Childhood Vaccination Rates, a Rare Health Bright Spot in Struggling States, Are Slipping
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Jen Fisher can do only so much to keep her son safe from the types of infections that children can encounter at school. The rest, she said, is up to other students and parents in their hometown of Franklin, Tennessee.
Fisher’s son Raleigh, 12, lives with a congenital heart condition, which has left him with a weakened immune system. For his protection, Raleigh has received all the recommended vaccines for a child his age. But even with his vaccinations, a virus that might only sideline another child could sicken him and land him in the emergency room, Fisher said.
“We want everyone to be vaccinated so that illnesses like measles and things that have basically been eradicated don’t come back,” Fisher said. “Those can certainly have a very adverse effect on Raleigh.”
For much of Raleigh’s life, Fisher could take comfort in the high childhood vaccination rate in Tennessee — a public health bright spot in a conservative state with poor health outcomes and one of the shortest life expectancies in the nation.
Mississippi and West Virginia, two similarly conservative states with poor health outcomes and short life expectancies, also have some of the highest vaccination rates for kindergartners in the nation — a seeming contradiction that stems from the fact that childhood vaccination requirements don’t always align with states’ other characteristics, said James Colgrove, a Columbia University professor who studies factors that influence public health.
“The kinds of policies that states have don’t map neatly on to ‘red’ versus ‘blue’ or one region or another,” Colgrove said.
Advocates, doctors, public health officials, and researchers worry such public health bright spots in some states are fading: Many states have recently reported an increase in people opting out of vaccines for their kids as Americans’ views shift.
During the 2023-24 school year, the percentage of kindergartners exempted from one or more vaccinations rose to 3.3%, the highest ever reported, with increases in 40 states and Washington, D.C., according to Centers for Disease Control and Prevention data. Tennessee and Mississippi were among those with increases. Nearly all exemptions nationally were for nonmedical reasons.
Vaccine proponents worry anti-vaccine messaging could accelerate a growing “health freedom” movement that has been pushed by leaders in states such as Florida. Momentum against vaccines is likely to continue to grow with the election of Donald Trump as president and his proposed nomination of anti-vaccine activist Robert F. Kennedy Jr. as secretary of the Department of Health and Human Services.
Pediatricians in states with high exemption rates, such as Florida and Georgia, say they’re concerned by what they see — declining immunization levels for kindergartners, which could lead to a resurgence in vaccine-preventable diseases such as measles. The Florida Department of Health reported nonmedical exemption rates as high as 50% for children in some areas.
“The religious exemption is huge,” said Brandon Chatani, a pediatric infectious disease doctor in Orlando. “That has allowed for an easy way for these kids to enter schools without vaccines.”
In many states, it’s easier to get a religious exemption than a medical one, which often requires signoff from a doctor.
Over the past decade, California, Connecticut, Maine, and New York have removed religious and philosophical exemptions from school vaccination requirements. West Virginia has not had them.
Idaho, Alaska, and Utah had the highest exemption rates for the 2023-24 school year, according to the CDC. Those states allow parents or legal guardians to exempt their children for religious reasons by submitting a notarized form or a signed statement.
Florida and Georgia, with some of the lowest reported minimum vaccination rates for kindergartners, allow parents to exempt their children by submitting a form with the child’s school or day care.
Both states have reported declines in uptake of the measles, mumps, and rubella vaccine, which is one of the most common childhood shots. In Georgia, MMR coverage for kindergartners dropped to 88.4% in the 2023-24 school year from 93.1% in 2019-20, according to the CDC. Florida dropped to 88.1% from 93.5% during the same period.
Andi Shane, a pediatric infectious disease specialist in Atlanta, traces Georgia’s declining rates to families who lack access to a pediatrician. State policies on exemptions are also key, she said.
“There’s lots of data to support the fact that when personal belief exemptions are not permitted, that vaccination rates are higher,” she said.
In December, Georgia public health officials put out an advisory saying the state had recorded significantly more whooping cough cases than in the prior year. According to CDC data, Georgia reported 280 cases in 2024 compared with 96 the year before.
Until 2023, Mississippi was one of the few states that allowed parents to opt out of vaccinating their kids only for medical reasons — and only with the approval of a doctor. That gave it among the highest vaccination rates in the nation as of the 2023-24 school year.
“It’s one of the few things Mississippi has done well,” said Anita Henderson, a pediatrician who has practiced in the southern part of the state for nearly 30 years. In terms of health, she said, childhood vaccination rates were the state’s one “shining star.”
But that changed in April 2023 when a federal judge ordered state officials to start allowing religious exemptions. The ruling has emboldened many families, Henderson said.
“We are seeing more and more skepticism, more and more vaccine hesitancy, and a lack of confidence because of this ruling,” she said.
State officials have granted more than 5,000 religious exemptions since the court order allowing them, according to the state health department. Daniel Edney, the state health officer, said most of the requests have come from “more affluent” residents in “pockets” of the state.
“Most people listen to the expert opinions of their pediatricians and family medicine doctors to stay on the vaccine schedule, because it’s what is best to protect their children,” he said.
West Virginia’s vaccine law — which hasn’t allowed nonmedical exemptions — also could soon change, Matthew Christiansen said in December before he resigned as the state’s health officer.
A bill that would have broadened exemptions made it through the legislature last year but was vetoed by outgoing Republican Gov. Jim Justice. The new governor, Republican Pat Morrisey, has been a vocal critic of vaccine mandates. And just a day after being inaugurated, he issued an executive order to propose provisions by Feb. 1 that could allow religious and conscientious exemptions.
“I want to send a message that if you have a religious belief, then we’re going to have an exception,” he said at a Jan. 14 press conference. “We’re not going to be the outlier.”
People asserting their personal freedoms to decline vaccines for their kids can ultimately curtail the ability of others to live full lives, Christiansen said. “Kids getting measles and mumps and polio and being paralyzed for their whole life is an impediment on personal freedom and autonomy for those kids,” he said.
Since the covid pandemic, anti-vaccine sentiment has been growing in Tennessee. One organization, Stand for Health Freedom, drafted a letter for constituents to send to their state lawmakers calling for the resignation of the medical director of Tennessee’s Vaccine-Preventable Diseases and Immunization Program. The group said she demonstrated a “lack of respect for the informed consent rights” of the people.
“They feel emboldened by the idea that this presidential administration seems to feel very strongly that a lot of these issues should be taken back to the states,” said Emily Delikat, director of Tennessee Families for Vaccines, a pro-vaccine group.
Ultimately, like many effective public health interventions, vaccines are a victim of their own success, said Henderson, the Mississippi pediatrician. Most people haven’t seen outbreaks of measles or polio, so they forget how dangerous the diseases are, she said.
“It may unfortunately take a resurgence of those diseases to raise awareness to the fact that these are dangerous, these are deadly, these are preventable,” she said. “I hope it doesn’t come to that.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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The Compass of Pleasure – by Dr. David Linden
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There are a lot of books about addiction, so what sets this one apart?
Mostly, it’s that this one maintains that addiction is neither good nor bad per se—just, some behaviors and circumstances are. Behaviors and circumstances caused, directly or indirectly, by addiction.
But, Dr. Linden argues, not every addiction has to be so. Especially behavioral addictions; the rush of dopamine one gets from a good session at the gym or learning a new language, that’s not a bad thing, even if they can fundamentally be addictions too.
Similarly, we wouldn’t be here as a species without some things that rely on some of the same biochemistry as addictions; orgasms and eating food, for example. Yet, those very same urges can also inconvenience us, and in the case of foods and other substances, can harm our health.
In this book, the case is made for shifting our addictive tendencies to healthier addictions, and enough information is given to help us do so.
Bottom line: if you’d like to understand what is going on when you get waylaid by some temptation, and how to be tempted to better things, this book can give the understanding to do just that.
Click here to check out The Compass of Pleasure, and make yours work in your favor!
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Carrot vs Kale – Which is Healthier?
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Our Verdict
When comparing carrot to kale, we picked the kale.
Why?
These are both known as carotene-containing heavyweights, but kale emerges victorious:
In terms of macros, carrot has more carbs while kale has more protein and fiber. An easy win there for kale.
When it comes to vitamins, both are great! But, carrots contain more of vitamins A, B5, and choline, whereas kale contains more of vitamins B1, B2, B3, B6, B9, C, E, and K. And while carrot’s strongest point is vitamin A, a cup of carrots contains around 10x the recommended daily dose of vitamin A, whereas a cup of kale contains “only” 6x the recommended daily dose of vitamin A. So, did we really need the extra in carrots? Probably not. In any case, kale already won on overall vitamin coverage, by a long way.
In the category of minerals, kale again sweeps. On the one hand, carrots contain more sodium. On the other hand, kale contains a lot more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. Not a tricky choice!
But don’t be fooled: carrots really are a nutritional powerhouse and a great food. Kale is just better—nutritionally speaking, in any case. If you’re making a carrot cake, please don’t try substituting kale; it will not work 😉
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If You’re Poor, Fertility Treatment Can Be Out of Reach
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Mary Delgado’s first pregnancy went according to plan, but when she tried to get pregnant again seven years later, nothing happened. After 10 months, Delgado, now 34, and her partner, Joaquin Rodriguez, went to see an OB-GYN. Tests showed she had endometriosis, which was interfering with conception. Delgado’s only option, the doctor said, was in vitro fertilization.
“When she told me that, she broke me inside,” Delgado said, “because I knew it was so expensive.”
Delgado, who lives in New York City, is enrolled in Medicaid, the federal-state health program for low-income and disabled people. The roughly $20,000 price tag for a round of IVF would be a financial stretch for lots of people, but for someone on Medicaid — for which the maximum annual income for a two-person household in New York is just over $26,000 — the treatment can be unattainable.
Expansions of work-based insurance plans to cover fertility treatments, including free egg freezing and unlimited IVF cycles, are often touted by large companies as a boon for their employees. But people with lower incomes, often minorities, are more likely to be covered by Medicaid or skimpier commercial plans with no such coverage. That raises the question of whether medical assistance to create a family is only for the well-to-do or people with generous benefit packages.
“In American health care, they don’t want the poor people to reproduce,” Delgado said. She was caring full-time for their son, who was born with a rare genetic disorder that required several surgeries before he was 5. Her partner, who works for a company that maintains the city’s yellow cabs, has an individual plan through the state insurance marketplace, but it does not include fertility coverage.
Some medical experts whose patients have faced these issues say they can understand why people in Delgado’s situation think the system is stacked against them.
“It feels a little like that,” said Elizabeth Ginsburg, a professor of obstetrics and gynecology at Harvard Medical School who is president-elect of the American Society for Reproductive Medicine, a research and advocacy group.
Whether or not it’s intended, many say the inequity reflects poorly on the U.S.
“This is really sort of standing out as a sore thumb in a nation that would like to claim that it cares for the less fortunate and it seeks to do anything it can for them,” said Eli Adashi, a professor of medical science at Brown University and former president of the Society for Reproductive Endocrinologists.
Yet efforts to add coverage for fertility care to Medicaid face a lot of pushback, Ginsburg said.
Over the years, Barbara Collura, president and CEO of the advocacy group Resolve: The National Infertility Association, has heard many explanations for why it doesn’t make sense to cover fertility treatment for Medicaid recipients. Legislators have asked, “If they can’t pay for fertility treatment, do they have any idea how much it costs to raise a child?” she said.
“So right there, as a country we’re making judgments about who gets to have children,” Collura said.
The legacy of the eugenics movement of the early 20th century, when states passed laws that permitted poor, nonwhite, and disabled people to be sterilized against their will, lingers as well.
“As a reproductive justice person, I believe it’s a human right to have a child, and it’s a larger ethical issue to provide support,” said Regina Davis Moss, president and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda, an advocacy group.
But such coverage decisions — especially when the health care safety net is involved — sometimes require difficult choices, because resources are limited.
Even if state Medicaid programs wanted to cover fertility treatment, for instance, they would have to weigh the benefit against investing in other types of care, including maternity care, said Kate McEvoy, executive director of the National Association of Medicaid Directors. “There is a recognition about the primacy and urgency of maternity care,” she said.
Medicaid pays for about 40% of births in the United States. And since 2022, 46 states and the District of Columbia have elected to extend Medicaid postpartum coverage to 12 months, up from 60 days.
Fertility problems are relatively common, affecting roughly 10% of women and men of childbearing age, according to the National Institute of Child Health and Human Development.
Traditionally, a couple is considered infertile if they’ve been trying to get pregnant unsuccessfully for 12 months. Last year, the ASRM broadened the definition of infertility to incorporate would-be parents beyond heterosexual couples, including people who can’t get pregnant for medical, sexual, or other reasons, as well as those who need medical interventions such as donor eggs or sperm to get pregnant.
The World Health Organization defined infertility as a disease of the reproductive system characterized by failing to get pregnant after a year of unprotected intercourse. It terms the high cost of fertility treatment a major equity issue and has called for better policies and public financing to improve access.
No matter how the condition is defined, private health plans often decline to cover fertility treatments because they don’t consider them “medically necessary.” Twenty states and Washington, D.C., have laws requiring health plans to provide some fertility coverage, but those laws vary greatly and apply only to companies whose plans are regulated by the state.
In recent years, many companies have begun offering fertility treatment in a bid to recruit and retain top-notch talent. In 2023, 45% of companies with 500 or more workers covered IVF and/or drug therapy, according to the benefits consultant Mercer.
But that doesn’t help people on Medicaid. Only two states’ Medicaid programs provide any fertility treatment: New York covers some oral ovulation-enhancing medications, and Illinois covers costs for fertility preservation, to freeze the eggs or sperm of people who need medical treatment that will likely make them infertile, such as for cancer. Several other states also are considering adding fertility preservation services.
In Delgado’s case, Medicaid covered the tests to diagnose her endometriosis, but nothing more. She was searching the internet for fertility treatment options when she came upon a clinic group called CNY Fertility that seemed significantly less expensive than other clinics, and also offered in-house financing. Based in Syracuse, New York, the company has a handful of clinics in upstate New York cities and four other U.S. locations.
Though Delgado and her partner had to travel more than 300 miles round trip to Albany for the procedures, the savings made it worthwhile. They were able do an entire IVF cycle, including medications, egg retrieval, genetic testing, and transferring the egg to her uterus, for $14,000. To pay for it, they took $7,000 of the cash they’d been saving to buy a home and financed the other half through the fertility clinic.
She got pregnant on the first try, and their daughter, Emiliana, is now almost a year old.
Delgado doesn’t resent people with more resources or better insurance coverage, but she wishes the system were more equitable.
“I have a medical problem,” she said. “It’s not like I did IVF because I wanted to choose the gender.”
One reason CNY is less expensive than other clinics is simply that the privately owned company chooses to charge less, said William Kiltz, its vice president of marketing and business development. Since the company’s beginning in 1997, it has become a large practice with a large volume of IVF cycles, which helps keep prices low.
At this point, more than half its clients come from out of state, and many earn significantly less than a typical patient at another clinic. Twenty percent earn less than $50,000, and “we treat a good number who are on Medicaid,” Kiltz said.
Now that their son, Joaquin, is settled in a good school, Delgado has started working for an agency that provides home health services. After putting in 30 hours a week for 90 days, she’ll be eligible for health insurance.
One of the benefits: fertility coverage.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Scheduling Tips for Overrunning Tasks
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Your Questions, Our Answers!
Q: Often I schedule time for things, but the task takes longer than I think, or multiplies while I’m doing it, and then my schedule gets thrown out. Any ideas?
A: A relatable struggle! Happily, there are remedies:
- Does the task really absolutely need to be finished today? If not, just continue it in scheduled timeslots until it’s completed.
- Some tasks do indeed need to be finished today (hi, writer of a daily newsletter here!), so it can be useful to have an idea of how long things really take, in advance. While new tasks can catch us unawares, recurring or similar-to-previous tasks can be estimated based on how long they took previously. For this reason, we recommend doing a time audit every now and again, to see how you really use your time.
- A great resource that you should include in your schedule is a “spare” timeslot, ideally at least one per day. Call it a “buffer” or a “backup” or whatever (in my schedule it’s labelled “discretionary”), but the basic idea is that it’s a scheduled timeslot with nothing scheduled in it, and it works as an “overflow” catch-all.
Additionally:
- You can usually cut down the time it takes you to do tasks by setting “Deep Work” rules for yourself. For example: cut out distractions, single-task, work in for example 25-minute bursts with 5-minute breaks, etc
- You can also usually cut down the time it takes you to do tasks by making sure you’re prepared for them. Not just task-specific preparation, either! A clear head on, plenty of energy, the resources you’ll need (including refreshments!) to hand, etc can make a huge difference to efficiency.
See Also: Time Optimism and the Planning Fallacy
Do you have a question you’d like to see answered here? Hit reply or use the feedback widget at the bottom; we’d love to hear from you!
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Blue Cheese vs Brunost – Which is Healthier?
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Our Verdict
When comparing blue cheese to brunost, we picked the brunost.
Why?
First, for the unfamiliar, as brunost isn’t necessarily as popular as blue cheese in N. America where most of our readers are:
Brunost, literally “brown cheese” is a traditional Norwegian affair made from aggressively boiling milk, cream, and whey in an iron cauldron. Whereas the blue in blue cheese comes from mold, the brown in brown cheese comes from caramelizing the milk sugars in the cauldron. When we say “cauldron”, yes, there is nowadays mass-produced brunost that is no longer made in something that could be mistaken for a witch’s brew, but the use of cast iron is actually important to the process, and has been the subject of regulatory controversy in Norway; first the cast iron was abandoned, then because that changed the cheese they fortified the product with added iron supplementation, then that was banned, then they reversed it because it affected iron levels in the general population. Nowadays, it is usually made with iron, one way or another.
Ok, so let’s see how they stack up against each other:
In terms of macronutrients, the two cheeses are comparable in fat, but brunost has more carbs—because whereas bacteria (and to a lesser extent, the mold) ate nearly all the carbs in the blue cheese, the caramelization of the milk sugars in brunost meant the result stayed higher in carbs. Both are considered “low GI” foods, but this category is still at least a moderate win for blue cheese.
When it comes to vitamins, brunost is higher in vitamins A, B1, B2, B3, B5, B6, and B12, while blue cheese is higher in vitamin B9. In other words, a clear and easy win for brunost.
In the category of minerals, brunost has more copper, iron, magnesium, manganese, phosphorus, and potassium. Meanwhile, blue cheese contains more zinc, although we can also mention that blue cheese has about 2x the sodium, which is generally not considered a benefit. The two cheeses are about equal in calcium and selenium. Adding these up makes for another clear and easy win for brunost.
In short, unless you are strongly avoiding [even low-GI foods’] carbs for some reason, brunost wins the day by virtue of its overwhelmingly better vitamin and mineral content.
Still, like most fermented dairy products, both cheeses can be enjoyed in moderation as part of a healthy diet (assuming you don’t have an allergy/intolerance).
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Seven Steps to Managing Your Memory – by Dr. Andrew Budson & Dr. Maureen O’Connor
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First, what this is not: a “how to improve your memory” book of the kind marketed to students and/or people who want to do memory-themed party tricks.
What this book actually is: exactly what the title and subtitle claim it to be: seven steps to managing your memory: what’s normal, what’s not, and what to do about it.
Drs. Budson & O’Connor cover:
- which memory errors can (and usually do) happen at any age
- how memory changes with normal aging, and
- what kinds of memory problems are not normal.
One thing that sets this book aside from a lot of its genre is that it also covers which kinds of memory loss are reversible—and, where appropriate, what can be undertaken to effect such a reversal.
The authors talk about what things have (and what things haven’t!) been shown to strengthen memory and reduce cognitive decline, and in the worst case scenario, what medications can help against Alzheimer’s disease and other dementias.
The style is halfway between pop-science and a science textbook. The structure of the book, with its headings, subheadings, bullet points, summaries, etc, helps the reader to process and remember the information.
Bottom line: if you’d like to get on top of managing your memory before you forget, then this book is for you.
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