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Despite a growing number of kids getting religious exemptions from required school vaccinations, Maryland still vaccinates a higher percentage of students than the national average. (Photo by Michael Loccisano/Getty Images)
“No Shots. No School. No Exceptions.” That’s what’s parents are greeted with on the Prince George’s County Public Schools webpage on required vaccinations for the upcoming school year.
But that’s not entirely true. In Maryland, there are exceptions — specifically, families can easily get religious exemptions to opt their kindergartners out of vaccine requirements in any school year.
And more Maryland families have been choosing that route for the last four school years, according to Maryland Department of Health data released this week.
About 1.7% of the state’s 63,000 kindergartners, or approximately 1,075 kids, cited religious reasons to be exempted from required vaccinations during the 2024-2025 school year.
It’s the highest percentage of religious exemptions since the 2019-2020 school year, when the start of the COVID-19 pandemic not only ushered in a new wave of vaccine hesitancy but also disrupted typical school procedures for many families.
Since the 2021-2022 school year, at least 1% of kindergartners in Maryland have had a religious exemption – a couple hundred a year – and it’s been rising since.
While it’s still a relatively small percent of students compared to the rest of the population, and well below the national rate, public health advocates call rising number of unvaccinated kids “concerning.”
“COVID put us behind the eight ball in terms of vaccination levels in kids,” said Dr. Georges Benjamin, executive director of the American Public Health Association.
“It’s a very concerning trend because we need to maintain adequate vaccination levels to maintain herd immunity,” Benjamin said Tuesday. “These childhood diseases are not benign. They’re very dangerous.”
Maryland law requires that children have a handful of vaccinations when they enter kindergarten, in order to protect themselves and their classmates from transmissible diseases, such as measles, polio and chickenpox, among others. Children can be exempted if there is a medical reason they cannot receive a vaccine or a religious restriction against it.
A medical exemption requires a written statement from a physician that vaccination would be harmful to the student. But invoking a religious exemption in Maryland is simple. Parents can just sign a form that says: “Because of my bona fide religious beliefs and practices, I object to any vaccine(s) being given to my child.”
Religious exemptions spiked in 2019-2020 when 2.7% of kindergartners, or 1,641 kids, opted out of vaccination requirements. The COVID-19 pandemic did not go into full swing until spring 2020, so those families would have opted out prior to the pandemic in the United States.
Public health officials and researchers look at nonmedical religious exemptions as an imperfect metric for vaccine hesitancy among families, though tracking such data is a tricky task.
“To the extent that people are looking at ways to opt out of being vaccinated, you will see a higher increase in people taking advantage of … religious exemptions,” Benjamin said.
The rate of religious exemptions varies by school district and can be influenced by population size.
Kent and Garrett counties have the highest rate of religious exemptions in the state, for example, with more than 4% of kindergartners in those counties getting a religious exemption from vaccines last school year, according to the data.
But Kent County had just 155 kindergartners in the 2024-2025 school year, so if seven kids had a religious exemption, that would account for 4.5% of Kent County kindergarten students.
Similarly, Garrett County had 243 students in its 2024-2025 kindergarten class. The 4.12% receiving a religious exemption from vaccinations represents about 10 kids.
“We have fewer kindergartners,” said Rebecca Aiken, school health services manager for Garrett County Public Schools. “It can really skew the numbers.”
She said that there could be many reasons why some kids are not up to date on their vaccinations or use a religious exemption to opt out of them.
She noted that some kids are homeless or do not have a stationary home life, moving between family members or living with grandparents, which can make record-keeping for immunizations challenging. The county tries to help families in those situations get their vaccinations or find their records.
But with the ease of religious opt-out for vaccines, Aiken said there’s no way to know why someone selects the religious exemption for vaccines.
“We can’t force them to prove their religion, so we have to take it at face value,” she said.
She noted that even if the families opt their kids out of vaccination requirements, the county health officials and school nurses help keep the families informed about communicable diseases.
Sherelle Jones, an official with the Prince George’s County Office of School Health, noted that compliance with the vaccination requirement is down for the upcoming school year, but she has not noticed a rise in vaccine hesitancy specifically.
She’s hearing that some families who do not have health care coverage have struggled to get their kids vaccinated. Prince George’s County Public Schools has hosted vaccination clinics in hopes of closing that coverage gap.
Last school year, Prince George’s County’s schools had about 1.7% of its kindergartners getting a nonmedical religious exemption from vaccinations, on par with the state as a whole.
Jones noted that there is still time for families to comply with the vaccination requirements, as school doesn’t start until Aug. 26 in Prince George’s County.
But Benjamin noted that families are coming in with more questions about vaccines, which he says is a result of new messaging at the federal level about when to receive vaccines and at what age.
“There is a very well-organized, well-funded antivaccine community out there,” Benjamin said. “Coupled with some of the mistrust that has been promoted by the current Health Secretary [Robert F.] Kennedy — that has raised the questions in people’s minds about when their kids should get their shots, how many shots they should get and whether they should get these shots.
“My colleagues that are practicing pediatrics are telling me that more and more parents are coming in with more questions about vaccinations,” he said. “I would not equate that to vaccine hesitancy, although there is certainly more of that.”
While the rate of religious exemptions is going up in Maryland, state health officials say that vaccine coverage among Maryland kindergartners is still high, especially compared to the rates nationally. The Centers for Disease Control and prevention said 3.6% of kindergartners nationwide were exempt from vaccinations for the 2024-2025 school year, up from 3.3% the previous year.
“In general, vaccine coverage rates remain high in Maryland. The overall exemption rates remain below the national average and stable at 2.2% compared to the previous school year,” said David McCallister, public information officer for the state health department in a written statement. The 2.2% figure combines both 1.7% of kids who have a religious exemption and the 0.5% who have a medical exemption in the 2024-2025 school year.
McCallister noted there’s been an increase in exemptions, “specifically non-medical exemptions” since the COVID-19 pandemic.
“The Department will continue to monitor school exemption trends very closely, especially with regard to their relationship to vaccine preventable diseases,” McCallister said. “MDH continues to recommend vaccinations for all children.”
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