Vaccination exemptions for kindergartners reached a record high last school year, with about 127,000 students lacking at least one of the required shots, according to new data released by the Centers for Disease Control and Prevention.
Measles vaccination rates dipped below the federal target for the fourth year in a row, the data shows. The decline comes as measles cases have reached their highest total since 2019. There have been 264 measles cases and 13 outbreaks reported nationwide so far this year, up from 59 cases and four outbreaks in 2023. Pennsylvania and New Jersey are among 31 states that have reported cases.
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The percentage of kindergarten students with one or more exemptions for childhood vaccines rose to 3.3% in the 2023-2024 school year, compared to 3% the prior year. Exemption rates increased in 40 states – exceeding 5% in 14 states, the CDC reported.
Vaccination exemption laws vary from state to state. Pennsylvania and New Jersey each require vaccination against various diseases, including measles, mumps, rubella, pertussis, hepatitis B and chicken pox to attend school. Vaccinations are not required in Pennsylvania if the child has medical, religious or strong moral or ethical convictions against immunization. New Jersey limits exemptions to medical and religious reasons.
Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia, answered some questions about the public health ramifications of the dropping vaccination rates and rising exemption rates among young children.
The interview has been edited for length and clarity.
PhillyVoice: Why do some people fear vaccines?
Paul Offit: I think it is reasonable to be skeptical about anything you put into your body or your child's body. You should be skeptical. And I think the skepticism is understandable. In the first few years of life, we ask parents to give children vaccines to prevent 14 different diseases, which can mean as many as 25 shots during that time. It can mean as many as five shots at one time to prevent diseases most people don't see, using biological fluids. It's not hard to imagine why there is pushback.
PV: Are vaccines safe and effective?
Offit: The answer to the question is yes. And then when people have questions about safety, like, 'Do these vaccines cause autism or diabetes or multiple sclerosis?' Those issues have been studied, and vaccines don't cause those problems. But a choice not to get a vaccine is not a risk-free choice. It's just a choice to take a different and more serious risk, and you're seeing what that risk is starting to look like.
If you look at the number of immunological components in vaccines, add them all up, it comes out to less than 200 immunological components. And by immunological component, I mean bacterial protein, viral protein, bacterial polysaccharide. That is not just figuratively, but literally, a drop in the ocean of what you encounter and manage every day.
You have trillions of bacteria that live on the surface of your body. The food you eat isn't sterile, the dust you inhale isn't sterile. One bacterium has about 3,000 immunological components. If you really want to scare yourself, just take a swab of your child's nose, put it on a slide, look at it under the microscope. It's teeming with bacteria.
PV: Why are exemptions rates rising?
Offit: If you'd asked me at the beginning of the pandemic, 'how did I think people would view vaccines?' I think they'd view them the way I viewed them, which is a life-saving measure for a time when we had nothing else. In 2020, we had nothing. We didn't have vaccines until December, and you had a virus that was killing thousands of people a day, and all you could do was avoid human to human contact. So we shuttered schools, we closed businesses, we restricted travel.
I would have thought that vaccines, which allowed us to at least come back to a life now that's normal, would have been seen as the hero that they were. But they weren't.
And I think it was mandates. When we mandated vaccines – mandated them for schools, mandated them for bars, restaurants, places of worship, sporting events – I think people saw that as government overreach. I don't think it was, but I think people saw it that way. And I just think this is the rebound from that.
PV: Why is vaccination a public health issue?
Offit: If you step on a rusty nail, and that nail penetrates through your skin, and it was contaminated with dirt, you're at risk of tetanus. If you choose not to get a tetanus vaccine, that is a personal decision. No one is going to catch tetanus from you. It's not a contagious disease or communicable disease.
On the other hand, if you choose not to inoculate or vaccinate yourself against SARS-CoV-2 (a virus that causes COVID-19), that's a contagious illness, so you're making a choice for yourself and for others.
Is it your right to catch and transmit a potentially fatal infection? I don't think so. There are at least 9 million people in this country who, because they're getting immune suppressive therapies for their cancers or for their rheumatologic diseases, can't be successfully vaccinated. They depend on you to protect them.
PV: What are the consequences of the decreasing vaccination rates of young children?
Offit: You're seeing what you would expect to see when there's an erosion in vaccine rates. Last year, we had about 50 cases of measles. This year, it's closer to 200. We've had almost 200 deaths from influenza in children less than 18 years of age. You've seen about a threefold increase in the number of cases of pertussis or whooping cough. When you have an erosion in vaccine rates, not surprisingly, you see an increase in the incidence of vaccine preventable diseases. It's children, it's always the most vulnerable among us, who suffer our ignorance.
When we get to about 1,000 cases (of measles) – and we're getting there – you'll start to once again see children die of measles in this country, which has a mortality rate of 0.1%. Roughly one per 1,000 will die.
It's a dangerous game we play. It's a game of Russian Roulette that you don't have to play. And frankly, the most dangerous aspect of getting vaccines, statistically, is driving to the office to get them.