Immunizing children against vaccine-preventable diseases is one of the most important ways to keep children healthy and able to attend school, socialize with friends and participate in activities that they enjoy. It is also the best way to keep a community safe.
The American Academy of Pediatrics (AAP) supports the continued requirement that children be immunized in order attend childcare and school in an updated policy statement, "Medical vs Nonmedical Immunization Exemptions for Child Care and School Attendance."
The AAP supports medical exemptions to specific immunizations as determined for each individual child. But it has long discouraged exemptions for other, non-medical reasons.
What happens when immunization rates fall & community immunity wanes?
The policy statement, which will be published in the August 2025 Pediatrics, was initially written in 2016 and was reaffirmed in 2022. It describes how exempting children from immunizations for nonmedical reasons creates unnecessary risk to both individuals and communities.
"The current measles outbreak is a tragic reminder of why it is so important that children have access to and receive all necessary immunizations," said
Jesse Hackell, MD, FAAP, the policy statement's lead author. "Soon, children will return to school, and while most families choose to vaccinate their children, there are areas where vaccination rates have fallen, increasing the risks of spreading disease."
Two unimmunized children have died in the rapidly spreading measles outbreak that has infected more than 1,288 people across the nation. That's the highest number recorded in 30 years, according to the Centers for Disease Control and Prevention.
State immunization requirements for school attendance
All 50 states, the District of Columbia, and Puerto Rico have regulations requiring proof of immunization as a condition for childcare and school attendance as a public health strategy to protect children in these settings. Although all allow exemption from specific immunizations for medical reasons, the majority also have various regulations and laws that allow nonmedical reasons for exemption that are contrary to optimal individual and public health.
The AAP recommends:
Equitable, timely access to vaccination to ensure consistent in-person schooling through a safety net of vaccine services through the medical home, public health, and school health programs.
Medically indicated exemptions to specific immunizations as determined for each individual student.
Education for pediatric health care providers to understand medically indicated reasons for granting exemptions.
Support for states, territories, and the District of Columbia to eliminate all nonmedical exemptions from immunizations as a condition of school attendance and development of policies to ensure that any medical exemptions are appropriate and evidence based.
Providing communities with information about immunization rates in childcare centers, schools, and other covered entities. Local public health departments could collect this data to determine the risk of outbreaks of vaccine-preventable diseases and provide parents with information about the safety of individual childcare centers and schools.
Pediatricians can partner with school nurses and administration to help ensure equitable and timely access to vaccination for students prior to school entry.
Vaccinating all those who are eligible also leads to community immunity, a way to help protect people who cannot receive certain vaccines. These include infants, pregnant women, elderly grandparents and people whose immune systems are weakened by certain medications or conditions.
Millions of deaths prevented by vaccines
In the United States, for children born from 1994-2003, data analysis and modeling suggest that routine childhood immunization will have prevented approximately 500 million cases of illness, 32 million hospitalizations, and 1.1 million deaths. Eventually, this has saved $540 billion in direct costs and $2.7 trillion in societal costs. "We understand families have questions and we as pediatricians are happy to answer them," Dr. Hackell said. "We want to help set your child up for success, which means keeping them healthy so they can learn, grow and thrive."
Policy statements created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in
Pediatrics.
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