Jen Fisher of Franklin, Tennessee, tries to do everything she can to protect her son from infections that any minor can contract at school. The rest, Fisher says, is up to other students and parents.
Fisher is especially careful because her 12-year-old son, Raleigh, lives with a congenital heart condition that has weakened his immune system. Raleigh has received all the vaccines recommended for those his age. But even with the protection provided by those vaccines, if Raleigh contracts a virus that for another child would mean being in bed for a couple of days, he could end up with a serious illness and in the emergency roomaccording to Fisher.
“We want everyone to be vaccinated so that diseases like measles and things that basically had been eradicated do not return“Fisher said. “Those can definitely have a very adverse effect on Raleigh.”
For much of Raleigh’s life, Fisher was able to rest easy because her home state, Tennessee, has had a high childhood immunization rate. For many years that rate has been a major public health achievement in a conservative-led state that in other areas has poor well-being results and reports the shortest life expectancy in the United States.
Mississippi and West Virginia, also governed by conservative politicians and having a generally low life expectancy, are other states with some of the highest vaccination rates for preschool and kindergarten-aged children in the country.
This apparent contradiction is due to the fact that childhood vaccination requirements are not always affected when conservative measures are imposed in some places.
“The types of policies that states have don’t fit neatly into the category of ‘red’ or ‘blue’ or one region or another,” said James Colgrove, a professor of Columbia University that studies what factors influence public health.
Anti-vaccine messages spread
However, activists, doctors, researchers, and public health officials They fear these public health achievements in states like Tennessee are disappearing: Several have recently reported an increase in people choosing not to vaccinate their children, as Americans’ opinions about immunization change.
During the 2023 to 2024 school year, the percentage of kindergarten-age children whose parents asked to exempt them from one or more vaccines increased to 3.3%, the highest number ever reported nationally, according to data from the Centers for Disease Control and Prevention. Disease Prevention (CDC). The increases were seen in with increases in 40 states, including Tennessee and Mississippi, as well as Washington, D.C.
Almost all of the exemptions requested were for non-medical reasons, such as possible allergies, but for issues such as personal opinions.
Those who advocate for childhood vaccination fear that anti-vaccine messages are reaching such a point that they could accelerate a growing “health choice” movement, which has been promoted by leaders in states like Florida.
The anti-vaccine push is likely to increase during the incoming Donald Trump Administration, as he has selected anti-vaccine activist Robert F. Kennedy Jr. to be his secretary of the Department of Health and Human Services.
Pediatricians in states with high exemption rates, such as Florida and Georgia, say they are concerned. They have seen declining levels of immunization among kindergarten-aged children and say that could lead to the resurgence of diseases like measles, which are preventable through vaccination.
For example, the Florida Department of Health has reported that in some areas of the state the rate of exemptions from childhood vaccinations for non-medical reasons is as high as 50%.
“The religious exemption is a big deal,” said Brandon Chatani, a pediatric infectious disease specialist in Orlando. “It’s created an easy way for these kids to go to school without being vaccinated.”
In many states it is easier to get a religious exemption than a medical onewhich often requires specialist approval.
In the last decade, California, Connecticut, Maine and New York have eliminated exemptions for religious and philosophical reasons when it comes to school vaccination requirements. West Virginia previously did not allow exemptions for these reasons.

In the 2023-2024 school year, Idaho, Alaska and Utah had the highest exemption rates, according to the CDC. These states allow parents or legal guardians to exempt their children for religious reasons by submitting a notarized form or signed declaration.
Florida and Georgia, which have some of the lowest reported vaccination rates for kindergartners, allow parents to exempt their children by submitting a form to the school or daycare.
Both states have reported drops in measles, mumps and rubella vaccination (called multiple vaccine or MMR vaccine), one of the most common childhood immunizations. In Georgia, MMR coverage for kindergarten-aged children fell from 93.1% in the 2019-20 school year to 88.4% in the 2023-24 school year, according to the CDC. In Florida it fell from 93.5% to 88.1% in the same period.
Last December, Georgia public health officials issued an advisory saying that the state had recorded significantly more cases of whooping cough than the previous year. According to CDC data, Georgia reported 280 cases in 2024, compared to 96 the previous year.
“There is a lot of data to support the fact that when exemptions for personal beliefs are not allowed, vaccination rates are higher“said Andi Shane, a pediatric infectious disease specialist in Atlanta, who said in some cases the low rates are because some families don’t have access to a pediatrician.
Setback in Mississippi
Until 2023, Mississippi was one of the few states that allowed parents to opt out of vaccinating their children only for medical reasons and only with the approval of a specialist. That made it one of the highest vaccination rates in the country through the 2023-24 school year.
But that changed in April 2023, when a federal judge ordered state officials to start allowing religious exemptions. The ruling has encouraged many families to stop immunizing their children, according to Anita Henderson, a pediatrician who has practiced in the southern part of the state for nearly 30 years.
“We are seeing increasingly skepticismmore vaccine hesitancy and a lack of trust because of this ruling,” he said.
State officials have granted more than 5,000 religious exemptions since the court order was issued, according to the state health department.
Daniel Edney, the state’s health officer, said most requests come from especially “affluent” residents in suburbs.
“Most people do listen to the advice of experts, such as their pediatricians and family doctors, to stay up to date with the vaccination schedule because it is the best way to protect their children,” Edney said.
In line with what has been seen in Mississippi, the vaccination law in West Virginia — which does not allow non-medical exemptions — may soon change, according to Matthew Christiansen, who was the state’s health officer until he resigned in December.
Last year, a bill seeking to expand the exemptions advanced in the state House before being vetoed by Jim Justice, the outgoing Republican governor.
Meanwhile, the incoming governor, Republican Pat Morrisey, has been an outspoken critic of vaccination requirements.
Limit others for ‘freedom’
People who use their personal freedoms to refuse to vaccinate their children may ultimately limit the ability of others to live fullyChristiansen said.
“That children contract measles, mumps and polio, and are paralyzed for life, is an impediment to the freedom and personal autonomy of these children,” he emphasized.
Since the COVID-19 pandemic, anti-vaccine sentiment has been on the rise in places like Tennessee, where Jen and Raleigh Fisher are from.
“A resurgence of these diseases may be needed to raise awareness that they are deadly and preventable.”
Anita Henderson pediatrician in mississippi
For example, the anti-vaccine organization Stand for Health Freedom released a letter to the public last October inviting people to sign and send it to their state legislators calling for the resignation of the person in charge of the vaccination program at the Tennessee Department of Health. , because they say it has supposedly demonstrated “a lack of respect” for people’s rights to have informed consent for medical issues.
Groups like that “feel empowered by the idea that this (incoming) presidential administration seems to believe strongly that many of these issues should be left up to the states” to decide, said Emily Delikat, director of Tennessee Families for Vaccines, a group pro-vaccination.
The curious thing is that, like many effective public health interventions, vaccines are victims of their own successaccording to Henderson, the Mississippi pediatrician.
Most people have not witnessed outbreaks of measles or polio, so they forget how dangerous these diseases are and believe that vaccination can be dispensed with, he added.
“Unfortunately, a resurgence of these diseases may be needed to raise awareness about the fact that they are deadly and preventable,” he said. “I hope it doesn’t have to come to that.”
This story was produced by KFF Health News, a national newsroom focused on in-depth coverage of health issues, which is one of the main programs of KFFthe independent source for health policy research, polling and journalism.