The 2019 measles outbreaks and near loss of the U.S. measles elimination status have once again brought the debate around vaccine requirements to the forefront. State vaccination requirements for day care and school entry are tools for maintaining high vaccination coverage rates, and, in turn, lower rates of vaccine-preventable diseases, such as measles. State laws also establish mechanisms for enforcement of school vaccination requirements and exemptions. All states provide medical exemptions, and some state laws also offer exemptions for religious and/or philosophical reasons.
The Centers for Disease Control and Prevention (CDC) recommends a kindergarten vaccine coverage rate of 95% or above for the measles, mumps and rubella (MMR) vaccine. The average rate for the 2018-2019 school year was 94.7%, ranging by state from 87.4% to 96.1%. The CDC compiles and distributes statewide vaccination rates and exemption rates for children entering kindergarten each school year to monitor national and state coverage trends. State immunization programs collect local data in order to identify “hot spots” in communities where immunization rates are lowest.
These efforts support achieving herd or community immunity, which refers to a population that has achieved immunity at a high enough level to make the spread of the virus unlikely. This protects those individuals who cannot receive a vaccination because they are too young or due to medical reasons. According to the CDC, most states could attain 95% immunization coverage if they could identify children without vaccinations, or who have not completed the full dose of the vaccine, and also do not have an exemption.
State lawmakers have tools to address low vaccination rates and increase the number of children receiving recommended vaccines. States can pass laws to remove philosophical and/or religious exemptions for vaccination requirements, but these debates can often be contentious. In addition, many of the measles cases this past year were in children younger than 5 years old. Some states have authorized other providers, such as pharmacists, to administer vaccines in order to improve access. Other states have taken measures to ensure certain vaccines are covered by insurers with no cost-sharing, in accordance with federal law. Some states require reporting to the state immunization registry to address vaccination rates at the state level. State lawmakers can also target areas of low vaccination rates through providing educational resources or funding, or supporting local health departments addressing low vaccination rates.