Kindergarten Routine Vaccination Rates Continue to Decline

Routine vaccination rates for kindergarten children continue to decline in the U.S., while exemptions from school vaccination requirements, particularly non-medical exemptions, have increased. These trends began during the COVID-19 pandemic and have continued over time (Figure 1). Recent trends appear to be related to increasing vaccine hesitancy, fueled in part by vaccine misinformation. The past few years have seen more skepticism among the public about the safety and effectiveness of measles vaccines, a decline in trust of health authorities in general, and increasingly partisan views on vaccine requirements. This issue brief provides an update on the latest trends in children’s routine vaccination and exemption rates.

While states and local jurisdictions, not the federal government, set vaccine requirements for school children, the federal government has a long-standing, evidence-based system for approving and recommending vaccines for the public, including the childhood vaccination schedule, which is used by states, pediatricians, and parents. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. has led recent efforts to re-examine the federal childhood vaccine schedule and replace members of the Centers for Disease Control and Prevention’s (CDC) vaccine advisory committee (ACIP). KFF polling from August 2025 found there is confusion among the public about U.S. vaccine policy, with half of the public thinking RFK Jr. has made “major” (26%) or “minor” (26%) changes to vaccine policy while the other half either say they “don’t know enough to say” (40%) or say no changes have been made (7%). In addition, half (48%) of parents are not sure if federal health agencies are currently recommending that healthy children receive a COVID-19 vaccine this fall or not. While there have not been changes to other routine childhood vaccinations, the CDC is no longer formally recommending the COVID-19 vaccine for healthy children, and COVID-19 vaccination rates among children are low. Changes (and confusion about those changes) at the federal level coupled with reduced support from the federal government for state and local health departments could further drive down vaccination rates among children.

What are recent trends in kindergarten children’s routine vaccination rates?

The share of kindergarten children up to date on their vaccinations continues to decline. Data collected and aggregated annually by the CDC from state and local immunization programs found that 92.5% of kindergarteners had been vaccinated against measles, mumps, rubella (MMR) and polio and 92.1% against DTaP (diphtheria, tetanus, and acellular pertussis) for the 2024-2025 school year. This is down from 95% across all three vaccines for the 2019-2020 (pre-pandemic) school year and below coverage levels of the past decade. In every school year since the pandemic began, the MMR vaccination rate has fallen below the Healthy People 2030 “target” rate of 95%, the level needed to prevent community transmission of measles, a highly contagious and life-threatening virus. This means approximately 286,000 kindergarteners were unvaccinated and unprotected against measles, and research shows the more unvaccinated children in a school, the larger risk of an outbreak becomes. While measles has been officially “eliminated” from the U.S. since 2000, the U.S. has reported more cases of measles in just the first half of 2025 than in any year since 1992, putting the U.S.’s elimination status potentially at risk.

Over three-quarters (39) of states had MMR vaccination rates below the “target” rate of 95% for the 2024-2025 school year, an increase from 28 states during the 2019-2020 (pre-pandemic) school year (Figure 2). Further, 16 states reported rates below 90% for the 2024-2025 school year, compared to only three states in the 2019-2020 school year. In the last year alone, over half of states experienced declines in vaccination rates across all state required vaccines, including MMR, DTaP, polio, and varicella. There is also substantial variation in vaccination rates across states, with MMR coverage rates among kindergarteners for the latest school year ranged from a low of 78.5% in Idaho to a high of 98.2% in Connecticut. There can also be variation in vaccination coverage within states, and, when there are clusters of unvaccinated people within a specific community, the risk of an outbreak is higher.

What are recent trends in kindergarten children’s vaccine exemption rates?

At the same time, the share of kindergarten children with an exemption from one or more required vaccinations increased. The share of children claiming an exemption from one or more vaccinations rose from 2.5% in the 2019-2020 school year to 3.6% in the 2024-2025 school year, the highest national exemption rate to date. Increases in non-medical exemptions accounted for the recent increases; non-medical exemptions increased from 2.2% to 3.4% while medical exemptions actually declined slightly from 0.3% to 0.2% from 2019-2020 to 2024-2025. While a seemingly small increase in non-medical exemptions, any increases limit the overall share of children able to be vaccinated and make it more difficult to reach vaccination rate goals. Studies have shown that higher exemption rates are associated with lower vaccination coverage rates and increased risk for disease outbreaks.

Seventeen states in the 2024-2025 school year had vaccine exemption rates over 5% compared with nine states during the pre-pandemic school year (Figure 3). Those states could not reach vaccination coverage rates at or above 95% even if all non-exempt children were vaccinated (rates shown here are for exemptions to one or more vaccines, so potentially achievable coverage rates could vary by vaccine type). In the last year alone, 37 states (including D.C.) experienced an increase in the share of kindergarteners claiming an exemption for one or more vaccines. As of 2025, all states and DC require children to be vaccinated against certain diseases, including MMR, in order to attend public schools, though exemptions are allowed in certain circumstances. All states allow a medical exemption, and 47 states (including D.C.) allow for a religious or personal belief exemption (or both). In recent years, some groups and state leaders have pushed to relax requirements and expand non-medical exemptions for school children while others have proposed the elimination of non-medical exemptions.