In recent years, paediatric immunisation rates in the US have been declining. Vaccines have long been a cornerstone of public health, as they protect children from serious, preventable diseases such as measles, polio, and whooping cough. Yet, increasing vaccine hesitancy, misinformation, and barriers to healthcare access undermine this safeguard. The implications of this trend extend beyond individual health by threatening herd immunity (when a large enough population is immune to a disease that it is difficult for a disease to spread), increasing the risk of outbreaks in communities across the country, and leading to a resurgence of diseases previously considered to be eradicated.
Data published by the US Centers for Disease Control and Prevention (CDC) in a Morbidity and Mortality Weekly Report published in October 2024 showed that, among preschoolers, all paediatric vaccines have declined from 95% in the 2019-20 school year to below 93% for the 2023-24 school year. Several factors are contributing to the decline in paediatric vaccination rates in the US. For example, the CDC reports that exemptions for vaccines among preschoolers increased from approximately 2.6% in the 2021-22 school year to 3.3% in the 2023-24 school year. Some states have exceeded a 5% exemption rate. Medical and nonmedical exemptions contributed to this trend, leading to increased susceptibility to outbreaks of preventable infectious diseases. An exemption rate of 5% or more is significant because it reduces herd immunity. This is particularly important for diseases such as measles, which require a coverage of nearly 95% to maintain herd immunity. According to leading data and analytics company GlobalData’s epidemiology forecast, vaccination rates for measles were below 92% in 2017 and are expected to remain around this level up to 2028. Other concerns associated with exemption rates of 5% or more are that they tend to be grouped in specific communities or settings, creating pockets of low vaccine coverage where a disease can spark a large outbreak. Misinformation about vaccine safety and efficacy continues to drive reluctance to vaccinate children among some parents. Social media and other online platforms allow for the rapid spread of misleading information that is unsupported by scientific data. Misleading content creates significant confusion among the public, especially when no fact checking is implemented. However, economic and logistical challenges also contribute to the recent decrease in vaccine coverage. Families without adequate health insurance are faced with out-of-pocket costs for vaccines, making routine childhood immunisations less accessible. Although programmes that provide free vaccines do exist in the country, some people may be unaware of these resources. Rural and remote areas also face accessibility barriers as individuals may have to travel long distances to reach vaccination clinics. Limited clinic hours can also lead to fewer children being vaccinated, as working parents may struggle to take time off without risking their income or job security. The Covid-19 pandemic has also played an important part in disrupting routine check-ups where vaccines would have been administered. Recovery from these missed appointments may be slow in areas where a larger proportion of preschoolers are not up-to-date with vaccines.
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Declining vaccine coverage is a public health concern because it directly impacts community and individual health, economic stability, and societal resilience. As the risk for the resurgence of once-controlled diseases such as polio and measles increases, so can the risk of severe illness, long-term complications, and death. Outbreaks strain healthcare systems and can lead to large medical bills. Additionally, the decrease in vaccine coverage can indicate a lack of trust in public health systems. Therefore, investing in vaccine education, ensuring equitable healthcare access, and combating misinformation can help reverse the trend to safeguard communities at large.
