Vaccination rates across the South Are Dropping Fast
Childhood vaccination rates are declining across the South, posing a serious threat to community health and increasing the risk of preventable disease outbreaks like measles and pertussis. This decline affects herd immunity, leaving vulnerable populations, such as infants too young to be vaccinated and immunocompromised individuals, at risk.
Growing distrust of vaccines is part of the problem. But adequate access to health care remains a significant problem as well. Parents face a variety of challenges with finding and accessing health care provider to get their children vaccinated. This can include transportation, childcare, and appointment availability as well as language barriers, and broader mis- an dis-information.
Below we provide snapshots of the four states SAPHL works in. We’d encourage you to also check out our state engagement pages (linked below) that provide a deeper dive on some of the specific counties with the lowest vaccination rates.
These declining vaccination rates will lead to outbreaks that create real costs for individuals and communities. When outbreaks happen, kids have to stay home—not just the sick ones, but whole classrooms can be quarantined. That leads to learning loss, stressed parents, and more kids falling behind—especially in rural areas where schools are already stretched thin. The quarantine alone for the average family dealing with a child who has measles cost (on average) $14,000 in lost productivity. The cost for a child hospitalized with Whooping Cough can be greater than $60,000.
And this doesn’t even consider the broader community impact. A Measles case takes $20,000 for the local health department to respond to - and pulls staff away from their day job like supporting maternal health or WIC. Major outbreaks also create headlines that undoubtedly hurt the reputation of the communities they start in.
Finding a Path Forward
The good news is there are solutions. To reverse these dangerous trends, protect children, and ensure the responsible use of public funds, policymakers and program administrators in Georgia, South Carolina, North Carolina, and Tennessee can adopt a multi-pronged strategy grounded in evidence and best practices. These recommendations are designed to be synergistic, addressing both vaccine hesitancy and access barriers simultaneously.
Improve data availability. The public deserves to better understand what the vaccination rates are in their community and at their child’s schools. Right now, that kind of data just isn’t publicly available beyond annual county level data in many places.
Make VFC Less of An Administrative Burden. The CDC provides a minimum set of requirements and then often times states create additional rules that limit how providers use the program. State health departments should pursue policies similar that seek to minimize those burdens and explicitly allow for a strategy that allows for more mobile vaccination efforts.
Standardize School District Compliance. Schools across every state that SAPHL works in are struggling to navigate an increasingly complex landscape of vaccination requirements and policies and are often left to their own devices to figure out what to do. States should standardize the compliance process to reduce the burden for school administrators.
Protecting School Vaccine Requirements. Every year there are a number of attempts to dismantle the school vaccine requirements. They remain and incredibly important bulwark for protecting the health and safety of our communities. It is crucial they stay in place.
Georgia presents the most acute risk in the region. For the 2024-25 school year, the state's overall kindergarten vaccination rate for all required vaccines, including MMR and DTaP, plummeted to 86.8%. This represents a stark decline from 94% a decade ago and is the lowest rate among Southern states. This coverage gap is mirrored by a surge in the state's vaccine exemption rate to 4.8%, one of the highest in the South. Critically, 98% of these exemptions—or 4.7% of all kindergarteners—were granted for religious reasons, while medical exemptions accounted for just 0.1%. Just as importantly - more than 9,000 kindergarteners have neither an exemption nor are up-to-date. They’re simply slipping through the cracks. Learn more about engagement opportunities here.
Tennessee is experiencing its fourth consecutive year of declining immunization coverage, with the overall rate for kindergarteners falling to 92.6%. Specific coverage rates for the 2024-25 school year were 94.3% for MMR and 93.8% for DTaP, both below the 95% target. State health officials directly correlate this decline with a steady increase in religious exemptions, which nearly doubled from 1.8% in 2020 to 3.4% in the 2023-24 school year. It’s also important to remember that this isn’t evenly distributed across the state. Only 78.7% of kindergarteners in Grundy county are fully immunized. Learn more about engagement opportunities here.
South Carolina reports kindergarten vaccination rates closer to the national average but still below the herd immunity threshold. For the 2022-23 school year, 2-dose MMR coverage was 91.2% and 5-dose DTaP coverage was 91.8%, with a total exemption rate of 3.4%. But again, many, many kids are slipping through the cracks. As in Georgia - thousands of kids have neither an exemption or are up to date. Learn more about engagement opportunities here.
North Carolina, while still below the target, showed a slight improvement in the 2024-25 school year, with MMR coverage at 94.2% and DTaP at 94%. Despite this, the rates are not sufficient for robust herd immunity against measles, and the state still recorded 3,948 exemptions for the school year. Learn more about engagement opportunities here.