More than 1 in 20 kindergartners in Minnesota schools last year lacked inoculation against measles, one of the most contagious infectious diseases, due to families’ personal objections. That rate has nearly doubled in the past decade, from 2.9% in 2015-16 to 5.7% in 2024-25.
While data on this year’s kindergartners isn’t yet available, public health advocates say the ongoing trend leaves Minnesota children increasingly vulnerable to a disease that is highly contagious, potentially deadly and easily preventable. Among those most endangered by the trend are children younger than kindergarten age, immunocompromised kindergartners who can’t get the vaccine for medical reasons and the unvaccinated children themselves and their families.
Measles, which is prevented by the MMR (measles, mumps and rubella) vaccine, is not an outlier. Minnesota has seen a similar increase in non-medical exemptions for all other childhood vaccines, Minnesota Department of Health data shows. Exemptions for the DTaP vaccine, which protects against diphtheria, tetanus and pertussis (whooping cough) are also up, as are exemptions for other kindergarten-age vaccines against hepatitis B, polio and varicella.
'Mandatory' immunizations
According to state statute, all five of these vaccines — MMR, DTaP, hepatitis B, polio and varicella — are mandatory for enrollment in kindergarten. But parents can enroll their children without vaccinating them if the parents have “conscientiously held beliefs” against the practice or against a specific vaccine. Unlike other states, which require a doctor to attest that the parents have been warned of the risks of skipping vaccinations, Minnesota only requires a notarized form from the parent.
Mandatory immunizations due before starting grades seven and 12 can similarly be sidestepped due to the parents’ beliefs.
Roughly 60,000 children start kindergarten every year in Minnesota, and tying enrollment to immunizations has been largely successful in ensuring most kids are vaccinated before entering the school system, said Dr. Rebecca Wurtz, a professor at the University of Minnesota School of Public Health.
But the strategy has become less effective over time.
“Since the incorrect association of the measles vaccine with autism, about 25 years ago, parents have questioned vaccines a lot more and have sought to not have their kids vaccinated,” said Wurtz, a physician and infectious disease specialist.
What do the numbers say about measles vaccinations?
The U.S. Centers for Disease Control and Prevention shows that Minnesota had the 11th highest non-medical exemption rate for all vaccines last school year, at an estimated 5.8% of kindergartners.
Data from the state Department of Health, which is based on schools annually reporting their own statistics, shows that for the past 10 years, vaccine exemptions have been increasing. But that change isn’t borne equally throughout the state.
Representatives of Kanabec County’s public health department, Wadena County’s public health department and the main school districts within each county, did not return MinnPost’s messages seeking comment.
Pandemic accelerated vaccine exemption trend
Following a drop in state exemption rates during the 2020-21 school year, driven by the shift to remote schooling, exemption rates for all kindergarten vaccines began increasing even faster.
“We have seen a decline in the fully vaccinated rate each school year since the start of the COVID-19 pandemic,” said Margo Roddy, manager of the vaccine-preventable disease section at the Minnesota Department of Health.
Wurtz agrees that COVID, and especially the government’s response to the pandemic, gave the vaccine-skeptic movement a boost.
“During the pandemic, many people questioned the government’s authority to make health decisions or requirements for them, and people extrapolated from their anger about masking requirements and stay-at-home orders to other governmental health mandates,” Wurtz said.
“Then a lot of people were suspicious of the COVID vaccine itself, and so that caused them to broaden their anxieties to all vaccines,” Wurtz said.
Vaccine resistance increases chances of outbreak
A central idea behind vaccines as an effective public health tool is that the more people are inoculated, the safer the overall population will be.
“Childhood immunizations are a cornerstone of public health, protecting our youngest from devastating diseases. It's important for families to understand that school-required vaccines remain safe and effective. Getting recommended immunizations not only saves individual lives but also protects entire communities by preventing outbreaks,” Roddy said.
Wurtz said the rise of vaccine hesitancy among Minnesota parents is creating the conditions for a deadly measles outbreak like the one that struck western Texas this year. That outbreak led to 762 cases, 99 hospitalizations and two deaths – both school-age children who were unvaccinated.
“The kids in Texas were well nourished and otherwise healthy, but two still died. And the exact same thing can happen in Minnesota,” she said, adding that measles is about 15 times more infectious than COVID and six times as contagious as the flu.
Health officials need to gain trust among skeptics
Both Wurtz at the University of Minnesota and Roddy at the Department of Health believe more Minnesotans need to be convinced of vaccines’ safety and efficacy.
The Department of Health is partnering with school administrators, health care providers and “trusted messengers to build vaccine confidence and remove barriers to access,” Roddy said.
The ever-shifting national public health environment will also affect Minnesotans' level of trust in their government’s health advice.
The CDC, part of the federal Health and Human Services Department led by longtime vaccine skeptic Robert F. Kennedy Jr., is currently in turmoil over its leadership and direction.
“Federally, there will be either a lack of [pro-vaccine] advocacy of any kind, or confusing mixed messaging and misinformation that only causes people to be more suspicious and believe less of what the government has to say about immunization,” Wurtz said.
“It's going to take literally decades to try and restore people's confidence in the importance and the safety of routine childhood immunization. It’s sad,” she said.
But, she said, tragedy may catalyze policy change before attitudes shift.
“If we see kids dying in Minnesota because there are outbreaks, I think that the public health authorities would be more interested in more rigorous requirements around exemptions,” Wurtz said.
This article first appeared on MinnPost and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
