In Missouri, 9% of kindergarten students are not vaccinated against measles, polio
By Ethan Colbert – St. Louis Post-Dispatch (TNS)
ST. LOUIS — Health officials are sounding the alarm about a decline in the percentage of young children being vaccinated against measles, mumps, rubella and polio.
More than 6,000 kindergarten students in Missouri public schools — roughly 9% of all kindergartners — in 2023 were not vaccinated against measles, mumps and rubella, according to new data from the state Department of Health and Senior Services.
Poliovirus vaccine
A 10-dose vial of the poliovirus IPV vaccine is seen Nov. 26, 2024, at the St. Louis County Department of Health in Berkeley. The number of Missouri children who are not vaccinated for polio has risen in the past five years.
And nearly 9% were not immunized against polio, a highly contagious and potentially deadly virus essentially eradicated in the U.S. after a vaccine was discovered in the 1950s.
The percentage of unvaccinated kindergarten students has grown every year in Missouri since 2019, when roughly 5% were unvaccinated against measles, mumps, rubella and polio.
The number of parents opting to not vaccinate their children has grown in nearly every part in the state. Some of the lowest rates are in the city of St. Louis, where 25% of kindergartners were not vaccinated against measles, mumps and rubella, known together as MMR. And 26% were not vaccinated against polio, state figures show.
Chart: Fewer Missouri kindergartners are immunized
Around 9% of kindergarten students in Missouri public schools were not vaccinated against measles, mumps, and rubella in 2023, and nearly the same percentage were not immunized against polio, state data shows.
“The lower the vaccination rates go, the higher the chances are that there will be introduction of an infectious disease into a community,” said Dr. Rachel Orscheln, a pediatric medicine professor at Washington University’s School of Medicine. “Every point that our overall vaccination rate drops, our risk increases for outbreaks of infectious diseases.”
State vaccination data for 2024 will be released in the summer. But the figures for the past few years — with each percentage point representing hundreds of Missouri children whose parents have not had them vaccinated — reflect a trend the state health department has been monitoring, said spokesperson Lisa Cox.
“This is a pretty big deal,” Orscheln said. “It is something that people need to take notice of, especially when you start to see statistically significant declines in vaccination rates.”
The anti-vaccination movement has gained considerable momentum recently, aided by the politicization of the COVID-19 vaccine and the rise of anti-vaccination politicians such as Robert F. Kennedy Jr., whom President-elect Donald Trump has tapped to lead the U.S. Department of Health and Human Services.
Kennedy has long promoted the debunked idea that vaccines cause autism. He’s also said repeatedly that he believes “there is no vaccine that is safe and effective.” In a 2021 podcast, he urged people to “resist” the U.S. Centers for Disease Control and Prevention’s recommendations on when kids should get vaccines, according to The Associated Press.
Kennedy, meanwhile, has insisted that he is not anti-vaccine, saying he only wants them to be rigorously tested.
“We’ve been fortunate because we’ve had high rates of protection through vaccinations,” Orscheln said. “People have become somewhat complacent about these infectious diseases. People no longer fear them.”
Mistrust in medicine
Many of the parents opting against vaccines are finding camaraderie in social media groups. Missouri Parents Against Vaccines, for example, has been around for nine years and claims more than 1,700 members on Facebook.
Some parents of unvaccinated children say they know their views are controversial and fear being ostracized by their family and friends or even losing their jobs. They’re not a monolithic group, identifying across regions, political parties and religious affiliations.
A St. Charles County mother, who works as a St. Louis public school teacher, said she did not vaccinate her child, now 10, because she questions the ingredients that drug makers use to produce the vaccines and the number of recommended shots. Her child attends school under a religious exemption for vaccinations because, she said, school administrators “can’t question it.”
The number of students receiving religious exemptions in Missouri public schools has grown from 1.8% to 3.2% for state-required vaccinations, according to state data.
The teacher said she questions “who is influencing” the CDC, the National Institutes for Health and public health officials advocating for vaccinations.
Chart: Immunization exemptions primarily cite religious reasons
Since 2020, more Missouri kindergarten students are being opted out of immunizations. The vast majority cite religious reasons rather than medical, and the trend is stronger among private school students than public.
“The corporate world has gotten way into medicine for them to be trustworthy anymore,” she said.
That kind of sentiment is exactly what St. Louis Director of Health Dr. Matifadza “Mati” Hlatshwayo Davis is trying to overcome.
She said some parents are hesitant to vaccinate or opt to not vaccinate because of a “mistrust in institutional medicine” over past “health care-related trauma and testing” on racial and ethnic minorities.
“Some people have valid mistrust for government agencies, so we work really hard to make sure people know that not only do we have amazing providers but we also have providers within your culture, maybe even within your own community,” Hlatshwayo Davis said.
The city health department has launched social media campaigns promoting vaccinations and other public health priorities. It has paid for billboards and advertisements in newspapers and local television. Staff members regularly participate in local radio shows and host meetings with parents.
“Our approach is about understanding what their concerns are — I never assume that every parent’s concerns are the same,” Hlatshwayo Davis said. “We really lean into being trusted messengers.”
Higher rates in counties
Vaccination rates in Jefferson, Lincoln, Franklin, St. Charles and St. Louis counties are in the 90th percentile — considerably higher than the city.
The discrepancy can be explained by a combination of factors, including that St. Louis County and other metro areas have higher health insurance rates, employment rates and income figures than St. Louis, says Dr. Kanika Cunningham, St. Louis County’s public health director.
“Those factors all clear the path to hospitals and to private doctors’ offices,” Cunningham said.
Those factors though, don’t explain the lower vaccination rates in areas such as Scotland County in northeast Missouri. The county has a population of about 4,600 and is 200 miles north of St. Louis, along the Iowa border.
Vaccination rates there have fallen by double digits in the past five years, despite Scotland County having a rural hospital and public health department.
In 2023, 61% of kindergartners there were vaccinated against measles, mumps and rubella, while just over half were vaccinated against polio.
Sarah Steele, the county’s health director, said she was “surprised” by its distinction as the lowest-vaccinated county in the state.
“I don’t feel like there is anyone out here saying, ‘Let’s not vaccinate our kids against measles or polio,’” Steele told the Post-Dispatch.
She said the department regularly promotes vaccines for school-age children in local media outlets and on social media.
The county hospital’s spokesperson did not respond to interview requests.
“We try to educate people about why these vaccines are vital, but I guess people will read and believe what they want to read and believe,” Steele said, adding the department will “push more education to the public.”
Increase in risk
The drop in vaccination rates poses a threat to areas “that are likely below herd immunity levels,” said Cox, of the state health department.
The state defines herd immunity for measles as 95% vaccination — meaning enough people are vaccinated that even those who aren’t have some protection from the illness.
Measles can be especially serious for children younger than 5 and those who are immunocompromised. Common symptoms include a rash that starts as flat red spots on the head and then spreads to other parts of the body; high fever; cough; red and watery eyes; and tiny white spots inside the mouth.
In some instances, the disease can develop into a brain infection; it can also be fatal.
According to the CDC, there have been 16 measles outbreaks this year, sickening more than 280 people across 32 states, including Missouri and Illinois. Missouri has had 10 confirmed measles cases in 2024, while Illinois has had about 100.
While the state’s vaccination rate for polio has declined in the past several years, it has not fallen below 80%, the defined herd immunity level, Cox said.
In 2022, an unvaccinated New York resident became the first person in the U.S. to be partially paralyzed by polio in decades. The person, who lived in upstate New York, is believed to have caught the virus from an international traveler who also was not vaccinated.
“As part of the younger generation of people … having kids in kindergarten, we have not seen polio,” said Dr. Charlie Landis, a pediatrician with Mercy Hospital Washington in Franklin County, where polio vaccination rates have fallen in recent years to 91%.
“Personally, as a parent of two young boys, that is kind of a scary thing,” Landis said.
“Our grandparents and great-grandparents grew up in an era where if you got polio, they knew that you could end up with paralysis that leads to breathing on an iron lung,” he added. “We don’t see those things these days, and that’s due to the success of the polio vaccine.”
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