Get your shots, kids
URI College of Pharmacy Clinical Professor Jeffrey Bratberg breaks
down the science of vaccines, their effectiveness in preventing
disease, and the dangers of under-vaccination among young students.
While vaccines have been shown to be safe and highly
effective in protecting against communicable disease, rates of vaccinations
among the youngest students have steadily inched down in recent years as
parents increasingly seek exemptions from school district vaccine requirements.
Exemption requests hit their highest levels last year, according to the Centers for Disease Control and Prevention, as a record 3.6 percent of kindergarten students were exempted from vaccine requirements, up from 3.3 percent the previous year.
Just 92.5 percent of kindergarteners were
vaccinated against such highly contagious diseases as measles, rubella and
mumps in the 2024-25 school year, the CDC reports. Before the COVID-19
pandemic, vaccination rates among kindergartners were higher than 95 percent—the
level needed to make an outbreak unlikely.
What is driving the surge of vaccine exemption requests, and what risk may it pose to children, both vaccinated and unvaccinated? As school districts field more exemption requests ahead of the school year, University of Rhode Island College of Pharmacy Clinical Professor Jeffrey Bratberg breaks down the science of vaccines, their effectiveness in preventing disease, and the dangers of under-vaccination among young students.
Q: What is leading to the surge of exemption requests in school districts around the country?
A: It’s important to note the rise is in non-medical
exemptions for religious or strongly-held beliefs, or simply personal beliefs,
depending on state law. These data are aligned with a years-long trend in
the United States and globally toward vaccine skepticism and less vaccine
confidence, which became more pronounced during and after the COVID-19
pandemic. Even as vaccines became easier to get at more places—pharmacies, mass
vaccination clinics, schools—social media, especially, has spread concern about
vaccines, leading to more exemptions. Now, vaccine skeptics are leaders of
federal health agencies, not only spreading misinformation, but also creating a
void in what had been a decades-long emphatic promotion of vaccines.
Q: What danger do unvaccinated children face?
A: Generally, unvaccinated children face more severe
disease, which can lead to more severe and longer symptoms, missed school and
activities, lost wages from family members, more risk of acquiring the
disease in the household. Especially for family members with higher-risk
conditions—but even among healthy kids—more hospitalization and death can
result. The United States had two unvaccinated children die of measles for the
first time in decades, entirely preventable deaths if vaccination rates remained
about 95 percent.
Q: Do children who are vaccinated face a danger as well?
A: Vaccines are not 100 percent protective, just like
surgery or medication are not 100 percent successful. The benefits of
vaccination far exceed the risks as the most studied, tested, and monitored
medical interventions, extending from the individual to their close contacts
and community, and creating herd immunity when vaccination rates top 95
percent. As rates of vaccination fall, children who may not have been diagnosed
with a higher-risk condition or who may not develop full immunity could be at risk,
which is why immunization is really a gift of safety to others.
Q: What do you think has led the recent surge in measles
cases nationwide?
A: When community, or herd, immunity declines below 95
percent for measles (the U.S. level currently sits around 93 percent and is
falling, nationwide), this most infectious disease will spread. Measles is
around 12 times more contagious than influenza and twice as contagious as
COVID-19. In the vast majority of outbreaks, more than 4 in 5 people infected
were not protected from the disease because they chose not to get vaccinated.
Q: What should people know about vaccine safety and
efficacy?
A: Routine vaccines are safe and save children’s lives.
Routine vaccines have prevented more than 1 million deaths and 500 million illnesses in the U.S. over
the last three decades. Recommended vaccines protect children from 21 serious diseases. High vaccination rates
protect all children—their benefits extend to those who are too young to be
vaccinated and people with health conditions that prevent them from getting
vaccinated. Following the routine vaccine schedule—designed to protect a child
at the right time, before they’re exposed to dangerous diseases—protects
children when they’re most vulnerable. Vaccinating a child on time protects
them early and helps prevent serious health problems.
Q: Are there people for whom vaccines are not safe?
A: There is a very small group of severely
immunocompromised people for whom vaccines will not work because their immune
system cannot produce antibodies. Some types of vaccines, which work by
replicating in the body to stimulate the immune system, may be dangerous for
them. With no immune system, this replication can go unchecked. These live
vaccines are also not recommended for pregnant people. (Importantly, past
national guidelines and current national pregnancy associations like the
American College of Obstetricians and Gynecologists, wholeheartedly recommend
the non-live, COVID-19 vaccine in pregnancy.) Finally, there may be children
who are too young for certain vaccines or those who haven’t completed their
vaccine series for whom certain vaccines pose a risk.
Q: Do falling vaccination rates present a risk to public
health? What are the likely consequences?
A: Yes, absolutely. We will see more preventable
outbreaks in more places affecting more people. As the numbers of infected
increase, there will be more preventable, costly, and disruptive
hospitalizations, and more preventable deaths.
