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.

A change in federal recommendations for childhood vaccines has concerned public health experts nationwide. (Getty Images)

This story was originally reported by Barbara Rodriguez of The 19th. Meet Barbara and read more of their reporting on gender, politics and policy.

The federal government is reducing the number of vaccines it formally recommends to all children in the United States, which public health experts say is an abrupt, potentially dangerous change that will sow confusion among families.

The Centers for Disease Control and Prevention said Monday that the agency now recommends vaccines against 11 diseases instead of the 17 previously suggested under America’s childhood vaccine schedule. Acting Director Jim O’Neill says the decision is based on a “comprehensive scientific assessment,” though the agency publicly bypassed a key federal vaccine panel that has long voted on recommendations that shape vaccine policy.

Federal officials claim the altered vaccine schedule will not impact vaccine access for the general public. But medical groups say they’re still determining how it might impact long-term vaccine supply, access and insurance coverage. And they worry how families with small children — many of whom are vaccinated against multiple diseases within the first two years — are interpreting the changes.

“We recognize parents are hearing a lot of information right now, and a lot of it is really confusing and really misleading,” said Dr. Sean T. O’Leary, chair of the Committee on Infectious Diseases for the American Academy of Pediatrics during a media briefing Monday. “Our role as pediatricians is to cut through all that noise and understand what the science actually shows so that parents can make informed decisions with confidence alongside with their pediatrician.”

Wisconsin health department: Vaccine recommendation changes spark ‘great concern’

Here’s what we know about the changes so far and what they mean for families with young kids.

What are the changes?

The childhood vaccine schedule is a series of recommended shots, historically set by the medical community and the federal government, for children as they age. Vaccines are not mandated in the United States, but the CDC’s recommendations impact the cost and availability for everyday people, since insurance companies turn to agency guidance to determine what they will cover. Individual states also require immunizations against several diseases in settings where infections can spread quickly, including at schools and day cares.

The CDC now recommends vaccines to all children against 11 diseases:

• Diphtheria
• Tetanus
• Acellular pertussis (whooping cough)
• Haemophilus influenzae type b (Hib)
• Pneumococcal conjugate
• Polio
• Measles
• Mumps
• Rubella
• Human papillomavirus (HPV)
• Varicella (chickenpox)

Officials will also recommend just one dose of the HPV vaccine instead of two. (A study published last month by the New England Journal of Medicine found one dose is highly effective).

Federal officials are recommending children who are part of “certain high-risk groups or populations” get vaccinated against six diseases:

• Respiratory syncytial virus (RSV)
• Hepatitis A
• Hepatitis B
• Dengue (the vaccine for this disease was already recommended only to children with a history of dengue infection or in an area where the disease is common)
• Meningococcal ACWY
• Meningococcal B

Officials will also recommend immunizations based on “shared clinical decision-making” for several vaccines that were once suggested for all:

• Rotavirus
• COVID-19
• Influenza
• Meningococcal disease
• Hepatitis A
• Hepatitis B

Previously, COVID-19, influenza and rotavirus were all included in general vaccine recommendations. The change comes amid an uptick in flu activity around the country. And before the rotavirus vaccine — which helps prevent a disease that causes severe diarrhea in young children — there were reportedly 70,000 related hospitalizations.

The changes, according to the CDC, are effective immediately and aimed at aligning the U.S. childhood vaccine schedule to those of “peer” countries. That follows a directive last month from President Donald Trump, after weeks of spreading disinformation about vaccines, to better reflect America’s schedule with other countries, including Denmark — an idea that public health experts warn is ignoring the United States’ lack of a comprehensive health care system.

The change was celebrated by Health and Human Services Secretary Robert F. Kennedy Jr., who has repeatedly dismissed the effectiveness of routine childhood vaccines.

“This decision protects children, respects families, and rebuilds trust in public health,” he said in a statement.

Who is considered part of a high-risk group or population?

Vaccination against six diseases is now recommended only for children part of “certain high-risk groups or populations.”

HHS said in accompanying documentation that for people in this category, “risk factors can include unusual exposure to the disease, underlying comorbidities, or the risk of disease transmission to others.”

The updated CDC site lists some of these new parameters:

• RSV: Children should get one dose if their birthing parent did not get a shot during pregnancy. Children should get a second dose at 8 to 19 months if they have a medical condition like chronic lung disease.
• Hepatitis A: Children should get vaccinated against the disease if they’re planning international travel to areas with high or intermediate cases of hepatitis A.
• Hepatitis B: Children whose birthing parent tests positive for the disease or whose status is unknown should vaccinate their newborn and continue the multi-dose series. This follows a CDC advisory panel’s recent recommendation to end a universal newborn shot.
• Dengue: Vaccination is recommended if a child is living in areas with endemic dengue or have a confirmed lab test of a previous infection.
• Meningococcal ACWY: Vaccination is recommended for children with anatomic or functional asplenia or HIV infection, and those traveling to countries with hyperendemic or epidemic meningococcal disease, and first-year college students living in residential housing.
• Meningococcal B: Vaccination is recommended for children with anatomic or functional asplenia and during outbreaks.

Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a co-inventor of the rotavirus vaccine, said some of these new definitions lack critical context. He noted people can get hepatitis A through food contamination.

“So basically you’re in a high-risk group for hepatitis A assuming you eat food,” he said. “Are they going to make that clear?”

Dr. Lori Handy, an associate director at the same center as Offit, said the new recommendations do not have the typical level of detail that accompanies the immunization schedule.

Handy added that the RSV monoclonal antibodies were previously recommended for all newborns, with a second dose during the next RSV season recommended for high-risk children.

“In my clinical opinion, all infants are at high risk of RSV infection, being that virtually all children are infected by age 2,” she said.

What does shared clinical decision-making mean?

HHS says shared clinical decision-making is between a health care provider and the patient, or the parent or guardian: “It is not always possible or pragmatic for public health officials to clearly define who will benefit from a vaccine, who has the relevant risk factors, or who are at risk for exposure. Parents and physicians, who know the child, may be better placed to make that judgment.”

On a CDC website dated January 2025, shared clinical decision-making is defined as “individually based and informed by a decision process between the health care provider and the patient or parent/guardian that may be informed by factors like an individual’s “characteristics, values, and preferences” and a health care provider’s clinical discretion as well as the “characteristics of the vaccine being considered.”

O’Leary said “shared clinical decision-making” is a confusing phrase for parents and health care providers.

“The fact is, pediatricians already do this all day every day. They routinely have long, detailed conversations with families about vaccines,” he said. “Changing a recommendation to shared clinical decision-making doesn’t change that. It just makes things more confusing for parents and clinicians.”

Survey data released last year by the Annenberg Public Policy Center (APPC) on the general public’s understanding of new COVID-19 guidelines found there was confusion over what such decision-making means.

“Expecting parents to engage in shared decision-making with health care providers about routine, thoroughly studied childhood vaccinations suggests that the public health community has doubts about the safety and efficacy of these vaccines when it does not,” said Patrick E. Jamieson, director of APPC’s Annenberg Health and Risk Communication Institute, in a statement. “These vaccines have been part of the recommended childhood schedule because the benefits of taking them substantially outweigh the risks.”

Will this impact access to shots?

HHS officials claim that anyone who wants a vaccine as previously recommended will be able to access it without additional cost, adding that all vaccines will still be covered by insurance companies.

“While non-consensus immunizations are not routinely recommended for all children, all these vaccines will continue to be available for anyone who wants them and will be covered by Medicaid, CHIP, the Vaccines for Children Program, and private health insurance,” according to HHS.

O’Leary said that claim doesn’t take into account some potential downstream consequences. He worries that some clinicians, who already face logistical costs with ordering and storing certain vaccines, may decide to stop stocking vaccines that are now under shared clinical decision-making because there could be a drop in demand. He also worries that pharmacists in certain pockets of the country may be unable to administer vaccines that are not universally recommended because of local laws and rules over who gives shots and under what circumstances. Others have noted that some combination shots are for diseases that now fall under different CDC categories.

If I want my child to receive vaccinations against diseases listed beyond the reduced 11 universal recommendations, will that be possible?

Given HHS’s claim that this altered schedule will not impact access for anyone, that technically means a parent who wants a vaccine that isn’t part of the non-consensus category — whether as a high-risk group or population or under shared clinical decision-making — should be able to access it.

“Parents can still choose to give their children all of the Vaccinations, if they wish, and they will still be covered by insurance,” Trump wrote on this Truth Social account on Monday. His post included a reference to “MAHA Moms” who he seemed to credit for the change, alongside Kennedy and other federal officials.

A spokesperson for HHS did not immediately respond to a request for clarification about access changes, but several officials emphasized on Monday that all vaccines listed on the schedule under any category would be available at no-cost. A major insurance group said last year that they would cover vaccines recommended through September 2025 into the end of 2026.

Why are Kennedy and his HHS staff making these changes?

Trump and Kennedy have both claimed without evidence that childhood vaccines are unsafe and that the country is an outlier compared to other nations — though the number of vaccines available in the United States is similar to countries like Australia and Germany. It follows years of anti-vaccine activism by Kennedy, who previously helped run an anti-vaccine group.

With Monday’s announcement, federal officials including Kennedy claimed the change would restore trust in vaccines — an assertion that medical groups said ignored the impact of vaccine messaging by Kennedy himself. Those groups have criticized Kennedy’s handling of a measles outbreak that began last year and continues to spread.

In the final months of the year, Kennedy directed the CDC to update its website to claim, without evidence, that vaccines cause autism. That follows his department’s guidance in the fall to warn pregnant people that taking over-the-counter pain relief medication could cause autism, which is false.

How are medical groups responding to the announcement?

AAP described the changes as “dangerous and unnecessary.”

Dr. Ronald G. Nahass, president of the Infectious Diseases Society of America, called it “irresponsible” for the federal government “to haphazardly change vaccine recommendations without a solid scientific basis and transparent process.” He worried it would further decrease vaccination rates and increase disease.

The Big Cities Health Coalition, whose members represent local health departments with roughly 61 million residents, said the announcement makes those local officials’ jobs harder amid confusion.

“We will continue to do everything in our power to ensure that those who live in our jurisdictions continue to have access to vaccines that protect their health and save lives,” said the group in a statement.

Where can I get more information about vaccines?

O’Leary noted that AAP continues to publish its own vaccination schedule. Several states, particularly those run by Democrats, have announced regional health alliances — both in the west and east — aimed at ensuring access to vaccines recommended by groups like AAP.

“It remains the trusted gold standard for keeping children healthy,” he said. “Following our schedule on time remains the best way to ensure children receive the strongest possible protection.”

Offit said parents with young children should turn to their pediatrician or family doctor, many of whom already seek guidance from groups like AAP, if they have questions about the changes and future availability.

“I do think that on the ground, I’ll be curious to see how much things change,” he said. “We’ll see.”

O’Leary added that AAP will be working with its partners across medicine and public health to ensure that parents have “credible science-backed vaccine recommendations they can trust.”

“Tragically, our federal government can no longer be trusted in this role,” he said.

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A child receives a COVID-19 shot. A reduction in the list of federally recommended childhood immunization has sparked alarm among public health experts. (Photo by Chip Somodevilla/Getty Images)

A federal government announcement this week dropping some vaccines from the list recommended for routine childhood immunization has drawn opposition from medical professionals nationwide and concern from the Wisconsin health department.

The Wisconsin Department of Health Services is reviewing information from the Centers for Disease Control and Prevention (CDC) about the change in vaccine recommendations “and is doing so with great concern for the health of children in our state,” Jennifer Miller, a DHS communications specialist, told the Wisconsin Examiner in an email message Tuesday.

“Health professionals and parents deserve accurate, credible information,” Miller wrote. “We have not yet seen new scientific evidence that would justify changes to longstanding recommendations that have and continue to protect the health of children in the United States.”

The decision to stop recommending certain vaccines is “dangerous and unnecessary,” the president of the American Academy of Pediatrics said in a statement posted Monday at the professional association’s website.

What does the new childhood vaccine schedule actually mean for your family?

Among the diseases dropped from those recommended for routine immunization are hepatitis A and B, rotavirus, respiratory syncytial virus (RSV), flu, and meningococcal disease.

“AAP continues to recommend that children be immunized against these diseases, and for good reason; thanks to widespread childhood immunizations, the United States has fewer pediatric hospitalizations and fewer children facing serious health challenges than we would without this community protection,” said Dr. Andrew Racine, AAP president, in the statement.

Miller said that DHS will continue its assessment of the CDC’s recommendation changes as well as those from “other trusted medical and public health agencies.” The department plans to issue more information on Thursday, she said.

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