Vaccination rates in schools cause concern for parents, medical professionals

Lucas James relies on others to be vaccinated because, for now, he can’t be.

A leukemia patient and stem cell transplant recipient, Lucas, 16, of Hempfield receives intravenous antibody treatments to help him rebuild his immune system.

“(Doctors) said he may never be able to be vaccinated again if his body doesn’t stop needing these transfusions,” said his mother, Megan James.

Lucas is among the growing number of school-age children who, for one reason or another, are not being vaccinated against preventable diseases. Some, like Lucas, may be unvaccinated for medical reasons. Others might be because of religious beliefs.

The trend is causing concern among medical professionals — and affecting the population’s herd immunity.

In Pennsylvania, students in kindergarten are required to have four doses of the vaccine against diphtheria, tetanus and pertussis; four doses of the polio vaccine; two doses of measles, mumps, rubella (MMR); three doses of hepatitis B; and two doses of the varicella (chickenpox) vaccine.

Students also can provide evidence of immunity, such as proof they’ve already had and recovered from a disease such as chickenpox.

Without the vaccinations, students must apply for an exemption. Increasingly, more parents or guardians are doing just that. Students in Pennsylvania also can be declared exempt from vaccines for religious or philosophical reasons.

Almost 1,800 students in Allegheny County submitted medical, religious or philosophical vaccination exemptions in 2024, compared with about 1,300 in 2020, a 38% increase, according to figures from the state health department.

Westmoreland County saw an even bigger jump — about 130% — with 926 students filing for exemptions in 2024, compared with just under 400 in 2020.

There are numerous reasons a child is unable to be vaccinated, including that they have weakened immune systems, are on chemotherapy or had an allergic reaction to a vaccine, said Dr. Joseph Aracri, system chair of pediatrics with Allegheny Health Network Pediatric Institute.

Someone like Lucas relies on herd immunity to remain illness-free. Herd immunity is when a disease has little chance of spreading within a population because people are resistant to it, either from having the disease and recovering or, more commonly, because they have been vaccinated against it.

Once a nonissue for many diseases, herd immunity is coming back into question for some diseases, according to the state Department of Health.

Data shows school-age children in several Western Pennsylvania counties below herd immunity levels for some diseases, including measles, mumps and rubella. Allegheny, Westmoreland, Butler, Fayette, Greene, Indiana and Beaver counties report vaccination rates for kindergarten-age children for the MMR vaccine are below the 95% threshold for herd immunity, according to 2024 data from the Pennsylvania Department of Health.

That can be concerning for someone like Lucas.

“He’d be very vulnerable if he were exposed to someone with a virus,” his mother said. “It would be very likely that he would catch something.

“Things like the measles are really scary for us.”

A sophomore at Hempfield Area Senior High School, Lucas was diagnosed with leukemia in January 2022. After two years of treatments, doctors thought the cancer had gone into remission, but it returned in January 2024, just days after he had finished a course of chemotherapy.

In June 2024, Lucas underwent a blood-making bone marrow stem cell transplant. The procedure left his immune system vulnerable.

While Lucas attends school in-person, he wears a mask to protect himself. Megan James said that if Hempfield’s vaccination rates drop, Lucas would need to be pulled out of school again.

“It’s very frustrating,” James said. “He’s been through enough. We shouldn’t have to isolate him because of misinformation.”

Neither federal nor state health agencies track how many students are fully up to schedule for all vaccines; they instead track the student population by individual vaccines.

Lucas’ doctors are keeping an eye on outbreaks and will notify her if it becomes dangerous, James said.

“Things that most kids can fight off, his body wouldn’t be able to fight back,” she said. “It’s scary times.”

Growing hesitancy

Vaccine hesitancy has become a growing trend thanks, in part, to the covid-19 pandemic and skepticism surrounding the covid vaccine, Aracri said.

People can easily fall victim to misinformation about vaccines on social media, said Barbara Nightingale, deputy director for clinical services with the Allegheny County Health Department.

“We are not surprised by the decline (in vaccination rates), since vaccine hesitancy has been growing across the U.S. and globally for the past decade,” Nightingale said. “Because vaccine misinformation feeds off fear, it can spread easily, particularly as more residents receive health information from social media.”

She recommends residents speak with their health care provider if they have any concerns about the effects or safety of vaccinations.

Aracri said this is the second time in his career he has seen a trending decrease in vaccination rates. The first time was in the late 1990s when a paper by an English anti-vaccine activist and former surgeon falsely claimed a link between the MMR vaccine and bowel disease and autism, he said.

Now Aracri is seeing what he calls hesitancy from parents rather than resistance in regard to vaccinating their children.

“I think that this time around what we’re seeing is just more questions and more of an understanding,” Aracri said.

The covid pandemic was a major culprit and particularly damaging from a vaccine acceptance standpoint, he said.

“(People were) being forced to get a covid shot, and the covid shot was supposed to bring an end to the pandemic,” Aracri said. “And we found out that, while it really didn’t — it protected those of our most vulnerable — but it didn’t necessarily prevent the spread or end the covid pandemic anytime sooner. So whenever you give a child a shot and they still end up getting covid, that makes you doubt the other things.”

This, combined with political unrest, has created uncertainty, he said.

“People have access to all kinds of unedited information that’s out there,” Aracri said. “Our job is to be able to, first, be aware of all misinformation, disinformation or whatever you want to call it, and be able to have that conversation and discuss with the patient the benefits of being vaccinated as opposed to the risks.”

Part of the problem: No vaccine is 100% effective for 100% of the population.

Different vaccines have different levels of effectiveness, Aracri said. The MMR vaccine is about 98% effective, he said, while other vaccines such as the flu shot — a seasonal vaccine — can be anywhere from 40% to 75% effective each year because the flu virus constantly mutates. He emphasized the importance for providers to counsel patients and parents when they have questions.

In-school concerns

Darcy Lutz has been a nurse at Shaler Area High School for the past six years. She said her job involves two main responsibilities regarding student vaccinations: making sure the school, parents and students are in compliance with Pennsylvania school health laws and providing accurate information about vaccines.

Lutz called the dropping vaccination rates concerning. Although, she said, the district’s percentages haven’t dropped from last school year, education about vaccines is more important than ever.

“We’re not here to fight with people about their strongly held beliefs,” Lutz said. “If people have questions, we’re always here to talk and educate.”

Shaler Area has a 97% MMR vaccination rate, but because the disease is so contagious, an outbreak could occur if that were to fall as little as 2%, Lutz said.

“The most vulnerable populations really rely on herd immunity,” she said. “When we see those rates dip, it really is dangerous.”

In her nine years as a school nurse, Lutz said, she has encountered various reasons children go unvaccinated. The biggest factor is access to health care, she said. Some families have no insurance or don’t have reliable transportation to get to a doctor. There’s also a rising immigrant and refugee population in the district, and some of those families are still working to catch up with the required vaccine schedule, she said.

The district has brought Allegheny County’s mobile health clinic to its schools to give families direct access to health care.

She also cited two other reasons for parents deciding not to vaccinate their children: misinformation and feeling as though their freedoms are being threatened when they’re told it’s required by law to get vaccinated.

Disease resurgence

Aracri pointed to a recent outbreak of the measles in Texas as an example of how a disease can reemerge.

He said a large population was unvaccinated, falling below herd immunity levels, and it caused an outbreak. It grew to be the largest measles outbreak in the U.S. in more than 30 years, with about 760 confirmed cases in Texas by August. The outbreak resulted in 99 hospitalizations and the deaths of two unvaccinated school-age children.

Nightingale said residents should know that many people are vaccinated against diseases that once were common and caused serious illness or death. For example, the polio vaccine, developed by Jonas Salk at the University of Pittsburgh and widely distributed during the 1950s, has brought down cases of polio worldwide by more than 99%, she said.

“All vaccines play an important role in saving lives, reducing disease and creating a healthy community,” Nightingale said. “This role is increasingly important when school-age children are involved, as their immune system is not completely developed.”

Nightingale said that if rates continue to drop, communities are at a higher risk of a resurgence of diseases.

“It is especially important for residents to remember that, like any medical intervention, vaccines carry some risks,” she said, “but for most people the risk of the disease is far greater.”