Map of the United States overlaid with silhouettes of children, vaccine syringes, and stethoscopes representing vaccine hesitancy and public health.

Vaccine Exemptions: Are We Putting Communities at Risk?

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Lena Kashyap in Health & Wellness June 2025 • 5 min read.

"A closer look at nonmedical exemptions and their potential impact on public health."


Vaccines stand as one of the monumental achievements of modern medicine, effectively eradicating or significantly reducing the incidence of numerous infectious diseases. These diseases, once rampant, posed severe threats to public health globally. However, the effectiveness of vaccines hinges on widespread adoption, creating what is known as herd immunity—a protective barrier where a high percentage of the population is immune, thereby safeguarding those who cannot be vaccinated, such as infants or individuals with certain health conditions.

In recent years, a growing number of parents have sought nonmedical exemptions (NMEs) from mandatory vaccination requirements for their children. These exemptions, often rooted in philosophical or religious beliefs, have sparked considerable debate among healthcare professionals, policymakers, and the public. As NME rates rise, concerns mount about the potential erosion of herd immunity and the subsequent resurgence of vaccine-preventable diseases.

This article delves into the complex landscape of vaccine exemptions in the United States, focusing on a detailed examination of nonmedical exemptions across different states and counties. By analyzing trends and geographical hotspots, we aim to shed light on the factors driving this movement and its potential implications for public health. Understanding these dynamics is crucial for developing effective strategies to promote vaccination and protect communities from preventable diseases.

Where Are Vaccine Exemptions Most Common?

Map of the United States overlaid with silhouettes of children, vaccine syringes, and stethoscopes representing vaccine hesitancy and public health.

Since 2009, there's been a noticeable increase in philosophical-belief vaccine nonmedical exemptions (NMEs) in many states that allow this policy. Specifically, 12 out of 18 states have seen a rise in these exemptions. These states include Arizona, Arkansas, Idaho, Maine, Minnesota, Missouri, North Dakota, Ohio, Oklahoma, Oregon, Texas, and Utah.

Certain metropolitan areas in the U.S. stand out as “hotspots” due to their high numbers of NMEs. These areas aren't cities, but rather the counties they reside in. They include King County and Spokane County in Washington, Multnomah County in Oregon, Maricopa County in Arizona, Salt Lake County and Utah County in Utah, Harris County, Tarrant County, Collin County and Travis County in Texas, as well as Oakland County, Macomb County, Wayne County, and Jackson County in Missouri.

  • Arizona (Maricopa County): Home to Phoenix, this county reports the highest number of NMEs, indicating significant parental hesitancy towards vaccinations.
  • Utah (Salt Lake and Utah Counties): With major cities like Salt Lake City and Provo, these counties also show high exemption rates, reflecting regional trends.
  • Washington (King and Spokane Counties): Including Seattle and Spokane, these counties in Washington contribute substantially to the state’s overall NME numbers.
  • Oregon (Multnomah County): Centered around Portland, this county is another key area where nonmedical exemptions are frequently claimed.
  • Texas (Harris, Tarrant, Collin, and Travis Counties): Featuring cities like Houston, Fort Worth, Plano, and Austin, these counties collectively represent a large portion of Texas’s NME figures.
  • Michigan (Oakland, Macomb, and Wayne Counties): Encompassing areas such as Troy, Warren, and Detroit, these counties highlight vaccine exemption trends in the Midwest.
  • Missouri (Jackson County): Including Kansas City, this county shows notable NME numbers compared to other areas in Missouri.
Looking at the numbers of kindergarteners with NMEs per county helps pinpoint areas with potentially vulnerable pediatric populations. These county totals are usually provided by state health departments, except for Missouri. In Missouri, data from private kindergartens (2015-2016) and public kindergartens (2014-2015) were combined from the National Center for Education Statistics (nces.ed.gov) to estimate NME raw counts.

Why This Matters

The high numbers of nonmedical exemptions in densely populated urban areas suggest that outbreaks of vaccine-preventable diseases could either start or spread quickly through these groups of unvaccinated or partly vaccinated children. The fact that the most vaccine-exempt children live in big cities with busy international airports might make this risk even greater. Continuous monitoring, community-based education, and policy adjustments are essential to address vaccine hesitancy and protect public health.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

What are vaccines and why are they so important for public health?

Vaccines are a cornerstone of modern medicine, designed to prevent infectious diseases. They work by stimulating the body's immune system to recognize and fight off specific pathogens. Their significance lies in their ability to eradicate or significantly reduce the incidence of diseases that once posed severe threats to global public health. The implications of widespread vaccine use extend beyond individual protection, contributing to herd immunity, where a high percentage of the population is immune, safeguarding those who cannot be vaccinated.

2

Could you explain what 'herd immunity' is and why it matters?

Herd immunity is a critical concept in vaccination. It refers to the protection conferred upon a community when a sufficiently high percentage of individuals are immune to a disease, whether through vaccination or prior infection. This immunity acts as a barrier, preventing the spread of the disease to susceptible individuals, such as infants too young to be vaccinated or those with compromised immune systems. The significance of herd immunity lies in its ability to protect the most vulnerable members of society. The implication of declining herd immunity includes the resurgence of vaccine-preventable diseases, endangering public health.

3

What exactly are nonmedical exemptions (NMEs) for vaccines, and what impact do they have?

Nonmedical exemptions (NMEs) are exemptions from mandatory vaccination requirements that are granted for reasons other than medical contraindications. These exemptions are typically based on philosophical or religious beliefs. The significance of NMEs lies in their potential to impact vaccination rates and herd immunity. The implication of increasing NMEs is the erosion of community protection against vaccine-preventable diseases. Certain states and counties, such as those in Arizona, Utah, Washington, Oregon, Texas, Michigan, and Missouri, have seen a noticeable increase in NMEs, raising concerns among healthcare professionals and policymakers.

4

Where in the U.S. are nonmedical vaccine exemptions most common?

Several metropolitan areas in the U.S. are considered "hotspots" for nonmedical exemptions (NMEs). These areas include counties like Maricopa County in Arizona, Salt Lake and Utah Counties in Utah, King and Spokane Counties in Washington, Multnomah County in Oregon, Harris, Tarrant, Collin, and Travis Counties in Texas, Oakland, Macomb, and Wayne Counties in Michigan, and Jackson County in Missouri. The significance of these hotspots lies in the concentration of unvaccinated individuals, which can increase the risk of disease outbreaks. The implication is that these areas may be more vulnerable to the spread of vaccine-preventable diseases, necessitating targeted public health interventions.

5

What are the potential consequences of having a high number of nonmedical vaccine exemptions?

High numbers of nonmedical exemptions (NMEs) can lead to outbreaks of vaccine-preventable diseases, especially in densely populated areas. The fact that many vaccine-exempt children live in big cities with busy international airports means diseases could either start or spread quickly. Continuous monitoring, community-based education, and policy adjustments are essential to address vaccine hesitancy and protect public health. If vaccine exemptions increase, herd immunity diminishes, leading to more disease outbreaks and endangering public health.

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