Madison Clarke
Vaccination rates among American children have been a topic of interest and debate in recent years, with some sources claiming that American children are among the most vaccinated in the world. While vaccination rates in the United States have historically been high, there are indications that these rates may be declining, especially when compared to previous years and other countries. This decline has been attributed to various factors, including disruptions caused by the COVID-19 pandemic, financial barriers, access issues, vaccine hesitancy, and the spread of vaccine-related misinformation. Additionally, there are concerns about the relatively high infant mortality rate in the United States compared to other high-income countries, despite American infants receiving more vaccines in their first year of life. These factors have prompted discussions and initiatives aimed at improving global vaccination coverage and addressing disparities to protect children from vaccine-preventable diseases.
| Characteristics | Values |
|---|---|
| Vaccination coverage among American children | 73% of children born in 2020 and 2021 were fully vaccinated with CDC-recommended vaccines by age 3 |
| Vaccination coverage among American children compared to the rest of the world | American children receive more vaccines in their first year of life than anywhere else in the world |
| Vaccination rates among American children by race and ethnicity | Non-Hispanic White children had the highest rate of vaccination at 75.5%, followed by children of multiple races or some other race (non-Hispanic) at 72.8%, Hispanic/Latino children (any race) at 69.9%, and African-American/Black children at 66.5% |
| Vaccination rates among American children by state | In 2021, the national child vaccination rate was 72.1%, ranging from 56.6% in West Virginia to 87.9% in Iowa |
| Factors influencing vaccination coverage among American children | Financial barriers, access issues, vaccine hesitancy, and vaccine-related misinformation |
| Impact of COVID-19 on vaccination coverage | Children born during the COVID-19 pandemic received fewer vaccines compared to children born in the 2010s |
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What You'll Learn
American children are the most vaccinated in the world
The COVID-19 pandemic has also contributed to a decline in vaccination rates among American children. Data from 2020 to 2021 shows that coverage with nearly all vaccines was lower among children born during this period compared to those born in 2018 and 2019. The CDC attributes this decline to disruptions caused by the pandemic.
Vaccination rates vary across different states, races, ethnicities, insurance coverage types, and poverty levels. As of 2023, Massachusetts is the only state with a vaccination rate higher than 90%. In 2021, the national child vaccination rate was 72.1%, ranging from a low of 56.6% in West Virginia to a high of 87.9% in Iowa. Non-Hispanic White children had the highest vaccination rate at 75.5%, while African-American/Black children had the lowest at 66.5%.
Children born in 2020 and 2021 are most likely to be vaccinated against polio (93.3%) and chickenpox (93.3%). However, the combined 7-series vaccination rate, which includes seven recommended vaccines, has declined. Only 72.8% of children born in 2020 and 2021 received the full set of seven vaccines by 35 months, compared to 74.4% of children born in 2013-2014.
While American children are highly vaccinated, there are disparities and challenges that need to be addressed to ensure equitable access to vaccinations and improve health outcomes.
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Vaccination rates vary across US states
Vaccination rates for children in the US have been declining in recent years, with children born in 2020 and 2021 receiving fewer vaccines than those born in the 2010s. This could be due to disruptions caused by the COVID-19 pandemic. By age 3, 73% of children born in 2020 and 2021 were fully vaccinated with the CDC-recommended vaccines, compared to 74.4% of children born in 2013-2014.
Vaccination rates vary not only across US states but also within them, with some counties having much higher or lower rates than others. For example, Massachusetts is the only state with a vaccination rate higher than 90%, while Montana has one of the lowest combined 7-series vaccination rates. The national non-medical vaccine exemption rate for kindergarteners has also been increasing, reaching 3.1% for the 2023-24 school year.
The CDC reports that the DTaP vaccination rate, which protects against whooping cough, peaked in 2018 at 89.3% and dropped to 87.0% in 2021. The MMR vaccination rate, which protects against measles, mumps, and rubella, also decreased from a peak of 94.7% in 2018 to 93.1% in 2021. However, the chickenpox and polio vaccination rates have remained above 91% since 2011, with children born in 2021 vaccinated against chickenpox by age 3 at a rate of 94.4%.
These variations in vaccination rates across US states and counties could be due to several factors, including local health department resources, public health infrastructure, and community attitudes towards vaccination. Addressing these disparities and ensuring equitable access to vaccines across the country is crucial to protecting public health and preventing the spread of vaccine-preventable diseases.
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Vaccination rates vary by race and ethnicity
Vaccination rates in the US vary by race and ethnicity. While trends for individual vaccines vary, complete vaccination is trending downward. For example, 72.8% of children born in 2020 and 2021 received the full set of seven vaccines by 35 months, compared to 74.4% of children born in 2013–2014.
In Michigan, African-American/Black children were nearly 30% less likely to have received the full schedule of recommended vaccinations compared to White children (49.8% vs. 79.3%) in 2019-2021. In the District of Columbia, Hispanic/Latino children were more than 20% less likely to have received the recommended vaccinations compared to White children (62.1% vs. 82.5%). In North Dakota, children of some other race or multiple races were 20% less likely to have received the recommended vaccinations compared to White children (60.1% vs. 80.1%).
Differences in vaccination rates by race and ethnicity are influenced by various factors, including access to healthcare services, outreach and education initiatives, and logistical barriers. Efforts to address these disparities have led to increasing equity in vaccination rates. For instance, between late April 2021 and July 11, 2022, the gap in vaccination rates between White and Black people decreased from 14 percentage points to 5 percentage points.
In terms of COVID-19 vaccination rates specifically, as of July 11, 2022, 87% of Asian, 67% of Hispanic, and 64% of White people across 36 states had received at least one COVID-19 vaccine dose, higher than the rate for Black people (59%). However, it is important to note that inconsistencies in racial/ethnic classifications across states and ongoing changes to the data can make it challenging to interpret and compare vaccination rates across different states and over time.
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Vaccination rates are lower in low-income countries
While immunisation is one of the most effective public health interventions, there are still significant disparities in vaccination rates between countries of different income levels. Low-income countries often lag behind in vaccination coverage, and this disparity has been further highlighted by the COVID-19 pandemic.
During the pandemic, the global failure to deliver enough vaccines to developing and low-income countries prolonged the pandemic and caused preventable deaths. In September 2021, the World Health Organization (WHO) set a target of vaccinating 70% of the global population by mid-2022. However, at that time, only 3% of people in low-income countries had received at least one dose, compared to 60.18% in high-income countries. Furthermore, of the more than 10 billion vaccine doses administered worldwide, only 1% were administered in low-income countries. This inequality in vaccine distribution has contributed to a widening gap between rich and poor.
Several factors contribute to the lower vaccination rates in low-income countries. One factor is limited access to vaccines and health services. For example, in 2024, 14.3 million infants worldwide did not receive the initial dose of the DTP vaccine, with 55% of these children living in 10 low-income countries, including Afghanistan, Ethiopia, and India. Additionally, rural areas within these countries often have lower vaccination coverage than urban areas due to limited access to health services.
Socioeconomic factors also play a role in vaccination rates. For instance, a review of 64 low and middle-income countries (LMICs) found that ethnic disparities resulted in increased zero-dose prevalence. Furthermore, lower maternal literacy and education levels are associated with decreased childhood immunisation rates. Additionally, economic support for workers in low-income countries declined during the pandemic, further exacerbating the impact of the virus on these countries.
The low vaccination rates in low-income countries have significant economic implications. Studies have shown that if low-income countries had similar vaccination rates to high-income countries, they could have increased their GDP and addressed pressing development challenges. For example, the costs associated with COVID-19 vaccinations in South Sudan could have covered all social assistance programmes and education expenditures. Therefore, it is essential to address vaccine inequality and ensure equitable access to vaccines worldwide.
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Vaccination rates are declining among children born during the pandemic
Vaccination rates are indeed declining among children born during the pandemic. UNICEF reports that 67 million children missed out on one or more vaccinations between 2019 and 2021, with 48 million of those not receiving a single routine vaccine. This is due to service disruptions, strained health systems, and decreased confidence in vaccines. The public perception of the importance of vaccines for children declined during the pandemic in 52 out of 55 countries studied, with a decline of over a third in the Republic of Korea, Papua New Guinea, Ghana, Senegal, and Japan.
In the United States, 73% of children born in 2020 and 2021 were fully vaccinated with CDC-recommended vaccines by age three. This is a slight decline compared to children born in the 2010s, with 74.4% of children born in 2013-2014 receiving the full set of seven vaccines by 35 months. The DTaP vaccination rate, which protects against whooping cough, also dropped from 89.3% in 2018 to 87.0% in 2021. The MMR vaccination rate, which protects against measles, mumps, and rubella, decreased from a peak of 94.7% in 2018 to 93.1% in 2021.
The COVID-19 pandemic disrupted the distribution and administration of routine childhood vaccines in the United States and other countries. There were transient declines in MMR and varicella vaccine coverage at age 13 months among children turning 13 months in March-April 2020, and substantial declines in doses of DTaP and MMR administered to children aged 0-23 months during March-September 2020 compared to 2019. However, coverage caught up for these birth cohorts at later ages, and for some vaccines and sociodemographic factors, coverage increased during the pandemic.
The decline in vaccination rates among children born during the pandemic is a concerning trend, as it could lead to a resurgence of vaccine-preventable diseases. The number of measles cases reported in the United States between January 1 and August 15, 2024, exceeded the annual number of cases reported from 2020 to 2023. The number of children paralyzed by polio increased by 16% year-on-year in 2022. These trends underscore the need for urgent action to catch up on missed vaccinations and prevent deadly disease outbreaks.
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Frequently asked questions
According to a 2017 article, American children are the most highly vaccinated in the world. However, another source from the same year mentions that infants in the U.S. receive more vaccines in their first year of life than anywhere else, yet the U.S. infant mortality rate is much higher than in other high-income countries.
The vaccination rates for American children vary by state, race, ethnicity, health insurance coverage type, and poverty level. In 2021, the national child vaccination rate was 72.1%, ranging from a low of 56.6% in West Virginia to a high of 87.9% in Iowa. Non-Hispanic White children had the highest rate of vaccination at 75.5%, followed by children of multiple races or some other race at 72.8%, Hispanic/Latino children at 69.9%, and African-American/Black children at 66.5%.
Global vaccination coverage varies by region and vaccine type. In 2024, 84% of infants worldwide received 3 doses of polio vaccine, and 85% received the first dose of the inactivated polio vaccine. The same year, 85% of infants received 3 doses of the DTP3 vaccine, protecting them against infectious diseases. However, 14.3 million infants did not receive the initial dose of the DTP vaccine, and 20.6 million children missed their first dose of the measles vaccine.
Financial barriers, access issues, vaccine hesitancy, and misinformation can impact vaccination rates. Additionally, disparities in race, ethnicity, health insurance status, poverty status, and urbanicity can contribute to variations in vaccination coverage.
