Vaccine mandate exemptions are becoming more common, researchers reported in a study published on Jan. 14.
Across most states and the District of Columbia, the median exemption rate for religious and philosophical reasons increased on an annual basis from 2010 to 2024, particularly after the COVID-19 pandemic started, Dr. Nathan Lo of Stanford University’s Department of Medicine and co-authors said in the new paper.
The median rate rose from 0.6 percent in 2010–2011 to 3.1 percent in 2023–2024.
Nearly all states require children to receive certain vaccines to attend school. Those states grant exemptions for medical reasons, typically with proof such as a doctor’s note. All but a handful also allow exemptions for nonmedical reasons, such as religious beliefs.
The researchers for the new paper asked for and obtained county-level vaccination data from state departments of health and other sources.
They acquired data for 3,053 counties in 45 states and the nation’s capital, predominantly for children entering kindergarten.
More than half of the counties with data available for 2010 and 2024 had an increase in nonmedical exemptions greater than 1 percent, and 5.3 percent recorded a jump of more than 5 percent.
Arizona, Idaho, Oregon, Utah, and Wisconsin had the highest rates of nonmedical exemptions in 2024, the researchers said.
States, including California, that eliminated nonmedical exemptions had declines.
Exemptions for medical reasons remained stable in the period of time studied, the researchers said.
The Journal of the American Medical Association published the findings in a research letter. The listed limitations of the study included the data not covering all counties in the country.
Conflicts of interest included one author who received grants from Pfizer.
“This county-level analysis reveals geographically focused areas of high vaccine exemptions that are less evident at the state level. Continuation of these increases in nonmedical exemptions could contribute to declining vaccination and resurgence of vaccine-preventable infectious diseases in the US,” Lo and coauthors stated. “These findings support the need to reconsider policy on use of nonmedical exemptions, which are actively being debated, to address declining childhood vaccination in the US.”
The Centers for Disease Control and Prevention, in an analysis of state-level data, reported in mid-2025 that rates of vaccination among kindergartners had declined from the previous year, while exemptions increased. About 138,000 kindergartners had exemptions in the 2024–2025 school year, the CDC said at the time.
Barbara Loe Fisher, president and co-founder of the National Vaccine Information Center, which advocates for ending vaccine mandates, told The Epoch Times in an email that the findings were not surprising because officials have narrowed medical exemptions over the years, “so parents have only the conscientious and religious exemptions available to protect their children from harm.”
The sharper increase from 2021 to 2024 reflects the public’s response to COVID-19 vaccine side effects and mandates, “which created fear and distrust of aggressive vaccination policies implemented by doctors and public health officials,” she added.