'End Non-Medical Vaccine Exemptions, AAP Says'

 

• An updated policy statement from the AAP reiterated the organization's support for laws that require certification of immunization for attending child care and school.
• Though the AAP supports legitimate medical exemptions, the organization continues to call for U.S. states and territories to eliminate nonmedical vaccination exemptions.
• U.S. vaccination rates in school-age children have recently declined while exemptions have risen.

The American Academy of Pediatrics (AAP) on Monday reaffirmed its support for ending nonmedical vaccine exemptions for daycare and school attendance in the U.S.

In an updated policy statement in Pediatricsopens in a new tab or window, AAP reiterated its support for laws and regulatory measures that require certification of immunization for attending child care and school, along with support for medical exemptions for specific vaccines, as determined for individual children, according to authors led by Jesse Hackell, MD, of New York Medical College in Valhalla and chair of AAP's Committee on Pediatric Workforce.

Though all 50 states, the District of Columbia, and Puerto Rico have regulations that require proof of vaccination as a condition for daycare and school attendance, the majority also have a "heterogeneous collection of regulations and laws that allow nonmedical reasons for exemption," Hackell and colleagues noted. At the time of the statement's writing, just five states -- California, Connecticut, Maine, New York, and West Virginia -- had laws only accepting medical exemptions from immunizations.

"We recommend that vaccination is required for participation in certain public activities, such as school and daycare, and if you choose not to vaccinate, you're essentially choosing to exclude yourself from those settings," Hackell told MedPage Today. "We recognize that excluding a child from public education does have problems, and yet, we reach the conclusion that, on balance, assuring the safety of the school and daycare environment outweighs that risk because there are other educational opportunities available."

Hackell also said that members discussed that a policy allowing nonmedical exemptions "puts the burden of protecting children who are susceptible, such as immunosuppressed children ... on their parents rather than on the school, and may serve to exclude those children from school for a decision that they or their parents are not able to make because of medical conditions," Hackell continued. "We felt that, on balance, again, it makes the school environment safer and protects those children who are susceptible because of medical conditions."

AAP's policy was first written in 2016 and last reaffirmed in 2022. In addition to AAP's support for ending nonmedical vaccination exemptions for school attendance, the statement:

• Urged states and territories to develop policies to make sure medical exemptions are appropriate and evidence-based
• Supported equitable and timely access to vaccination to ensure consistent in-person schooling
• Recommended that pediatricians continue to counsel families requesting nonmedical exemptions and "not participate in vetting or endorsing applications for nonmedical exemptions"
• Called for daycare centers and schools to comply with state laws requiring current and accurate documentation of immunization status and appropriate medical exemptions, and for state departments of health and education to enforce such laws on a uniform and equitable basis
• Recommended that public health authorities provide communities with information about immunization rates in daycare centers and schools to determine whether there are risks of outbreaks of vaccine-preventable diseases and to offer parents information about the safety of individual facilities

In recent years, U.S. school-entry vaccination rates have fallen as exemptions have continued to riseopens in a new tab or window. "States that permit nonmedical exemptions have had steady increases in the number of exemptions over time, with the national rate of exemption gradually increasing as well, reaching 3% in the 2022-23 school year," Hackell and colleagues wrote.

Furthermore, religious exemptions have increased in states that don't offer other nonmedical exemptions but have "broadly defined religion for the purposes of obtaining vaccine exemption," they noted. "The ease of requirements to obtain nonmedical exemptions can have a significant impact on the rate of exemptions and immunizations."

Earlier this year, researchers reported that measles, mumps, and rubella vaccination rates in children declined in certain counties across the U.S.opens in a new tab or window during the COVID-19 pandemic, and the U.S. is currently facing its worst year for measlesopens in a new tab or window in more than three decades, with multiple outbreaks across the country.

"It's important to highlight that we've had a record number of cases of measles for this century, and that two unimmunized childrenopens in a new tab or window have died from measles, which is the first time in many, many years," Hackell said. "And to me, a death of a child from a preventable disease is the ultimate tragedy, and that's what we're seeking to prevent."

"Vaccines are effective, they're safe, and they save lives," he said, "and we have to make sure that we reach every community and help them understand that."

Disclosures

The authors did not report any relevant financial disclosures.

Primary Source

Pediatrics

Source Reference: opens in a new tab or windowHackell JM, et al "Medical vs nonmedical immunization exemptions for child care and school attendance: policy statement" Pediatrics 2025; DOI: 10.1542/peds.2025-072714.

https://www.medpagetoday.com/pediatrics/vaccines/116686