Trevor James
Nebraska has one of the widest gaps in vaccination rates between urban and rural areas in the United States. While access to vaccines is widely available, with vaccines being as close to [people] as groceries, the state's rural vaccination rates remain low. This is particularly concerning for the vulnerable population aged 65 and above. Nebraska's governor, Pete Ricketts, has consistently recommended that Nebraskans get vaccinated, emphasizing personal responsibility and choice. However, the decision to get vaccinated is ultimately left to individuals, with no state-wide mandates in place.
| Characteristics | Values |
|---|---|
| Vaccination Requirements | Vaccination is not mandated by the government and is a personal choice. |
| Vaccination Rates | Nebraska has the widest rural-urban vaccination divide in the nation, with the lowest rates in the Panhandle and Sand Hills. |
| MMR Vaccine | Recommended for all Nebraskans, especially those planning to travel internationally. |
| Polio Vaccine | Most Americans were vaccinated in early childhood, but records may be difficult to obtain in some states. |
| Measles | CHI Health urges vigilance and recommends vaccination as cases are on the rise. |
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What You'll Learn
Religious exemptions from school vaccine requirements
Nebraska's vaccination rates are a cause for concern, with the state recording the widest rural-urban vaccination divide in the nation. This gap is particularly worrying in the context of a more contagious strain of the virus emerging and becoming dominant across the country.
Nebraska's childhood vaccination rates are declining, even as the threat of measles looms. This is largely driven by an increase in religious exemptions, the only non-medical exemption to school vaccine requirements allowed under state law. Families are increasingly seeking these exemptions, with the COVID-19 pandemic contributing to the rise. In Lancaster County, the percentage of children receiving an exemption has roughly doubled in the past five years. Statewide, parents are regularly opting out of routine vaccines for their children, such as those targeting measles, chickenpox, and pertussis.
Allie Bush, an outspoken vaccine opponent and founder of Nebraskans Against Government Overreach, is a strong believer in religious exemptions for childhood vaccinations. Bush intends to claim the religious exemption if her youngest child ends up attending public or private school. She holds the belief that "any pharmaceutical that's intended to outdo or enhance God's design wasn't in his plan for us and isn't necessary." Bush's family relies on home remedies and homeopathic treatments.
The Catholic Church has been educating families on its teachings related to vaccines while also acknowledging exemption rights under state law. A 2023 Pew Research study found that white evangelicals in the U.S. are increasingly opposed to school vaccination requirements, with 40% saying parents should not be mandated to vaccinate their children, up from 20% in 2019. This shift coincides with a growing number of Nebraskans identifying as evangelical. Notably, Bush herself identifies as Christian and believes that one need not be religious to claim a religious exemption.
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Rural-urban vaccination divide
Nebraska does not mandate vaccination for its residents. However, there is a notable rural-urban vaccination divide in the state. Nebraska has the widest disparity in vaccination rates across the United States, with 71.3% of urban residents receiving at least one dose of a COVID-19 vaccine compared to only 43.2% in rural areas. This gap is even more pronounced among those aged 65 and older, with 84% vaccinated in urban counties and 60% in rural counties.
Several factors contribute to this rural-urban vaccination divide in Nebraska. Firstly, rural residents tend to have more conservative political beliefs and a general distrust of government, which can lead to higher vaccine hesitancy. Secondly, rural areas may have limited access to healthcare services, with numerous rural hospital closures in recent years. Additionally, safety concerns, potential side effects, and a lack of trust in the vaccines themselves have been cited as reasons for hesitancy among rural Nebraskans.
To address this divide, public health officials suggest that trusted local voices, including Republican elected officials, doctors, nurses, and clergy, should encourage vaccination. Improving vaccine confidence, ensuring equitable access, and collaborating with various community organizations and healthcare providers are also recommended strategies to promote vaccination in rural Nebraska.
While Nebraska's overall vaccination rates are commendable, with the state ranking in the top half nationally, the rural-urban disparity remains a concern. This gap leaves vulnerable rural communities at higher risk of contagious strains of viruses, such as the COVID-19 variant first identified in India, which has already been detected in some parts of rural Nebraska.
Addressing the rural-urban vaccination divide is crucial to achieving vaccine equity and reducing COVID-19-related illnesses and deaths in Nebraska and across the United States. By implementing innovative strategies and collaborating with local communities, public health practitioners can work towards narrowing this divide and protecting the health of all Nebraskans, regardless of their place of residence.
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Vaccination for international travel
Vaccinations are an important consideration when planning international travel. While there may not be mandatory vaccination requirements for entry into Nebraska, specific vaccinations are recommended and often necessary for safe travel abroad. Here are some key points to consider regarding vaccinations when planning international travel:
Pre-Travel Vaccination Planning:
Start the vaccination process well in advance of your departure. Many vaccinations require at least two weeks prior to travel to be effective, and some may need multiple doses administered over several weeks or months. Visit a travel clinic or healthcare provider specializing in travel medicine for pre-travel advice and to determine which vaccinations are recommended or required for your specific destinations.
Recommended and Required Vaccinations:
The recommended and required vaccinations for international travel will vary depending on your destination country or countries. Research the health advisories, immunization requirements, and recommendations specific to each country you plan to visit. Common diseases that travelers may encounter, such as typhoid fever, hepatitis A, poliomyelitis, cholera, and traveler's diarrhea, can often be prevented through proper vaccination.
Obtaining Necessary Vaccinations:
Once you have identified the necessary vaccinations for your trip, work with your healthcare provider to obtain the required doses. Keep in mind that some vaccinations may not be suitable for everyone, so be sure to discuss your individual health needs and concerns.
Documentation of Vaccinations:
After receiving the necessary vaccinations, ensure that you obtain proper documentation. The Travel Clinic can provide you with a World Health Organization (WHO) "International Certificate of Vaccination or Prophylaxis." This yellow booklet records your inoculations with officially approved stamps. Having this documentation is essential for verifying your vaccination status when traveling internationally.
Other Health Considerations:
In addition to vaccinations, there are other health considerations to keep in mind when planning international travel. Familiarize yourself with the locations of quality healthcare facilities and hospitals in your destination countries. Learn the emergency numbers, but also understand that in some places, it may be more reliable to take a taxi to a hospital instead of waiting for an emergency response. Additionally, consider the availability of proper medications at your destination and plan to bring any necessary medications with you in their original containers.
By carefully planning your vaccinations and following the recommended health guidelines, you can help ensure a safer and healthier international travel experience.
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Whooping cough cases in Nebraska
Nebraska does not mandate vaccination, and the state's rural-urban vaccination divide is the widest in the nation. While access to vaccines is no longer an issue, Nebraska's rural vaccination gap among the vulnerable 65-and-over age group is a concern. The administration has recommended that Nebraskans get vaccinated and take responsibility for their healthcare.
In May 2025, Nebraska reported its first confirmed case of measles in Sheridan County. The patient was a vaccinated child with no travel history. This triggered a risk assessment survey for individuals who may have been exposed to measles at specific locations.
Now, regarding whooping cough cases in Nebraska, the state witnessed an increase in 2024. Douglas County saw a significant rise, with 183 reported cases, triple the previous highest of 64 cases in 2013. Lindsay Huse, the director of the Douglas County Health Department, attributed this to a waning booster effect over time, leaving adolescents vulnerable. The state of Nebraska recorded 451 confirmed and probable cases of whooping cough within the same year. The disease, caused by the pertussis bacteria, poses the greatest danger to infants and immunocompromised individuals. It is characterised by severe coughing and is spread through social activities and close contact in schools and sports.
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Flu vaccine development in Nebraska
Nebraska has witnessed a wide rural-urban disparity in vaccination rates, with the state's rural areas exhibiting lower vaccination coverage than its urban centres. This gap is particularly pronounced among the vulnerable population aged 65 and above. The reasons for this disparity include conservatism, distrust of the government, and personal beliefs about vaccination.
In the context of vaccine development, Nebraska has been at the forefront of creating an influenza vaccine that targets multiple strains of the virus. Scientists at the University of Nebraska-Lincoln (UNL) have developed an experimental vaccine called Epigraph, which has shown promising results in swine trials, conferring robust immunity against 12 different flu strains, including the H1N1 virus. This vaccine was designed using advanced computational modelling to analyse over 6,000 historical flu strains and identify stable immune-triggering markers for broader protection.
The Epigraph vaccine has been touted as a potential universal flu vaccine, offering long-lasting protection and preventing viral evolution in pigs, which are known to facilitate the transmission of influenza viruses between birds and humans. The development of this vaccine is particularly significant given the annual deaths caused by influenza A and the potential for pigs to be a source of dangerous bird flu mutations.
In addition to human flu vaccine development, Nebraska researchers at UNL are also working on creating a vaccine to protect dairy cattle from bird flu. The Veterinary Diagnostic Centre, funded by state tax dollars, has been at the forefront of addressing the avian influenza outbreak, and its staff have been working on developing a vaccine to protect dairy herds from bird flu. While the vaccine development is ongoing, there is optimism that it will be effective, and it is expected to be approved by the U.S. Department of Agriculture soon.
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Frequently asked questions
Vaccination is not mandated by the government in Nebraska. The state's governor, Pete Ricketts, has stated that it should be a personal healthcare choice and encouraged Nebraskans to consult their doctors about getting vaccinated.
Nebraska has the widest rural-urban vaccination gap in the nation. Counties with the lowest vaccination rates are found in the Panhandle and Sand Hills regions, where conservatism and distrust of the government are high. Nebraska's rural vaccination gap among the vulnerable 65-and-over age group is also a concern for public health officials.
Any Nebraskan planning to travel, especially internationally, is advised to ensure they are up to date with their MMR (measles, mumps, and rubella) vaccine. Nebraska health officials encourage residents to consult their healthcare providers or local health departments to ensure they are adequately vaccinated before travelling.
