For more than a half-century, vaccines have had remarkable success eradicating the most lethal and devastating childhood infectious diseases, saving millions of lives and ushering in a relative golden era of global public health.
But now, America is dangerously backsliding.
The vast majority of counties across the United States are experiencing declining rates of childhood vaccination and have been for years, according to an NBC News data investigation, the most comprehensive analysis of vaccinations and school exemptions to date.
This six-month investigation, done in collaboration with Stanford University, gathered massive amounts of data from state governments and archives of public records reaching back years or decades. The data focused on core childhood vaccines that, together, regard someone to be “up to date” on immunizations; these are the measles, mumps, rubella, polio, whooping cough and diphtheria shots.
With the help of infectious disease researchers at Stanford, NBC News filed scores of requests for documents, including materials obtained under the Freedom of Information Act, and wrestled different types of data into a standardized format to map and compare rates across thousands of counties.
One key finding of the analysis is stunning: A large swath of the U.S. currently does not have the basic, ground-level immunity medical experts say is necessary to stop the spread of measles, which had once nearly been eliminated. The data further reveals that:
- Since 2019, 77% of counties and jurisdictions in the U.S. have reported notable declines in childhood vaccination rates. The declines span from less than 1 percentage point to more than 40 percentage points.
- Vaccine exemptions for school children are rising nationwide: As many as 53% of counties and jurisdictions saw exemption rates more than double from their first year of collecting data to the most recent.
- Among the states collecting data for the measles-mumps-rubella (MMR) vaccine, 68% of counties and jurisdictions now have immunization rates below 95% — the level of herd immunity doctors say is needed to protect against an outbreak.
“As childhood vaccination rates fall, we’ll see more diseases like measles,” Dr. Sean O’Leary, an infectious diseases expert with the American Academy of Pediatrics, said about the findings. “And we’ll see more children die — tragically — from diseases that are essentially entirely preventable.”
St. Louis offers a window into the striking findings.
The city known as the “Gateway to the West” — home to some of the country’s most influential vaccine research and development institutes, including the Washington University School of Medicine — may be quickly losing its ability to prevent infectious diseases.
The rate of children starting kindergarten in St. Louis with all the state-required vaccines has plummeted from 91.6% during the 2010-2011 school year to 75.9% in 2024-2025.
And the number of families seeking an exemption for their children rose from 0.3% in 2010 to 3.4% last school year, according to the NBC News investigation. In Missouri, exemptions can be granted either for medical or religious reasons.
In 2010, almost 90% of kindergartners attending school within the St. Louis city limits had received their recommended MMR shots, which prevent nearly all cases of measles — the most contagious virus known in the world. In the last school year, MMR coverage rates among kindergartners plummeted to 74%.
That’s below even Gaines County, Texas, the epicenter of the 2025 measles outbreak, where 77% of kids were vaccinated last school year. That puts St. Louis at a high risk for a surge of the virus, which tore through largely unvaccinated communities in West Texas. The outbreak killed three people, including two young girls.
“That’s a heavy, heavy fact,” said Virginia Wilson, head nurse at the Premier Charter School in St. Louis, which has 1,058 students from pre-K through middle school. “We’re just in a waiting phase before measles comes and rocks the state of Missouri.”
The story of St. Louis is emblematic of the nation’s immunization declines. A combination of rising exemptions, difficulties accessing health care services, and anti-vaccine messages fueled by social media and, more recently, the federal government, has laid a path for preventable diseases to potentially explode in the U.S.
Having a lower vaccination rate than Gaines County, those are some scary words. I wish I could say that things might get better in the near future, but we know that that isn’t so, not with the current sociopath in charge of Health and Human Services. It’s going to be rough, and the next big outbreak could well be worse than the one we just went through.
Reform Austin looked at the data for Texas.
Under Texas law, the MMR vaccine is required for all students attending public and private schools. However, families can request exemptions for medical or “reasons of conscience,” including religious beliefs. The rise in such exemptions has contributed to the declining coverage.
Some counties stand out for their particularly low vaccination rates. Irion County, located west of San Angelo, recorded the lowest MMR coverage among kindergartners this school year, with only about two-thirds fully vaccinated.
Gaines County — where nearly 20% of kindergartners had nonmedical exemptions — a severe measles outbreak earlier this year led to over 760 reported cases, 99 hospitalizations, and two children deaths. Nearly half the total cases occurred in Gaines County alone.
Vaccination rates have dropped even in Texas’ largest population centers. In Harris County, the rate has declined from 96.6% to 91% over the past ten years. Similar declines have been observed in Dallas County (down to 90.2%) and Travis County, which now stands at just 86.7%.
Blanco County, within the Austin metropolitan area, has also experienced a steady decline. The coverage rate there dropped to 86.1% this year. On the other hand, Caldwell County has remained relatively stable, maintaining a rate above 95% for most of the past decade.
Counties like Bastrop, Hays, and Caldwell continue to report MMR coverage rates that meet or exceed CDC recommendations.
Irion is a very small county, so in absolute numbers its unvaxxed population is also very small. Even Gaines County has more than ten times its population. But still, it’s the concentration of unvaxxed people that breeds outbreaks. And Travis County, y’all need to do better. I don’t know what else to say.
The anti-vax nuttery has extended to some people resisting getting their dogs vaxxed against rabies. Disney needs to put “Old Yeller” back into the theaters.
I don’t care if you don’t get vaxxed… because I’m going to be vaxxed. If you pass away from an illness that could have been prevented via a short, sharp stab of a needle…well, it’s God’s will.
CL, you should care, since your vaccinations are only effective if a sufficiently high percentage of the population is also vaccinated. Not sure how you missed that tidbit during all the various outbreaks in the past several years. It was sort of all everyone was talking about.