Oklahoma’s kindergarteners are now the least-vaccinated in the region.

More than three years into the COVID-19 pandemic that scrambled perceptions of routine public health measures and attitudes toward vaccinations, Oklahoma now has the highest rate of exemptions from immunizations for kindergartners, according to state and federal data. 

The latest survey of vaccination readiness to start the school year showed the exemption rate rising to 3.5% in the 2021-22 school year. That’s up from an exemption rate of 2.4% the previous school year, according to the Oklahoma State Department of Health. Survey results from the 2022-23 school year are still being processed. 

Public health officials pay attention to kindergarten vaccination rates because they are an important indicator of community immunity and allow officials to better target health resources if a disease outbreak occurs. Students with exemptions on file can be excluded from school or school-sponsored activities depending on the degree of risk to the school. 

Dr. Steven Crawford, a family physician and board chairman of the Oklahoma Alliance for Healthy Families, said COVID-19’s effects reached across all parts of society. Intense health and policy discussions have been hotly debated on social media, with some relying on Dr. Google, he said. 

“A lot of misinformation has been promoted, primarily on social media,” Crawford said. “Some people believe social media more than they believe clinical experts, and that’s become a real challenge in our world for all kinds of things, whether for medical information or non-medical information.”

Mass vaccinations, many developed in the 1950s and 1960s, have nearly eliminated smallpox, polio, measles, mumps, rubella, whooping cough and other diseases, according to World Health Organization data.

Parents or guardians in Oklahoma can sign a form if they want to declare an exemption to the state’s requirement for vaccinations in schools. Oklahoma allows medical, religious or philosophical reasons to declare an exemption from the law. They can be for one or multiple vaccines. 

The state’s medical exemption rate has remained flat at less than 0.5% in the past decade. Those exemptions require a doctor’s authorization. But higher numbers of religious and philosophical exemptions have pushed Oklahoma’s overall rate higher. That doesn’t include COVID-19 vaccines, which are not part of the recommended series of shots for kindergartners. 

Oklahoma had the highest exemption rate in the region for the 2021-22 school year, according to federal survey data. In a seven-state region including Oklahoma, New Mexico’s exemption rate was the lowest at 1.4%. Colorado, which has had the region’s highest exemption rate in recent years, had an exemption rate of 3.2%, according to the federal Centers for Disease Control and Prevention.

Elsewhere, Maine and Mississippi are two states heading in opposite directions on kindergarten vaccination-exemption policies. 

Maine got rid of philosophical and religious exemptions in 2021. Its vaccination coverage for kindergartners increased the next two school years, the state’s health department reported. Mississippi has had one of the South’s lowest vaccination-exemption rates, but a recent federal court injunction ordered state officials to offer a religious exemption. Mississippi requires parents or guardians to review a video about vaccine efficacy and safety before granting its new religious exemption. 

Crawford said he suspects some of the increase in exemptions in Oklahoma may be coming from parents who still believe in the benefits of immunizations but who have taken the exemption because it’s easier than taking time out of their home and work lives to get their child vaccinated. 

It’s been almost a decade since Oklahoma lawmakers last contemplated changes to the state’s exemptions for school vaccinations. At that time, the focus was to get rid of the philosophical exemption. But a coalition of vaccine-skeptical parents organized opposition to that effort into a group now known as Oklahomans for Health and Parental Rights. The group has transformed itself into a lobbying force at the Capitol and now claims more than 20,000 members. 

Lawmakers in 2021 approved Senate Bill 658, which prohibited COVID-19 vaccines as a requirement for school attendance and required schools to tell parents and guardians about the state’s three vaccine exemptions for kindergarten enrollment. 

“The battle at the moment is a continued effort to expand exemptions and put more barriers in place to children getting adequately vaccinated,” said Crawford, the doctor with the Oklahoma Alliance for Healthy Families. “It’s all under the banner of parental choice. But not having philosophical exemptions have created the benefits that our nation has had from vaccine-preventable diseases over many years.”  

Oklahoma’s jump in the exemption rate comes as misinformation around vaccine safety continues to roil political campaigns. Robert F. Kennedy Jr., who is running for the Democratic nomination for president in 2024, is among the most high-profile figures to repeat debunked conspiracy theories about vaccines. A recent KFF survey on health misinformation found a polarized political and media climate can lead to different views on what constitutes misinformation. 

“While exposure to misinformation may not necessarily convert the public into ardently believing false health claims, it is likely adding to confusion and uncertainty about already complicated public health topics and may lead to decision paralysis when it comes to individual health care behaviors and choices,” the survey said. “In any case, this ‘malleable middle’ presents an opportunity for tailored interventions. Furthermore, reinforcing accurate information may need to go hand-in-hand with combating false health claims.” 

Crawford said majorities of both self-identified Republican and Democratic voters remain in favor of immunizations for school-age children. Almost 6 in 10 Republican voters and 8 in 10 Democratic voters have a favorable view of immunizations. 

“COVID became such a touchpoint to people, and it was profoundly affecting social issues from school attendance to wearing a mask and got involved in presidential politics,” Crawford said. “Because of those issues, it really created havoc, and it’s going to take a while to resolve. Unfortunately, some in that camp will continue to feel that way because of the politics, not because of the medical issues.”  

Crawford said trust in institutions of all kinds is down across the board, but people still trust their own doctors when it comes to health information. He said several federal agencies monitor different parts of the vaccine-safety system, from the CDC to the Food and Drug Administration and the Department of Health and Human Services

“Vaccines are the most watch-over part of our healthcare system in regards to safety,” Crawford said. “It’s appropriate they do that because these (immunizations) are being given to healthy people.” The state health department surveys public and private elementary schools between November and April to collect the kindergarten vaccination coverage data. The data for the 2022-23 school year is still being analyzed. Surveys are voluntary, although return rates are typically high.

Paul Monies has been a reporter with Oklahoma Watch since 2017 and covers state agencies and public health. Contact him at (571) 319-3289 or pmonies@oklahomawatch.org. Follow him on Twitter @pmonies. 

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