Reviewed by Sanchi Malhotra MD, University of California Los Angeles
Non-medical vaccine exemption rates have increased from 1% in 1991 to 3% in 2023 among kindergarteners. This cross-sectional study used state-level kindergarten vaccination and exemption rates from the CDC for school years 2011 through 2023 looking at vaccination coverage for 4 vaccines: DTaP, hepatitis B, MMR, and polio. Authors identified changes to state exemptions during the study period: 4 states repealed all non-medical exemptions during study period, 2 states partially repealed non-medical exemptions and 1 state loosened requirements allowing for more exemptions. After total repeal of non-medical exemptions, kindergarten exemption rates in those states dropped significantly by 3.2% within 3 years compared to states that maintained nonmedical exemptions. There was minimal evidence of substitution toward medical exemptions after repeal: increased by only 0.4%. Partial repeal of nonmedical exemptions was associated with smaller (2.2%) and less persistent changes compared with total repeal. Total repeal was associated with increased kindergarten vaccination rates of 2 to 4 percentage points relative to non-repeal states. Impact of total exemption repeal grows over time, with the largest estimates observed 3 to 4 years after state passage. Amid growing vaccine hesitancy, restricting exemptions may play a role in maintaining vaccination coverage and may be a strategy worth advocating for at the legislative level.
Reference:
Bald A, Gold S, Yang YT. State Repeal of Nonmedical Vaccine Exemptions and Kindergarten Vaccination Rates. JAMA Pediatr. Published online October 27, 2025. doi:10.1001/jamapediatrics.2025.4185