New Data Underscores Need to Catch up on Routine Childhood Vaccinations

The Centers for Disease Control and Prevention (CDC) released updated data on vaccination coverage among kindergartners, showing a continued decline in the share of children with the recommended doses of routine childhood vaccines needed to prevent the spread of harmful diseases. The report includes data on vaccination rates by state for four vaccines: measles, mumps, and rubella (MMR); diphtheria, tetanus, and acellular pertussis (DTaP); poliovirus; and varicella. Coverage for all four vaccines declined in most states, with nationwide coverage of about 93% in the 2021-2022 school year, compared to 94% in the 2020-2021 school year, and 95% pre-COVID-19 pandemic.

National MMR coverage among kindergarten students (93.5%) remained below the threshold needed to provide community protection (95%) for the second consecutive year. MMR vaccination rates varied widely by state, from 78% in Alaska to 98% in New York. But local areas with many un- or under-vaccinated children can lead to outbreaks even if the larger community has high vaccination rates. In the US, measles outbreaks usually start as travel-related, but then spread quickly through un- or under-vaccinated communities, including infecting babies who are still too young to be vaccinated (as happened recently in Ohio).

The American Academy of Pediatrics’ recommended vaccine schedule indicates that children should receive their first MMR dose between 12-15 months of age and their second dose between 4-6 years old, usually as part of routine well-child visits. School vaccination requirements are an important policy tool to make sure children are protected against vaccine-preventable diseases generally, and kindergarten enrollment is well-timed to make sure that children are protected against measles in particular. However, the COVID-19 pandemic and related disruptions to well-child visits and in-person school have made it harder to identify and reach un- and under-vaccinated children.

Only 13 states reported MMR coverage of 95% or higher. Importantly, most states (33) could achieve the 95% target by increasing follow-up with un- and under-vaccinated students (e.g., unvaccinated students that do not have a qualifying exemption and students that may have received 1 but not both recommended MMR doses). This is good news – no law or policy changes are required to achieve community-wide protection. Using local-level data, states could identify schools or communities with low vaccination coverage and conduct tailored outreach campaigns and vaccination drives, making it easier for families to catch up.

However, in 4 states (Arizona, Idaho, Oregon, and Utah), even if all non-exempt kindergartners caught up on their MMR vaccines, the total share of children protected would still be below the 95% threshold required to achieve community-wide protection. In these states, lawmakers should revisit school exemption policies to make sure vaccination coverage can reach the necessary levels to protect vulnerable groups.


Kelly Whitener is an Associate Professor of the Practice at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.