On the other hand, Colorado and Maryland, regularly ranked among states with the best health systems, reported childhood vaccination rates roughly at or below 90 percent for the 2020-21 school year, the most recent year for which C.D.C. data for all states is available. Colorado’s measles-mumps-rubella rate was 90.5 percent, and Maryland’s was 87.6 percent, both in the bottom quartile among states.
Surprisingly, perhaps, the vaccination rate for children in the nation’s capital is a dismal 78.9 percent for measles, mumps and rubella, dangerously below the point at which the spread of the virus will begin to fall, and the vaccination rate for polio is 80 percent, essentially identical to the disease’s herd immunity threshold.
Covid vaccine acceptance and anti-vax attitudes do not fully explain differences among states. Neither do red-blue partisan affiliations or the strength of a state’s public health system. Instead, the decline is rooted in longstanding policies among some states that allow, for instance, for nonmedical exemptions, failures to rigorously enforce vaccination requirements and inadequate public health campaigns.
Here’s how the decline can be reversed.
States should eliminate nonmedical exemptions. Five of the six states that prohibit these exemptions were well above the national average for vaccination rates in the 2020-21 school year. (The sixth, West Virginia, did not report its vaccination rates in the last year on record.) The impact of prohibiting nonmedical exemptions is well documented. After a 2014-15 measles outbreak that began at Disneyland, the California Legislature and governor approved a law that effectively eliminated nonmedical exemptions.
The result: an increase of 3.3 percentage points in the measles-mumps-rubella vaccination rate, which put the state above the immunity threshold for measles. By contrast, Idaho, Arizona, Oregon and Wisconsin had the highest exemption rates in 2020-21, and each had vaccination rates below the national average for measles, mumps and rubella and for diphtheria, tetanus and pertussis.
States should also end extensions granted to schoolchildren to complete routine vaccinations during the pandemic and undertake vigorous community outreach and education campaigns to encourage vaccinations by emphasizing their safety and importance. With the pandemic and staffing shortages, many schools have had less time to conduct vaccination assessments or contact parents on missing documentation. States must provide the resources to ensure compliance.
Children age 14 or older should be allowed to obtain without parental permission all missed childhood polio, measles and other recommended vaccinations. In many states, precedents exist for adolescent consent for treatment of sexually transmitted diseases and psychiatric care.