As the United States continues to battle the lingering effects of the pandemic, another crisis is brewing in the form of dwindling vaccine coverage among kindergartners. According to a recent analysis by the Centers for Disease Control and Prevention, routine childhood vaccination coverage has dropped from 95% – the target coverage – prior to the pandemic, to a new low of 93% in the 2021-2022 school year.

A 2% drop might not sound significant, but it means nearly 250,000 kindergarteners are potentially not protected against measles. The national coverage of MMR vaccination which protects against measles, mumps and rubella, is now the lowest it has been in over a decade.

Pandemic disruptions and misinformation

The prime factors contributing to this decline include pandemic-related disruptions such as missed well-child doctor’s appointments and barriers to access for children living below the poverty line or in rural areas.

It would of course be naive to think that vaccine misinformation and disinformation haven’t played significant roles in the decline. But while anti-vaccine rhetoric has previously led to a rise in exemptions for school immunization requirements, the current data suggests this is not the present cause.

Official exemptions have slightly increased by only 0.4 percentage points — not nearly enough to account for the discrepancy in vaccine coverage — and this could mean that vaccination coverage may rebound as America continues to move on from the pandemic. But is this just wishful thinking?

The CDC officials also acknowledged that rampant anti-vaccine sentiments surrounding the rollout of COVID-19 vaccines may have spilled over into routine childhood vaccination, making a full rebound less likely. Parents may have simply decided to ignore the vaccination notices for their children, taking advantage of looser regulations during the height of the pandemic, as well as reduced access to vaccination appointments, extended timelines for enforcement, and delays in data collection that are still ongoing.

“Certainly misinformation is a problem and has always been a problem, and we’re still trying to understand the extent to which misinformation around COVID-19 vaccines has spread to misinformation about other childhood vaccines,” Dr. Sean O’Leary, chair of the American Academy of Pediatrics’ Committee on Infectious Diseases, said on a call with reporters last week.

More than a third of US parents say that vaccinating children against measles, mumps and rubella should be an individual choice and not a requirement to attend public school, even if that may create health risks, according to survey data published Friday by the Kaiser Family Foundation (KFF).

That’s a notable increase from pre-pandemic times. A similar poll from the Pew Research Center found that 23% of parents opposed vaccine requirements in schools in 2019, but that’s now jumped to 35% in the KFF survey.

“As schools return to in-person learning, high vaccination coverage is critical to continue protecting children and communities from vaccine-preventable diseases,” the CDC researchers wrote in the study, who added that vaccination does not only protect the children themselves but also the broader community.

Ohio is among the states with the lowest vaccination rates against measles in kindergartners. Last school year, fewer than 90% of kindergartners were vaccinated in Ohio. This lack of vaccination led to an outbreak in the Columbus area with 83 cases among children, mostly unvaccinated.

Outbreaks like this are preventable and harm children’s ability to learn, grow and thrive. This is also exemplified by recent cases of polio reported in New York. Vaccination throughout childhood is crucial as it equips children’s immune systems to resist diseases, leading to healthy childhood and adulthood.

In all, 13 states saw two-dose MMR coverage at or above the national target of 95%, while nine states and the District of Columbia had coverage rates below 90%.

Despite these challenges, there is a silver lining. According to additional data released by the CDC, vaccination coverage in 24-month-old children slightly increased prior to and during the pandemic. By 24 months, children are recommended to get a suite of primary-series vaccinations, with boosters and additional doses given by the 4-5 year range, around the start of kindergarten.

This is a crucial time for the United States to step up and ensure that our youngest citizens are protected against preventable diseases. The long-term effects of a decrease in vaccination coverage can be devastating, not only for individual children but for the entire community.

“Despite challenges caused by the COVID-19 pandemic, we must stay vigilant to ensure children get the vaccines they need to protect themselves against serious diseases,” said Dr. Georgina Peacock, director of the Immunization Services Division in the CDC’s National Center for Immunization and Respiratory Diseases.