States relax vaccination mandates — even amidst raging measles outbreak
With a longstanding vaccine skeptic at the helm of the nation's health department, the movement is poised to gain more traction.
TroibNews 
The U.S. is on track to exceed 1,000 measles cases this year as the viral illness—once so rare that many young doctors do not recognize its distinct rash—experiences a troubling resurgence.
As of May 1, the outbreak has affected 29 states and resulted in three fatalities. Despite this alarming situation, some local lawmakers are considering or already implementing policies that could further ease the way for parents to opt out of vaccination requirements for their children in schools.
Last month, Idaho Governor Brad Little enacted a groundbreaking ban on vaccine mandates for schools and businesses in the state, where the vaccination exemption rate for kindergarteners is already the highest in the nation.
On his first day in office, West Virginia Governor Patrick Morrisey issued an executive order allowing religious exemptions from school and daycare vaccination requirements, marking a significant shift in a state that had previously permitted only medical exemptions.
Additionally, lawmakers in conservative states such as Florida, Louisiana, and Texas are deliberating measures that would make it more challenging for healthcare providers to refuse care—ranging from organ transplants to pediatric visits—for unvaccinated individuals.
These state-level initiatives, combined with separate proposals aimed at limiting or banning the use of messenger RNA vaccines like those developed for COVID-19, emerge as vaccine skepticism grows, particularly with figures like Robert F. Kennedy Jr. rising in influence as the new Secretary of Health and Human Services. However, this trend is not entirely new; national immunization coverage for kindergarteners has been declining since the 2019-20 school year, with origins traceable to a group of mothers in Texas. Texas has long been a hub of vaccine resistance and is now at the center of a measles outbreak that threatens to undermine the U.S.’s prior status of having eliminated sustained measles infections.
“The nation has caught up to Texas, because we have been dealing with this rhetoric and these little micromovements,” remarked Rekha Lakshmanan, chief strategy officer at The Immunization Partnership, an organization dedicated to promoting vaccination in the state.
Founded in 2015 by Rebecca Hardy, Texans for Vaccine Choice was created to lobby against legislation aimed at ending religious and philosophical exemptions in Texas. Over the years, the group's influence has grown, with more state lawmakers—primarily Republicans—showing support at events like its annual rally in Austin.
“A group of moms got together and basically said, ‘Not on our watch,’” Hardy stated.
The societal agreement on vaccination—that individuals get vaccinated to help protect their communities—seems to be weakening in the U.S., as more parents are turning to social media to find pediatricians who support their choice to forgo vaccinations. Many parents question the number of vaccinations recommended for their children compared to the 1980s and 1990s.
According to data from the Centers for Disease Control and Prevention, national immunization coverage among kindergarteners for the 2023-24 school year fell to 93 percent, with the rate of exemptions for at least one vaccine rising to 3.3 percent among students. Fourteen states have reported exemption rates above 5 percent.
This decline poses a threat to herd immunity against highly contagious diseases like measles and whooping cough, which require coverage rates of at least 95 percent.
Although measles was officially declared eliminated in the U.S. in 2000, that designation is now at risk. Measles is no longer considered eliminated if a chain of infections persists for over 12 months, a scenario that public health officials anticipate due to the current outbreak.
Experts in public health are increasingly concerned that skepticism surrounding vaccines and the growing "medical freedom" movement—aligned with Kennedy’s “Make America Healthy Again” campaign—will lead to a rise in vaccine-preventable diseases among children, many of which can result in severe health complications or death. Measles is viewed as a warning sign for other lesser-known but serious illnesses, such as whooping cough and Hib disease.
Some public health professionals are now contemplating who might serve as "trusted messengers" to advocate for vaccination, given the declining trust in scientific institutions.
“Right now, we’re losing trust in our institutions in general,” Dr. Seth Berkley, former CEO of Gavi, a global vaccine alliance, commented at a vaccine conference in Washington last month.
A historic action was taken when Governor Little signed a bill in early April prohibiting Idaho schools and businesses from mandating a “medical intervention”—such as a vaccine—as a condition for enrollment or employment. The law, effective July 1, was modified after the governor vetoed an earlier version that he believed would impede schools’ abilities to exclude students with communicable diseases like measles or pink eye.
The legislation that Little eventually endorsed included specific references to Idaho laws allowing both school vaccination requirements and exemptions, as well as provisions permitting schools to keep students with contagious illnesses out of classes. Richard Hughes, a vaccine law expert at Epstein Becker Green who advised on the modifications, indicated that it preserves Idaho’s existing system for mandates and exemptions.
Nevertheless, the law also refers to Idaho’s parental rights statute, leaving its full implications ambiguous. Hughes expressed concern that this could empower vaccine opponents to contest any attempts by schools to uphold their existing requirements.
The Health Freedom Defense Fund, which claims to have authored the original Idaho bill, stated shortly after its passage that the law guarantees “no Idahoan will ever again be compelled to undergo unwanted medical interventions as a condition of employment, education, or daily life.”
Louisiana lawmakers are set to evaluate similar legislation in committee this week.
“It was definitely disappointing to see that pass in Idaho, just to know it can be used to set a precedent for potentially doing things like that in other states,” said Jennifer Herricks, founder of Louisiana Families for Vaccines.
While all 50 states allow medical exemptions from vaccine mandates, only five have prohibited exemptions based on religious or personal beliefs. However, Morrisey has taken steps in West Virginia to revise the state's long-time policy of limiting exemptions to medical reasons.
Morrisey, a Republican, signed an executive order in January directing health officials to create a process for residents to object to immunization requirements on religious or conscientious grounds, citing a state law on religious protections enacted in 2023. Nonetheless, the state House rejected a Senate bill designed to formalize his directive just weeks before the legislative session concluded.
“I'm not a doctor—the experts that I rely upon absolutely are rock solid, rock solid, behind the fact that we need to be taking the vaccines,” stated GOP Senator Jim Justice, Morrisey’s predecessor who vetoed an earlier attempt to relax vaccine policies in the state.
West Virginia's public health agency is still reviewing religious exemption requests. A webpage outlining the medical exemption process explains the rationale behind the state’s previous refusal to grant non-medical exemptions.
“Non-medical exemptions have been associated with increased occurrence of vaccine-preventable disease outbreaks originating in and spreading through schools,” reads a statement from the state Office of Epidemiology and Prevention Services.
In Texas, members of the health committee in the state House recently spent nearly two hours hearing testimony for and against legislation backed by Texans for Vaccine Choice, aimed at facilitating easier access to vaccine exemptions for parents. The majority of the more than a dozen witnesses opposed the proposal, which would allow guardians to print exemption affidavit forms at home instead of waiting for the state to mail them upon request.
Overall, vaccination coverage among kindergarteners in Texas for the 2023-24 school year reached 94.4 percent for mandated immunizations. However, there is significant disparity across the state, with nearly 100 private schools and public districts reporting MMR vaccination rates below 75 percent.
Some legislators expressed sympathy for Texans for Vaccine Choice's position, suggesting that the bill would alleviate paperwork burdens without necessarily increasing the number of exemptions.
“This legislation doesn't affect whether kids can opt out of these vaccinations,” argued Republican state Representative Mike Olcott. “It just has to do with the expediency of how quickly they can opt out.”
However, public health advocates and concerned parents countered that such changes could lead to an increase in exemptions, highlighting the ongoing measles outbreak as a stark reminder of the consequences associated with exemption-friendly policies.
“Texas has given countless rights and protections to parents who choose not to vaccinate,” parent Heather Lacy Cook stated during testimony. “I'm happy for that, but my rights are dwindling.”
Emily Johnson for TROIB News
As of May 1, the outbreak has affected 29 states and resulted in three fatalities. Despite this alarming situation, some local lawmakers are considering or already implementing policies that could further ease the way for parents to opt out of vaccination requirements for their children in schools.
Last month, Idaho Governor Brad Little enacted a groundbreaking ban on vaccine mandates for schools and businesses in the state, where the vaccination exemption rate for kindergarteners is already the highest in the nation.
On his first day in office, West Virginia Governor Patrick Morrisey issued an executive order allowing religious exemptions from school and daycare vaccination requirements, marking a significant shift in a state that had previously permitted only medical exemptions.
Additionally, lawmakers in conservative states such as Florida, Louisiana, and Texas are deliberating measures that would make it more challenging for healthcare providers to refuse care—ranging from organ transplants to pediatric visits—for unvaccinated individuals.
These state-level initiatives, combined with separate proposals aimed at limiting or banning the use of messenger RNA vaccines like those developed for COVID-19, emerge as vaccine skepticism grows, particularly with figures like Robert F. Kennedy Jr. rising in influence as the new Secretary of Health and Human Services. However, this trend is not entirely new; national immunization coverage for kindergarteners has been declining since the 2019-20 school year, with origins traceable to a group of mothers in Texas. Texas has long been a hub of vaccine resistance and is now at the center of a measles outbreak that threatens to undermine the U.S.’s prior status of having eliminated sustained measles infections.
“The nation has caught up to Texas, because we have been dealing with this rhetoric and these little micromovements,” remarked Rekha Lakshmanan, chief strategy officer at The Immunization Partnership, an organization dedicated to promoting vaccination in the state.
Founded in 2015 by Rebecca Hardy, Texans for Vaccine Choice was created to lobby against legislation aimed at ending religious and philosophical exemptions in Texas. Over the years, the group's influence has grown, with more state lawmakers—primarily Republicans—showing support at events like its annual rally in Austin.
“A group of moms got together and basically said, ‘Not on our watch,’” Hardy stated.
The societal agreement on vaccination—that individuals get vaccinated to help protect their communities—seems to be weakening in the U.S., as more parents are turning to social media to find pediatricians who support their choice to forgo vaccinations. Many parents question the number of vaccinations recommended for their children compared to the 1980s and 1990s.
According to data from the Centers for Disease Control and Prevention, national immunization coverage among kindergarteners for the 2023-24 school year fell to 93 percent, with the rate of exemptions for at least one vaccine rising to 3.3 percent among students. Fourteen states have reported exemption rates above 5 percent.
This decline poses a threat to herd immunity against highly contagious diseases like measles and whooping cough, which require coverage rates of at least 95 percent.
Although measles was officially declared eliminated in the U.S. in 2000, that designation is now at risk. Measles is no longer considered eliminated if a chain of infections persists for over 12 months, a scenario that public health officials anticipate due to the current outbreak.
Experts in public health are increasingly concerned that skepticism surrounding vaccines and the growing "medical freedom" movement—aligned with Kennedy’s “Make America Healthy Again” campaign—will lead to a rise in vaccine-preventable diseases among children, many of which can result in severe health complications or death. Measles is viewed as a warning sign for other lesser-known but serious illnesses, such as whooping cough and Hib disease.
Some public health professionals are now contemplating who might serve as "trusted messengers" to advocate for vaccination, given the declining trust in scientific institutions.
“Right now, we’re losing trust in our institutions in general,” Dr. Seth Berkley, former CEO of Gavi, a global vaccine alliance, commented at a vaccine conference in Washington last month.
A historic action was taken when Governor Little signed a bill in early April prohibiting Idaho schools and businesses from mandating a “medical intervention”—such as a vaccine—as a condition for enrollment or employment. The law, effective July 1, was modified after the governor vetoed an earlier version that he believed would impede schools’ abilities to exclude students with communicable diseases like measles or pink eye.
The legislation that Little eventually endorsed included specific references to Idaho laws allowing both school vaccination requirements and exemptions, as well as provisions permitting schools to keep students with contagious illnesses out of classes. Richard Hughes, a vaccine law expert at Epstein Becker Green who advised on the modifications, indicated that it preserves Idaho’s existing system for mandates and exemptions.
Nevertheless, the law also refers to Idaho’s parental rights statute, leaving its full implications ambiguous. Hughes expressed concern that this could empower vaccine opponents to contest any attempts by schools to uphold their existing requirements.
The Health Freedom Defense Fund, which claims to have authored the original Idaho bill, stated shortly after its passage that the law guarantees “no Idahoan will ever again be compelled to undergo unwanted medical interventions as a condition of employment, education, or daily life.”
Louisiana lawmakers are set to evaluate similar legislation in committee this week.
“It was definitely disappointing to see that pass in Idaho, just to know it can be used to set a precedent for potentially doing things like that in other states,” said Jennifer Herricks, founder of Louisiana Families for Vaccines.
While all 50 states allow medical exemptions from vaccine mandates, only five have prohibited exemptions based on religious or personal beliefs. However, Morrisey has taken steps in West Virginia to revise the state's long-time policy of limiting exemptions to medical reasons.
Morrisey, a Republican, signed an executive order in January directing health officials to create a process for residents to object to immunization requirements on religious or conscientious grounds, citing a state law on religious protections enacted in 2023. Nonetheless, the state House rejected a Senate bill designed to formalize his directive just weeks before the legislative session concluded.
“I'm not a doctor—the experts that I rely upon absolutely are rock solid, rock solid, behind the fact that we need to be taking the vaccines,” stated GOP Senator Jim Justice, Morrisey’s predecessor who vetoed an earlier attempt to relax vaccine policies in the state.
West Virginia's public health agency is still reviewing religious exemption requests. A webpage outlining the medical exemption process explains the rationale behind the state’s previous refusal to grant non-medical exemptions.
“Non-medical exemptions have been associated with increased occurrence of vaccine-preventable disease outbreaks originating in and spreading through schools,” reads a statement from the state Office of Epidemiology and Prevention Services.
In Texas, members of the health committee in the state House recently spent nearly two hours hearing testimony for and against legislation backed by Texans for Vaccine Choice, aimed at facilitating easier access to vaccine exemptions for parents. The majority of the more than a dozen witnesses opposed the proposal, which would allow guardians to print exemption affidavit forms at home instead of waiting for the state to mail them upon request.
Overall, vaccination coverage among kindergarteners in Texas for the 2023-24 school year reached 94.4 percent for mandated immunizations. However, there is significant disparity across the state, with nearly 100 private schools and public districts reporting MMR vaccination rates below 75 percent.
Some legislators expressed sympathy for Texans for Vaccine Choice's position, suggesting that the bill would alleviate paperwork burdens without necessarily increasing the number of exemptions.
“This legislation doesn't affect whether kids can opt out of these vaccinations,” argued Republican state Representative Mike Olcott. “It just has to do with the expediency of how quickly they can opt out.”
However, public health advocates and concerned parents countered that such changes could lead to an increase in exemptions, highlighting the ongoing measles outbreak as a stark reminder of the consequences associated with exemption-friendly policies.
“Texas has given countless rights and protections to parents who choose not to vaccinate,” parent Heather Lacy Cook stated during testimony. “I'm happy for that, but my rights are dwindling.”
Emily Johnson for TROIB News
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