Data-Driven Assessment of Nonmedical Vaccination Exemption Can Guide Public Health Response

* Abbreviation: NME — : nonmedical exemption Kindergarten immunization requirements are an important inflection point to ensure children are fully vaccinated before they begin school, but some parents choose to obtain an exemption from school immunization requirements. All states have medical exemptions, and 47 states also offer nonmedical (philosophical and/or religious) ones, with considerable variation in the process to obtain the exemption.1 Eleven states mandate some type of education, ranging from online modules to in-person meetings, before receiving a nonmedical exemption (NME).2 Nationally, the proportion of kindergartners with an NME has increased from 1.4% for the 2011–2012 school year to 2.6% for the 2019–2020 school year, whereas medical exemptions have remained at 0.2%.3 Clusters of high exemption rates can lead to outbreaks of vaccine-preventable diseases.4 In this issue of Pediatrics , Masters et al5 assess the … Address correspondence to Sarah J. Clark, MPH, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, 300 NIB, SPC 5450, 300 N Ingalls St, Ann Arbor, MI 48109-5456. E-mail: saclark{at}med.umich.edu