health practitioners say allows for widespread “herd immunity.”

The measles vaccine is usually given in combination with mumps and rubella vaccines, first at the age of 1 with a booster by the time a child is 5.  

Some people aren’t eligible for the vaccine, either because they’re younger than 6 months old or because they have a compromised immune system due to another illness.

“It’s a live vaccine, and live vaccines have the potential of causing infections in people who are immune-compromised, like bone marrow transplant recipients or a patient with AIDS” or people on medications that suppress the immune system, McBride said.

That makes it even more important for people who are eligible to get the vaccine, public health experts say.

A national map produced by ABC News in collaboration with Boston Children’s Hospital, Harvard Medical School and Icahn School of Medicine at Mount Sinai in New York shows that none of the counties in Wisconsin has as many as 90% of  5-year-olds fully vaccinated for measles.

The lowest rates of measles vaccinations for that age group are in Portage and Columbia counties, with fewer than 60%. A cluster of counties around Oshkosh have vaccination rates in the low 60s; another cluster around Eau Claire in the mid-60s, and Milwaukee, Racine and Waukesha counties have vaccination rates in the high 60s. In the rest of the state, vaccination rates for children 5 or younger are in the range of 70% to more than 80%.

“The decision to get vaccinated is still very nuanced,” Sethi said — influenced by a variety of factors. Those include complacency, which may lead people to dismiss the need for a vaccine, he said. Other factors include how convenient it may be to get the shot, confidence in the vaccine’s effectiveness and a sense of community responsibility.

HHS shift, CDC silence

One source of shakier confidence has been a shift at the U.S. Department of Health and Human Services and the Center for Disease Control and Prevention (CDC), in the agencies’ stance on vaccines under HHS Secretary Robert F. Kennedy Jr., who had a history of anti-vaccine campaigning for years before his appointment.

Kennedy has made some appeals for people to get the measles vaccine, and in an appearance on CNN Sunday, Dr. Mehmet Oz, director of the Centers for Medicare & Medicaid Services, urged viewers, “Take the vaccine, please.”

But researchers at Johns Hopkins University in a report published in December documented that amid the 2025 measles surge, CDC social media accounts “have gone quiet, creating a ‘void’ in online health communication. In this vacuum, measles messaging has been dominated by news media rather than expert health authorities, resulting in polarized and potentially inaccurate information.” 

By the year 2000, measles vaccination had become so widespread that the U.S. was identified as having eliminated the disease. Canada, which also had that status, lost it in 2025, and the U.S. appears to be on the verge of losing it as well, Sethi said.

Yet the measles vaccine is both extraordinarily effective and essentially the only weapon against the virus.

“There isn’t any kind of other medicine that can abort it,” McBride said. “It is completely dependent on either preventing it or having natural infection and supporting the individual through it.”

The infection itself can be extremely serious, however, he said. In addition to fevers, cough and the rash, which is painful, secondary complications can do much more bodily damage. Those can include bacterial infections, pneumonia, vision and neurological damage and cardiovascular system harm as well.

In about one of every 1,000 cases, a delayed neurological condition can arise 10 years after a person is infected “that is completely fatal,” McBride added. Among the hundreds of cases across the U.S. now, “there certainly is somebody who’s walking around today who will be dead of measles in 10 years, who doesn’t know it. And that’s incredibly scary.”

People born before 1957 are more likely to have natural immunity from having been exposed to measles in childhood. “After 1957 we can’t really make that claim for people,” McBride said. “And so our immunity is dependent on vaccine status.”

People living in Wisconsin can look up their immunization status on the Wisconsin Immunization Registry, McBride said. Some people’s records might be incomplete, either because they received a vaccine in another state or because they got a vaccine before 1999, when the registry was launched. Earlier vaccines were logged on paper by health providers, according to the Wisconsin Department of Health Services.

Interest in the MMR vaccine appears to be rising. News reports and public health announcements drawing attention to recent measles cases and the importance of the vaccine “certainly raises new awareness and attention to it,” he said.

More patients are asking about the shot and more doctors and nurses are asking whether there needs to be any changes to the current vaccine schedules recommended by the American Academy of Pediatrics or the state health department.

McBride said the current cases in Wisconsin don’t point to any change in those recommendations, however. For health care providers, “The most helpful interventions would be to evaluate your patients and make sure they are up to date with the measles vaccine.”

A sign at a University of Utah health clinic warns visitors about the spread of measles. Under the Trump administration, federal health officials have cut back the number of recommended vaccines, and more states are offering exemptions 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 vaccination before the pandemic are among those losing ground as exemptions and unfounded skepticism take hold, encouraged by the Trump administration’s stance under U.S. Health and Human Services Secretary Robert F. Kennedy Jr.

Expanded exemptions for parents are likely to drop both Mississippi and West Virginia from the top national rankings they held before the pandemic, according to a Stateline analysis of federal data. Other states like Florida, Idaho, Louisiana and Montana also are pushing the envelope on vaccine choice.

At least 33 states were below herd immunity in the 2024-25 school year, compared with 28 states before the pandemic in 2018-2019, the analysis found. Herd immunity refers to the percentage of people who must be vaccinated or otherwise immune from an infectious disease to limit its spread.

Research shows that in the case of measles — a highly contagious disease — states need to maintain at least 95% vaccination rates to protect people who can’t get vaccinated. Other diseases have similar herd immunity rates. People who can’t be vaccinated might include infants too young to receive certain vaccines and those with underlying health conditions.

Misinformation and expressions of distrust from influential leaders have an effect on parents, doctors say, as do new state exemptions making it easier for families to avoid the vaccines.

Some people who never questioned vaccines before notice a national debate and get confused, said Dr. Patricia Tibbs, a pediatrician in rural Mississippi and president of the Mississippi chapter of the American Academy of Pediatrics. New religious exemptions may already be fueling an increase in pertussis, also known as whooping cough, in Mississippi, she said.

“If they hear something about it in the news, then it must be right, they think,” Tibbs said. “We’re just following the guidelines and informing patients that this is a scientific discussion. Nothing has changed about the science. But people who don’t know science are making decisions.”

Under Kennedy’s leadership, federal support for vaccination has continued to slide, and many states have joined a movement to set their own course by following more science-based recommendations from doctors. On Jan. 26 the Governors Public Health Alliance, a group of 15 Democratic governors, endorsed child and adolescent vaccination standards from the American Academy of Pediatrics rather than the federal government.

Federal health officials in Trump’s administration have cut back the number of recommended vaccines. The chair of a vaccine advisory committee, pediatric cardiologist Kirk Milhoan, suggested in a Jan. 22 podcast that individual freedom was more important than protecting community health with vaccines, even for measles and polio.

New leading states

Before the pandemic, Mississippi and West Virginia had the highest kindergarten vaccination rates in the nation, according to the Stateline analysis. About 99% of kindergartners in each state had their required vaccinations before entering public schools in the 2018-2019 school year.

In the latest statistics for the 2024-25 year, Connecticut gained the No. 1 spot, followed by New York and Maine. Those states have reined in exemptions to school vaccine requirements, while Mississippi and West Virginia have begun to allow more exemptions.

West Virginia didn’t report 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 wouldn’t be available until later this year.

But the state is likely to be pushed out of the top 10. Republican Gov. Patrick Morrisey issued an executive order a year ago giving parents the right to ask for religious exemptions. To date, the state has approved 693 such requests for the current school year, spokesperson Gailyn Markham wrote in an email. That alone is enough to shift the state’s ranking significantly.

Stateline computed an average of required kindergarten vaccination rates to compare states. The analysis uses 2018-19 as a pre-pandemic baseline because a large number of states did not report the information in 2019-20 in the chaos that followed the early COVID-19 spikes and school closings.

A January study published by JAMA Pediatrics found increased vaccination rates among kindergartners in states that had repealed nonmedical exemptions, suggesting the repeals “played a role in maintaining vaccination coverage in repeal states during a period of heightened vaccine hesitancy.”

Requirements and exemptions

All 50 states and the District of Columbia require students to have certain vaccines before attending public school. They also all allow exemptions for children who cannot receive vaccinations for medical reasons, and most states allow nonmedical exemptions, often for religious or sometimes personal reasons. But Florida Republican Gov. Ron DeSantis’ administration has proposed dropping all requirements, and Idaho enacted a 2025 law allowing vaccination exemptions for any reason. Idaho had the lowest rate of kindergarten vaccination, about 80% in the 2024-25 school year before the law took effect in July last year.

Louisiana in 2024 enacted a law dropping COVID-19 vaccine requirements for public schools, and the state has opted to halt publicity about flu vaccination and end public vaccine clinics.

A Florida bill that progressed out of committee in January would maintain school vaccine requirements but expand exemptions to include “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 proposal to revoke vaccine requirements and the bill that would expand exemptions. Florida’s kindergarten vaccination rate fell from 94% before the pandemic to about 90% in 2024-25, according to the Stateline analysis.

“They’re ignoring the 90% of their constituents who want vaccines and want to stay safe,” said Takagishi. “The legislators are listening to the louder voice of those who want to oppose vaccines instead of the majority. We also know that there are teachers in the school system and school nurses who are fighting this because it puts them at risk.”

All states except Montana report kindergarten vaccine statistics to the federal government. Montana enacted a 2021 law making vaccine status private and unavailable for statistical reports, over the objections of medical experts. The law also made medical exemptions easier for families who think their children have been injured by vaccines.

Dr. Lauren Wilson, a pediatrician and then-vice president of the Montana chapter of the American Association of Pediatrics, said in a hearing that the law would make “vaccination information unavailable for responding to and mitigating public health emergencies.”

“Vaccines have saved millions of lives. I personally have seen cases of tetanus, pertussis, measles and meningitis and the tragedies that these mean for families,” Wilson said in her testimony.

A 2023 court order forced Mississippi to accept religious exemptions. West Virginia allows religious exemptions following the governor’s order last year.

Tibbs, who practices pediatrics in rural Jones County, Mississippi, said she has been seeing more pertussis than usual, and thinks vaccine exemptions could be a factor.

In Mississippi, which reported 394 religious exemptions for the 2024-25 school year, overall rates remained high enough that year, at about 97.8%, to ensure “herd immunity” in most cases.

Mississippi has granted 617 religious vaccination exemptions for kindergartners this school year, about 1.8% of the class, according to Amanda Netadj, immunizations director for the state health department. About 96.3% of kindergartners have all required vaccinations this year.

But the state’s whooping cough cases last year were the highest they’d been in at least decade, and in September health officials announced an infant had died of the disease — the state’s first whooping cough death in 13 years.

“We do have a lot of people getting the religious exemption,” Tibbs said. ”But still, on any given day, the majority of my patients will still get their vaccines. We are keeping our fingers crossed that the numbers stay high enough.”

Stateline reporter Tim Henderson can be reached at thenderson@stateline.org.